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February 19, 2009 By:
Frank Rosci, JE Feature
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Dr. Steven Shapiro

A recent news report that Vick's Vapo Rub -- valued for generations as a trusted remedy for chest discomfort caused by colds and flu -- may be harmful to young lungs has set off alarms of concern among many parents and left them wondering about children's health remedies in general.

Steven Shapiro, D.O., and the head of pediatrics at Abington Memorial Hospital, talks about the Vapo Rub scare and other issues related to kids' health.

"Vapo Rub has been in use for a century. Your grandmother used it. It was rubbed on chests and on clothing, if not directly on the skin, and was used in vaporizers thought to be very helpful, but it has been found to cause reflex airway compromises," explains Shapiro. "The [medical] literature has reported a couple of kids who've had airway problems because of it. In the final analysis, all it does is make your nose tingle.

"Basically, Vapo Rub should be avoided for all children. The data suggests it doesn't do much except cause excess mucous. Most pediatricians have agreed with the concept that it has little or no real benefits."

Parents should err on the side of caution, advises Shapiro: "There is no place for it and similar products, and there is no place for kids' decongestants either because many of these have specific central-nervous-system depressions associated with them, such as extreme irritability or fussiness, lethargy and even seizures. I don't think any of these medications is useful.

"If we see five kids out of a million with seizures, that's still a very significant number since when you carry those numbers out, it becomes a very serious cause for concern."

In general, Shapiro acknowledges, physicians have moved on to an evidenced-based platform for many of their decisions.

"Evidenced-based decision-making is beginning to predominate, and in a world where there a is a lot of confusion about medicines, that makes a lot of sense," says the pediatrician.

Alternatives to the use of over-the-counter medicinal products, he continues, include using a vaporizer filled simply with water and teaching young kids to blow their noses. Other recent advise is giving older kids honey to soothe their throats -- but never give honey to children under 1.

For further comfort from colds, says the physician, parents can give children acetaminophen and ibuprofen, both of which are non-aspirin-based, in addition to plenty of fluids.

Says Shapiro: "The common cold has a period of involvement and improvement that has to run its course of three, four or five days. If the child is sick for longer than that or has other symptoms, then it becomes a matter for a physician."

Bonnie Fass-Offit, M.D., a pediatrician at Kids First-Haverford, affiliated with the Children's Hospital of Philadelphia, says that Vapo Rub should not be used on kids under 2, but that it's still safe in very small amounts for older kids on the chest only, though never around the nose or in the nostrils.

"I don't see the cause and effect in the report. It may be that kids affected by Vapo Rub may have had some other reasons for their congestion," she says. "Preliminarily, the further study of Vapo Rub is something to watch. It should be used cautiously for now."

For years, doctors have been saying that there isn't much that can be done for the common cold.

"The lines of cough syrups, which I have never recommended, at the drugstore have been used for years, but most shouldn't be, especially in kids under 2, because they can cause dangerous side effects for children," adds Fass-Offit. "But there is some value to using plain cough syrup, such as Delsym for children over 2 and the DM (Dextromethorphan) preparations, such as Robitussin DM."

Parents can make their own cough syrup, too, she says -- something in use in her office -- by mixing to taste an ounce of warm water with a couple of teaspoons of Karo Syrup and lemon juice, and giving a teaspoonful as needed.

"Colds make kids feel miserable, so there are going to be some sleepless nights for them. To help them to feel a bit better, there are some very safe things parents can do, such as bringing kids into the shower and steaming up the bathroom to loosen excess mucous; using saltwater drops in a bubble syringe, which is safe for babies and older kids of any age; using a washcloth to mechanically get rid of excess mucous; giving older kids zinc and Echinacea; and tea, hot chocolate and soup, because warm fluids do definitely help.

"And one thing is critically important -- getting a good night's sleep at the first sign of a cold. That gives a good shot at warding it off since there are scientifically known immune-system benefits from sleep," says Fass-Offit.

At the Einstein Medical Center, Adam K. Rowden, D.O., director of the hospital's division of toxicology in the department of emergency medicine, says that the jury's still out on the Vapo Rub issue: "I think it's still okay to use it moderately in the correct way, but avoid cough and cold medicines for kids. They don't work -- and don't use decongestants at all because there is the tendency to use too much. Not only is there a risk of seizures from decongestants being given to kids, but a few deaths have been reported."

 

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