Diane Kate E.

Tobias
Use of Over-the-Counter Cough and Cold Medications in Children Younger Than 2 Years

Commonly Used OTC Preparations

Once infected with a virus, vasodilation and increased vascular permeability occur in the nasal mucosa, causing nasal obstruction and rhinorrhea. These symptoms last an average of 7-10 days, often accompanied by sneezing, cough, headache, and fever. These symptoms frequently cause a decrease in nighttime sleep, which triggers parents to call their primary care professional for advice. Primary care professionals and phone triage personnel often recommend that parents try one or more of the following OTC cold medication classes: decongestants, antitussives, antihistamines, and expectorants. Decongestants, such as phenylephrine and pseudoephedrine, relieve nasal congestion by constricting the dilated blood vessels in the nasal mucosa following a viral infection. These medications also act peripherally, targeting and receptors, potentially causing tachycardia and hypertension. Other common adverse effects in children include irritability, hallucination, and dystonic reactions (Committee on Drugs, 1997). Cough is a reflex response to mechanical, chemical, or inflammatory irritation of the tracheobronchial tree mediated through neurons in the brain stem or cough center (Committee on Drugs, 1997). Antitussives, such as dextromethorphan, work to decrease cough by directly inhibiting the cough center in the brain and effectively elevating the threshold for coughing. Adverse effects of dextromethorphan in children include behavioral disturbances and respiratory depression (Committee on Drugs, 1997). Antihistamines such as diphenhydramine work to decrease mucus production and are structurally similar to histamine, thereby preventing its effects at the receptor level. Expectorants such as guaifenesin work to increase bronchial mucus production, thereby making coughs more productive and clearing the airway. Many of these drugs are sold both as single active ingredients and in combination with each other. With more than 100 different formulations available to parents, OTC medication dosing can be confusing for parents, leading to the administration of toxic doses of medications (Carr, 2006).

Research Findings
Many studies have examined the use of OTC cough and cold medicines in children. More recently, this topic has resurfaced because of an increase in infant deaths due to OTC cold medicine use (Centers for Disease Control and Prevention [CDC], 2007). Schroeder and Fahey (2004) conducted a search of the Cochrane Central Register of Controlled Trials and found seven trials looking at the use of OTC cough and cold medicines in children. These trials looked at the use of antitussives, mucolytics, antihistamine-decongestant combinations, and other drug combinations. Of these trials, two found limited effectiveness in relieving the target symptoms. The first (Reece, Cherry, Reece, Hatcher, & Diehl, 1966) is out-of-date, and the second (Korppi, Laurikainen, Pietikaenen, & Silvasti, 1991) is foreign.

Yoder, Shaffer, LaTournas, and Paul (2006) and Paul et al. (2004) both conducted studies comparing the effectiveness of dextromethorphan, diphenhydramine, and placebo in treating nocturnal cough in children with URIs. Yoder et al. based the results on the childs assessment, while Paul et al. based their results on the parents assessment of nocturnal cough symptoms. Both studies found there to be no significant difference between the three treatment groups when assessing cough frequency, impact on sleep quality, and cough severity. Merenstein, Diener-West, Halbower, Krist, and Rubin (2006) conducted a double-blind, randomized, controlled clinical trial looking at the use of diphenhydramine in infants aged 6-15 months. This study found no difference in nighttime sleep between the placebo and treatment group. Conduct of the study was stopped by the Data Safety Monitoring Board. Not only have OTC cough and cold medicines been found to be no more effective than placebo, but more importantly, they also have been found to be harmful. The CDC (2007) found that approximately 1500 children younger than 2 years were treated in U.S. emergency departments for adverse effects, including overdoses, between 2004 and 2005. The CDC and National Association of Medical Examiners investigated the deaths of infants associated with OTC cough and cold medicines. In 2005, the deaths of three infants younger than 6 months were examined and all were found to have cough and cold medicines as the underlying cause of death. The most prominent drug associated with death was pseudoephedrine (Wingert, Mundy, Collins, & Chmara, 2007). All three of these infants had excessive levels of OTC cough and cold medicines in their bloodstream, ultimately leading to their early deaths.

Summary: The common cold or upper respiratory infection (URI) is a self-limiting viral illness that affects people of all ages, especially children. The common cold brings with it many undesirable symptoms such as cough, nasal congestion, rhinorrhea, and sleep loss, that parents will be worried and will not know what to do.First line of defense that pediatric health care professionals recommend are the OTC meds. The occurrence of URIs shows clear seasonality, cases are more often when winter comes because of the cold weather. Studies have shown rhinovirus to be the most common cause of URIs in children. There are also many viruses that can cause URI in children, and it can trigger and spread in different mechanism such as: (1) hand contact with secretions containing the virus; (2) inhalation of small-particle, viruscontaminated aerosols in the air; or (3) direct hit from the infected person by large-particle aerosols containing the virus. Rhinovirus infection begins once the virus adheres to the anterior nasal mucosa. From the anterior nasal mucosa, the viruses migrate to the posterior nasopharynx, where they gain entrance to the epithelial cells and begin replication. The shedding of rhinovirus peaks on the second day following nasal inoculation and then rapidly decreases.. Once patient was infected with a virus it can cause nasal obstructioin and rhinorrhea. With these children will suffer from decrease of sleep. Parents commonly know and most advised by the

doctors when it comes to these are the OTC drugs such as the following OTC cold medication classes: decongestants, antitussives, antihistamines, and expectorants. Decongestants, such as phenylephrine and pseudoephedrine, relieve nasal congestion by constricting the dilated blood vessels in the nasal mucosa following a viral infection. Antitussives, such as dextromethorphan, work to decrease cough by directly inhibiting the cough center in the brain and effectively elevating the threshold for coughing. Antihistamines such as diphenhydramine work to decrease mucus production and are structurally similar to histamine, thereby preventing its effects at the receptor level. Expectorants such as guaifenesin work to increase bronchial mucus production, thereby making coughs more productive and clearing the airway. Studies shows that OTC drugs are no longer effective and many infants and children died because of cough and cod with the use of OTC and one cause also is overdose.

Conclusion: Cough and colds are very common sickness in children younger than two years because of their weak line of defense and they are more prone of viruses. it is more common on winter. Most parents doesnt have the right knowledge about handling this disease they will just buy OTC drugs without even knowing the proper and right dosage of it. Having URI can cause children to suffer from sleep loss, nasal congestion, cough that can lower their immune system and their appetite. Using OTC drugs are no longer effective according to the reaserch. Research says that many infants died because of using OTC drugs. It is also very harmful because of the adverse effect that it can give and overdose because of not taking the right dosage. Parents must be educated and learned some measures to prevent URI.

Reference: http://www.jpedhc.org/article/S0891-5245(07)00166-6/fulltext