Intended for healthcare professionals

Practice Practice Pointer

Treatments for cough and common cold in children

51app 2024; 384 doi: (Published 25 January 2024) Cite this as: 51app 2024;384:e075306
  1. Peter J Gill, paediatrician and assistant professor 1 2 3 4,
  2. Igho J Onakpoya, senior associate tutor4,
  3. Francine Buchanan, patient and family engagement manager1,
  4. Kathryn A Birnie, clinical psychologist and assistant professor5 6 7,
  5. Ann Van den Bruel, general practitioner and professor8
  1. 1The Hospital for Sick Children, Toronto, ON, Canada
  2. 2Child Health Evaluative Sciences, SickKids 51app Institute, Toronto
  3. 3Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto
  4. 4Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  5. 5Department of Anesthesiology, Perioperative, and Pain Medicine, University of Calgary, Calgary, AB, Canada
  6. 6Department of Community Health Sciences, University of Calgary, Calgary
  7. 7Alberta Children's Hospital 51app Institute, Calgary
  8. 8Academic Centre for Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
  1. Correspondence to P J Gill peter.gill{at}sickkids.ca

What you need to know

  • Upper respiratory tract infections are common, self-limiting illnesses that resolve without intervention in up to 10 days

  • Treatments for the common cold do not shorten the length of illness but may relieve a child’s discomfort by alleviating the effects of the most bothersome symptoms

  • Antitussives, antihistamines, decongestants, expectorants, and aspirin are not recommended for use in children under the age of 6

  • Safe treatments for bothersome symptoms include saline nasal irrigation, pasteurised honey for cough, and analgesics, but most symptoms require no interventions

Upper respiratory tract infections (URTIs) are common, self-limiting illnesses that are distressing for children and families.123 Despite the large number of treatments marketed for relief of cough and common cold symptoms, the evidence for their efficacy is of poor quality with high risk of bias. Most studies find no evidence of benefit in reducing nasal symptoms and cough, and several treatments have serious risk of harm. Clinicians and healthcare practitioners can discuss with families how coughs and colds develop, can provide reassurance and safety netting advice, and discuss the pros and cons of treatments that are safe and may offer some symptomatic benefit. This practice pointer aims to describe commonly used cough and common cold therapies in children (aged 12 and under), including the data on their safety and effectiveness, and to provide recommendations for practitioners and parents on how to manage bothersome symptoms and reduce the use of inappropriate treatments.

Cough and common cold therapies

What constitutes an over-the-counter cough and common cold therapy, and what requires a prescription, varies internationally. Despite limited data on effectiveness, revenue in the over-the-counter market in 2023 is estimated at $41.27bn (£32.5bn; €37.7bn ) and popularity of these medications continues to increase. Sales are estimated to grow 6% year on year into 2027, with most revenue growth concentrated in the US but …

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