Last reviewed: September 2018
Last updated: October  2018

Expert review recommends against use of decongestants in children under 6 years of age

An expert review has concluded that over-the-counter decongestant medications should not be used for the treatment of the common cold in children under 6 years of age, and should be used with caution in children ages 6 to 12 years.

The review found no evidence that decongestants (with or without an antihistamine) alleviate nasal symptoms such as congestion, rhinorrhea, or sneezing in children. However, there is evidence that they may cause adverse effects such as drowsiness and gastrointestinal upset. More serious harms such as convulsions and rapid heart rate, as well as death, have also been linked to decongestant use in very young children.

Saline nasal drops or irrigations may be used safely, but do not always give effective relief. There is no adequate evidence for other treatments in children. Antibiotics are neither effective nor recommended.

The review also looked at the use of over-the-counter products in adults. Evidence supports the use of decongestants (with or without an antihistamine or analgesic) for 3 to 7 days if cold symptoms are bothersome; however, the effect is considered small.

Reassure the patient that the common cold is self-limiting and that symptoms usually clear in 7 to 10 days.

See Management: approach See Management: treatment algorithm

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • acute onset
  • rhinitis
  • sore throat
  • sneezing
  • postnasal drainage/drip
  • cough
  • fever
  • nonspecific red pharynx
  • nasal mucosal edema/erythema
  • purulent drainage in nares and posterior pharynx
  • pulse <100 bpm; no hypotension

Other diagnostic factors

  • malaise
  • myalgia
  • halitosis
  • inflamed tonsils

Risk factors

  • exposure to affected individuals
  • young age
  • winter season
  • daycare attendance
  • exposure to cigarette smoke or other respiratory irritants

Diagnostic investigations

Investigations to consider

  • CBC
  • throat swab
  • sputum culture
  • heterophile antibody test
  • C-reactive protein (CRP)
  • chest x-ray
  • sinus CT scan
  • viral testing
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Professor

Department of General Practice and Primary Health Care

University of Auckland

Auckland

New Zealand

Disclosures

BA is an author of a number of references cited in this topic.

Associate Professor of Integrated Care

Department of General Practice and Primary Health Care

University of Auckland

Auckland

New Zealand

Disclosures

TK is an author of a number of references cited in this topic.

Peer reviewers VIEW ALL

Senior Research Fellow

Division of Community Health Sciences

St. George's University of London

London

UK

Disclosures

CC declares that he has no competing interests.

Professor

Faculty of Health Sciences and Medicine

Bond University

Queensland

Australia

Disclosures

CDM declares that he has no competing interests.

Associate Professor

Department of General Practice and Primary Health Care

Ghent University

Belgium

Disclosures

ADS declares that she has no competing interests.

Mary Lowell Leary Endowed Professor

General Internal Medicine

Paediatrics

Mayo Clinic

Rochester

MN

Disclosures

GP has no competing interests in regards to the common cold. He does consult with a variety of manufacturers and performs research studies related to influenza, founded by vaccine manufacturers, none of which involves virus related to the common cold.

Professor of Clinical Medicine

Albert Einstein College of Medicine

Director

Intensive Care Unit

Weiler Division/Montefiore Medical Center

Bronx

NY

Disclosures

PD has served as a consultant to Reckitt Benckiser, Procter & Gamble, Wyeth Pharmaceuticals, Novartis, Glaxo SmithKline, and Boehringer Ingelheim.

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