Over-the-counter cold and cough medicines should no longer be given to children younger than 4, according to a new warning from the makers of these children's medications. So what do you do if you child's coughing the night away or sneezing nonstop? We asked top pediatricians how to help your child feel better and sleep soundly -- safely.

By Lauren Gelman

Do cold and cough medicines actually work?

The evidence says no: Over-the-counter cold and cough medicines do little or nothing to fight off germs and relieve symptoms like congestion, runny noses or coughs. Numerous studies have shown that babies and toddlers given cold and cough medicines don't have fewer side effects or feel better any quicker than children who don't receive any. "Most babies and kids with colds will start feeling better in less than five days, whether or not they take medicine," says Dennis Kuo, MD, a pediatrician at the Johns Hopkins University School of Medicine.

Swear that giving your baby meds before bed helps her snooze better? It's likely a parental placebo effect, says Jennifer Shu, MD, a pediatrician and coauthor of Heading Home With Your Newborn. "These drugs may help you feel better, so you assume they work on your baby too," she explains.

Which medicines are we talking about?

Over-the-counter cold and cough medicines generally fall into the following four categories, though the majority of medicines contain multiple ingredients to treat various symptoms (look for wording like "multi-symptom," "cough & cold," "decongestant plus cough", etc.)

  • Decongestants: Supposed to relieve nasal congestion, but can cause side effects like increased heart rate, jitteriness, vomiting and shaking. Ex: Sudafed.
  • Antihistamines: Supposed to dry up runny noses, though they really only effectively treat symptoms caused by allergies, not cold viruses, says Ari Brown, MD, pediatrician and author of Baby 411 and Toddler 411. "And though they are sedating, recent research shows that babies and kids with colds don't sleep any better after receiving an antihistamine," she says. Side effects include hyperactivity, drowsiness, dry mouth, and, in rare cases, hallucinations. Ex: Benadryl.
  • Cough suppressants: Supposed to reduce the need to cough, but can cause side effects like excessive sleepiness or jitteriness, dizziness and vomiting. Ex: Delsym, Robitussin DM.
  • Cough expectorants: Supposed to loosen mucus so it's coughed up more easily. Though rarer than with other types of cold and cough medicines, side effects can include nausea, vomiting, diarrhea and headaches. Ex: Robitussin.

Many manufacturers have voluntarily recalled infant versions of cough and cold medications, including the ones listed below. If you still have them stashed in your medicine cabinet, toss them now. And although versions for kids 2 and older are still available, never give meds intended for older kids to your baby or toddler.

  • Dimetapp Decongestant Plus Cough Infant Drops
  • Dimetapp Decongestant Infant Drops
  • Little Colds Decongestant Plus Cough
  • Little Colds Multi-Symptom Cold Formula
  • PediaCare Infant Drops Decongestant (new and original formulas)
  • PediaCare Infant Dropper Decongestant & Cough (new and original formulas)
  • PediaCare Infant Dropper Long-Acting Cough
  • Robitussin Infant Cough DM Drops
  • Triaminic Infant & Toddler Thin Strips Decongestant
  • Triaminic Infant & Toddler Thin Strips Decongestant Plus Cough
  • Tylenol Concentrated Infants' Drops Plus Cold
  • Tylenol Concentrated Infants' Drops Plus Cold & Cough

Why are cold and cough medicines unsafe for young children?

More and more research shows that not only do these medicines not work, they may also have significant side effects -- even if administered correctly. "Each child metabolizes medicine differently, so even if you give her the correct amount for her weight, it can still cause some dangerous side effects," says Dr. Shu. Side effects include nausea and vomiting, insomnia, eating more or less than usual or, more rarely, hallucinations and even seizures.

What's more, because these drugs may contain overlapping ingredients (combos of decongestants, antihistamines, cough suppressants and expectorants) your child can accidentally overdose from taking more than one medication at a time -- like a cough syrup and cough and cold drops, say -- even if you follow the correct dosing instructions for each one.

Safe Remedies for Kids

How do I help my child sleep and feel better without medicine?

