This page provides general advice about dealing with colds and the flu, including dosage recommendations for some commonly used OTC medicines. Please note that many cough/cold products have been reformulated recently. In part that is because many products contained pseudoephedrine, which is now stocked behind pharmacy counters in accordance with the Combat Methamphetamine Act. Pseudoephedrine is the best-studied decongestant in adults, but NO decongestant has been well studied in children. Often doses have been extrapolated from adult data. We also know that adult studies report common side effects including an increase in blood pressure, increase in heart rate, and restlessness. Other decongestants (including phenylephrine, which has replaced pseudoephedrine in many products), have not been widely studied, and where studied, have shown limited benefit.

Our favorite cold/cough preparations are listed below, but if you have found something helpful for your child in the past, feel free to continue using it at the manufacturer’s recommended dosing, or call our office for additional guidance. Remember these medicines will not make the cold go away; they only help to make your child feel better until the dosing wears off. In general, upper respiratory infections/colds last 10-14 days from onset of symptoms until completely resolved.As a parent you must weigh the potential benefits and risks, and use these medications only when your child is experiencing significant enough symptoms to warrant TEMPORARY relief. Nothing replaces rest, fluids, TLC and time.

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Do not give cold/cough medicines to infants less than 6 months of age. Mechanical alternatives such as suctioning the nose and throat with a bulb suction syringe, loosening mucus with saline solution (Ocean nasal spray, NaSal nose drops, etc.), and using a cool mist humidifier/vaporizer will help infants breath more easily while congested.

In general, it is best to give medicines only for the specific symptoms that a child is experiencing. Remember these products treat symptoms only. They will not make your child’s cold resolve faster, but they may help to make him/her more comfortable in the meantime. Do not use a multi-symptom product with a combination of acetaminophen and cold/cough products, because combo products often result in inadequate doses of acetaminophen. Please refer to the Tylenol/Motrin dosage chart for those doses. To ensure the correct dose, make sure you have a working thermometer at home (with fresh batteries).

During the cold/flu season your child may experience back-to-back colds/illnesses. Choose your medicines wisely. You can help your child through an illness by encouraging plenty of fluids and rest; avoiding airway irritants like cigarette smoke, scented candles, fireplaces and potpourri; and by providing extra TLC. Good hand-washing will help keep your child from picking up viruses which can live on surfaces for an extended period of time. You can help prevent the spread of germs in your own home by cleaning commonly handled surfaces such as doorknobs, light switches, and the remote control, with Lysol or another antiseptic cleanser.

Runny noses and congestion

One of our favorite cold products is Grape Dimetapp Elixir. This is a combination antihistamine and decongestant that tastes good and generally does not make children “hyper” like the decongestant Sudafed often does. Look for the Dimetapp Cold & Allergy Elixir (not the infant drops), and refer to the following dosage chart:

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Dimetapp Elixir Age Dose 2-5 years 1 tsp every 4 hours 6-11 years 2 tsp every 4 hours 12 and up 4 tsp every 4 hours

Benadryl (Diphenhydramine) comes as 12.5 mg/tsp or 12.5 mg chewable tabs, and as 12.5 OR 25 mg tabs/capsules. This is strictly an antihistamine. It can be used for allergies, to dry up a runny nose, or for itching and hives. Benadryl usually makes children sleepy, but in about 5% of patients causes a “paradoxical” reaction and makes them hyper. (Don’t try it for the first time when you are boarding an airplane with a toddler, in case they happen to be one of those 5%.) Benadryl should be given every 6 hours as needed. Since the medicine may make your child sleepy, some people try to use a slightly lower dose during the day, with the full dose given at night.

Benadryl Weight Dose in mg Liquid Chewable 10-14 lbs 6.25 mg ½ tsp 15-20 lbs 9.375 mg ¾ tsp 21-25 lbs 12.5 mg 1 tsp 1 tablet 26-30 lbs 15.625 mg 1¼ tsp 1¼ tablet 31-35 lbs 18.75 mg 1½ tsp 1½ tablet 36-40 lbs 21.875 mg 1¾ tsp 1¾ tablet Over 40 lbs 25 mg 2 tsp 2 tablets Over 12 yrs 25-50 mg 2-4 tsp 2-4 tablets

Coughs

In general, coughing is a protective mechanism that clears mucus from the lower part of the respiratory tract, and ordinarily there is no reason to suppress it. You may consider an occasional dose of a cough suppressant (generally something with dextromethorphan) for a child who has not been able to sleep/rest for an extended period of time. In my experience, cough suppressants are marginally effective in some (but not all) children.

Delsym is a dextromethorphan/cough suppressant which is supposed to last for 12 hours and can be dosed according to the following chart:

Delsym Age Dose (1tsp=5ml) 2-5 years ½ tsp every 12 hrs 6-11 years 1 tsp every 12 hrs 12 and up 2 tsp every 12 hrs

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Guaifenesin is a mucous thinner and expectorant, which can be very helpful in loosening mucus and helping children “expectorate” or cough their mucous clear from their lower respiratory tract. This can be found in a liquid form in Robutussin Chest Congestion Guiafenesin Syrup, or Mucinex Liquid, or in Mucinex “mini-melt” form or tablets. Please read dosages carefully as there are different strengths in these preparations. “Mini-melts” are meant to be dissolved on the tongue similar to the candy “Pixi Stix”, they are NOT meant to be chewed.

Robitussin Chest Congestion Syrup Age Dose 2-5 years ¾-1 tsp every 4 hrs 6-11 years 1-2 tsp every 4 hrs 12 and up 2-4 tsp every 4 hrs

Robitussin Head and Chest Congestion PE now contains phenylephrine which has been described above and is only marginally beneficial at best. See www.robitussin.com for additional information/dosing and ingredient information.

Mucinex Liquid (Guifenesin 100 mg/5ml) Age Dose 2-5 years ½-1 tsp every 4 hrs 6-11 years 1-2 tsp every 4 hrs Mucinex Mini-Melts/Tablets Age Children’s (50 mg) Junior (100 mg) Extended Release Tabs 2-5 years 1-2 packets every 4 hours 1 packet every 4 hours N/A 6-11 years 2-4 packets every 4 hours 1-2 packets every 4 hours N/A 12 and up N/A 2-4 packets every 4 hours 1-2 tablets every 12 hours

Mucinex Extended Release tablets (for use in children 12 and older) also comes in a formulation with pseduoephedrine (for congestion) called Mucinex D, but is stocked behind the pharmacy counter. More information on Mucinex can be found at www.mucinex.com.

For night time coughs, we have found Triaminic Night-Time Cough & Cold to be helpful. This medicine contains an antihistamine, decongestant and a cough suppressant in a formula that lasts for 6 hours and tends to not interfere with sleep. Please refer to the dosage chart below:

Triminic Night-Time Cough & Cold Age Dose 2-5 years/24-47 lbs 1 tsp (5ml) every 6 hours 6-12 years/48-95 lbs 2 tsp (10 ml) every 6 hours

Katie Baker, DO, FAAP

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