As the seasons change and parents reach for over-the-counter cold medicine for their icky-feeling children, they may be baffled by new instructions: Do not give them to kids under 4. Drug companies recently announced they are voluntarily changing the labels for OTC cold and cough medicines in a nod to pediatricians long arguing they do little good and aren’t worth the risks.
So now what?
Here’s a very helpful article from Helena Oliviero of the Atlanta Journal-Constitution that I think will be very helpful to parents:
“I just want my children to be comforted, to sleep well at night and get over it,” said Ray Alyssa Rothman, Atlanta mom to three kids 4 and under.
Dr. Brad Weselman of Kids Health First Pediatric Alliance said parents need not fret — or open the medicine cabinet.
He believes OTC options not only pose a danger of an accidental overdose, but also a threat of side effects. Some medications can make children excessively groggy, making it difficult for them to concentrate at school, he said. Others, he said, can make a child “wired” and increase their heart rate.
Instead, Weselman suggests saline drops, warm apple juice and gargling with salt water.
“We know parents want to give their kids something when they are miserable,” he says. “And I feel the same way. But the benefits don’t balance the side effects.”
The new labels — slated to hit the shelves this upcoming cold season — are being employed after a study found more than 7,000 children get rushed to emergency rooms every year because of adverse reactions with OTC cough and cold medicines. 
Most of the cases involve kids overdosing when parents aren’t around, according to the study published in the April issue of Pediatrics, the journal of the American Academy of Pediatrics.
Meanwhile, the Food and Drug Administration has already recommended OTC remedies not be used for children under 2. And the FDA is studying the effectiveness for children under 12, and considering whether to further restrict the use.
The FDA has also expressed support of the Consumer Healthcare Products Association’s move to voluntarily change the labels to discourage use for children under 4.
Doctors say parents often run into trouble when they give their child multiple medications. For example, a parent may give their child a multi-symptom cold medicine as well as Tylenol, not realizing they are essentially administering a double dose of acetaminophen.
Still, doctors say the latest change doesn’t mean you have to take children’s Tylenol and Ibuprofen off the table. Doctors say they are still an approved, fever-reducing measure and considered safe (as long as they are administered appropriately).
Jennifer Walker, a Woodstock pediatric nurse and mom to three kids, said nighttime is when parents really want to dip into the medicine cabinet to help their children (and themselves) get a good night’s sleep. 
And she knows of some instances when a cough medicine appeared to help — even with her own kids. But she said she will no longer recommend OTC cold medicines to children under 4, and believes alternatives can go a long way in providing relief.
And while Walker said she understands some parents may be frustrated with these new labels and guidelines, she also thinks it’s a good idea to err on the side of caution.
“Although some parents may think, ‘The government doesn’t trust us,’ that’s not the whole issue,” Walker said. “It’s always good when governing bodies pull back and evaluate.”
Ultimately, she said administering OTC meds is the parent’s decision. And she said that’s the way it should be.
Rothman said she turns to several natural remedies to ways to combat colds including liquid vitamin C, vitamin-rich kiwi fruit, extra rest and saline drops. But she also keeps OTC medicines on hand, too.
“I don’t think it’s an abuse to have them,” Rothman said. “I think it’s good to have when you have a child with a really bad cough and you don’t want it to get worse.”
She laminated information about proper dosage of medicine for children and keeps it in her pantry. And her family keeps a log anytime her child is given any medication.
Still, she said the change in labels and questions about OTC medications have caused her pause.
She said she will now “think twice and use less.”
“Your kids are the most precious thing in the world and you want to make sure you are doing the right thing.”
ALTERNATIVES TO OTC MEDICINES
• Saline nose spray can help alleviate stuffy noses.
• A humidifier can help moisturize kids’nasal passages.
• Plenty of fluids: Any warm liquid — apple juice even water — can help relieve congestion and sooth throats. (Avoid citrus because it can irritate throats.)
• Plenty of rest: Naps, lounging and taking it easy is key to recovery.
• Popcicles can help soothe throats and provide a source of liquid.
• Hot or cold packs: Apply around congested sinuses. Both can make you feel more comfortable, but avoid hot packs if the child is running a fever. That will only raise the temperature.
• Gargling with warm saltwater can bring temporary relief to a sore throat. But practice with plain water to make sure your child can gargle. (Generally kids need to be 6 or 7 before they can gargle.)
• Vaseline: Place a small dab on the upper lip to alleviate chafing from a runny nose.
• Peach syrup: Drain the heavy syrup from canned peaches in heavy syrup and drink it to help soothe sore throats. (Note: Honey is often recommended to help sooth sore throats but doctors say parents should not give it to children under 2 because of the risk of infant botulism, a rare type of food poisoning only affecting little ones.)
• Chicken soup: It’s warm. It’s easy on the tummy and you can just taste the TLC of homemade soup. (Just make sure to limit salt since that can cause dehydration.)
WHEN TO SEE THE DOCTOR
With or without over-the-counter drugs, it’s sometimes hard to know when the is the right moment to make an appointment with your child’s physician. Here are the conditions that suggest it’s time to see the doctor.
• A fever accompanied by vomiting or rash.
• Difficulty breathing: if your child is flaring nostrils, breathing fast (more than 40 times a minute) or working hard to breathe.
• If your child has a fever of more than 102. A baby under six months with a low grade fever of 100.2 should be seen by doctor.
• If your child is sick for more than a week, even if there is no fever present. He could have a sinus infection or ear infection that needs treatment.
• Trust your parental instincts. Signs that something is wrong: a child who seems very lethargic; or a child who, after being given medicine, does not transition into a short period of playfulness.
• “More important than any list I can give you is for parent intuition,” said Weselman. “If you think, ‘This just doesn’t seem like my child,’ have the little one seen by a doctor.
Source: Kids Health First Pediatric Alliance and pediatric nurse Jennifer Walker, co-author of “The Moms on Call Guide to Basic Baby Care.”