"Understandably, parents will try anything to help their child feel better and sleep through the night during a cold," says Dr. Brown. "I too have spent my share of nights with a sick kid sleeping on my shoulder." But with no proven benefit and definite established risk, ditch the meds and try these natural -- and effective -- remedies instead:

Rx: Soothe congestion with saline drops

Why it works: Saline nasal drops help move the mucus out of the nose. Until your child can blow her own nose (anywhere from age 2 to 6), you'll also need a bulb syringe to remove the gunk.

What to do: Rest baby in your lap so her head's titled slightly back, then, using an eye dropper, squirt a drop or two of saline solution into each nostril. Squeeze the bulb to get the air out, then gently put the tip into your child's nostril; as you stop squeezing, the mucus should flow in. (Don't forget to clean the bulb out after!)

Doing this up to four times a day -- and especially before bed -- may cut back on your kid's congestion and help her sleep more soundly. If your baby's breastfeeding or bottlefeeding, do this right before her feedings. "Babies breathe through their noses while eating, so this will help them feed easier and longer," Dr. Kuo says.

Rx: Fuel up with fluids

Why it works: If your child's drinking enough, it will loosen the mucus in her nose and throat, which will help her breathe. Plus, feverish kids lose fluids and may become dehydrated more easily, so it's very important to keep the liquids coming.

What to do: "Offer clear fluids such as Pedialyte; if you're breastfeeding, breastmilk, every hour or so to babies under 2," says Kuo. "For older kids, use a sippy cup with diluted fruit juice, Gatorade, or flat soda, since these fluids are absorbed better than plain water." Can you overdo it? Probably not. Most kids will reflexively refuse the drink if they've had too much already, says Kuo.

Rx: Make bedtime better with a humidifier

Why it works: A cool-mist humidifier in the nursery or your child's room helps moisten nasal passages, which may soothe a sore throat and ease those haunting nighttime coughs.

What to do: Remember to change the water and clean the filter every other day to avoid germ build-up. And steer clear of hot-water humidifiers, which can pose a burn risk to young kids, should they accidentally topple over.

Rx: Treat the fever

Why it works: You've probably heard that fevers aren't necessarily harmful -- they're usually just a sign that your child's fighting off the cold. But if the fever's making your baby cranky, restless or achy, medications like acetaminophen (Tylenol) or ibuprofen (Motrin) can bring the temperature down within an hour.

What to do: Don't give meds to babies under 3 months until you call the pediatrician -- he'll likely want you the bring the baby in. You can give acetaminophen to babies between 3 and 6 months and ibuprofen to babies over 6 months.

What about cold and cough medicines for kids older than 4?

The FDA is still evaluating whether these medicines are safe for children under 11. Though older kids may experience fewer side effects, some experts feel it's still not worth the risk, given the lack of evidence that they actually help improve symptoms. "I have a 6-year-old with a cold and was about to give him medicine yesterday, when I decided not to," says Dr. Shu. "How awful would I feel if he did have a reaction?" Your best bet: Waiting it out and trying natural remedies like saline drops, plenty of fluids -- including feeding chicken soup -- and a humidifier at night. If you want to try medicine, pay careful attention to the drug label to avoid side effects or potential overdose.

When should I call the doctor for a cold or cough?

Generally speaking, there's no need to call the doctor right away unless you notice your child's running a high fever for his age:

  • Your baby is younger than 3 months and has a rectal temperature of 100.4 degrees F or higher.
  • Your baby is 3 to 6 months and has a rectal temperature of 101 degrees F or higher.
  • Your child is older than 6 months and has a rectal temperature of 103 degrees F or higher.

You should also alert the pediatrician if you notice any of the following conditions:

  • Your baby's very dehydrated: Hasn't had a wet diaper in six hours, has a dry mouth and has few or no tears when she cries.
  • Cold symptoms don't start to improve after five days (could indicate it's something else, like bronchitis, a sinus infection or even pneumonia).
  • Your kid seems very fussy, tired and out of it, even with no fever.
  • Your child's breathing is rapid or labored.
  • Your child refuses to drink (a sign she may have trouble breathing).

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