In light of the recent Food and Drug Administration warnings against using over-the-counter cold medicines in children under 2 years of age, parents and physicians alike are wondering what nondrug treatments have proven safe and effective in treating and preventing the common cold.

“Most people know that there are warnings against giving young children medications,” Dr. Margot Weinberg, who practices pediatric integrative medicine in Pittsford, N.Y., said in an interview. “The cold medicines have not proven to be effective, and there's some concern that they might actually dry out the membranes.” However, try telling that to the parent of a sick, screaming child.

“We [as physicians] need to be armed with some advice to give the parents, because they get frustrated when we say, 'you can't use cold medicines,'” she added.

One remedy that might decrease the duration and severity of colds, but not necessarily the incidence, is the use of probiotics—live microorganisms that affect intestinal microflora, according to Dr. Weinberg. She cited a randomized, controlled, double-blind trial in which patients given probiotic supplementation had colds that lasted an average of 2 days less than colds of controls, and experienced less severe overall symptoms during their illness (Vaccine 2006:24;6670–4). Granted, the study was in adults, but Dr. Weinberg said that she believed the results were generalizable to children. She recommends probiotics to patients in the form of yogurt and other fermented foods, like sauerkraut and miso soup.

Dr. Kathi J. Kemper, chair of the American Academy of Pediatrics Provisional Section on Complementary, Holistic, and Integrative Medicine, also recommends probiotics to pediatric patients, occasionally in a supplement form, as with Culturelle (manufactured by Amerifit Brands Inc.). Probiotics “are generally safe and well tolerated by healthy toddlers and school-age children,” she said.

A second nondrug therapy for the common cold mentioned by Dr. Kemper was Andrographis paniculata, a bitter herb used in traditional Indian medicine.

Although the herb is relatively unknown in the United States, one systematic safety and efficacy review that included seven double-blind, controlled trials and nearly 900 patients concluded that the herb is “superior to placebo in alleviating the subjective symptoms of uncomplicated upper respiratory tract infection. There is also preliminary evidence of a preventative effect” (Planta Med. 2004;70:293–8). Dr. Kemper cited the Swedish Herbal Institute's “Kan Jang” A. paniculata supplement as the one with which she was most familiar.

A better known, fairly controversial remedy typically used in holistic care of common colds is Echinacea. Dr. Kemper, also of Wake Forest University, Winston-Salem, N.C., conceded that there is “substantial variability” in the composition of products purporting to contain effective amounts of the agent. However, she cited one secondary analysis of data from a randomized, double blind, placebo-controlled trial of 524 children aged 2–11 years, in which researchers found that patients taking echinacea experienced a 28% decreased risk of subsequent infection after an initial infection, compared with patients taking placebo (J. Altern. Complement. Med. 2005;11:1021–6).

Vitamin C and zinc are two at-home remedies that are already familiar to most parents and physicians. In a Cochrane database systematic review (PLoS Med. 2005;2(6):e168[doi:10.1371/journal.pmed.0020168

Regarding the use of zinc, one study looked at 200 children randomized to either 15 mg oral zinc sulfate (n = 100) or placebo sulfate once daily for 7 months. The dosage was increased to twice daily at the onset of a cold, until symptoms resolved. Children in the zinc group had a significantly lower incidence of colds, a shorter mean duration of symptoms when they were sick, and less severe symptoms (Acta Paediatr. 2006;95:1175–81).

For parents not willing to give their children vitamin C and zinc supplements, which Dr. Kemper said can cause upset stomach in some patients, Dr. Weinberg often instructs about which foods are rich in those elements (see box).

According to Dr. Kemper, one of the most important steps a physician practicing holistic cold management can take is simply to ask the patient or parent what preferred home remedies they've already tried. She said to support culturally appropriate practices that you know are definitely safe, even when the evidence supporting them is sparse or nondefinitive. Ask parents to report to you on their experience with the remedy, she said, and then, try them on yourself. “Having your own experience will help you feel more comfortable advising patients.”

The FDA plans to issue a second recommendation this spring on the safety of cold medicines in patients aged 2–11, according to an agency advisory (www.fda.gov/cder/drug/advisory/cough_cold_2008.htm

Both Dr. Weinberg and Dr. Kemper had no conflicts of interest to disclose in relation to this article.

Foods Rich in Vitamin C, Zinc

Vitamin C:

berries

broccoli

cantaloupe

carrots

green beans

honeydew melon

orange

papaya

peaches, dried

peas

romaine lettuce

spinach

strawberries

sweet potato

tomatoes

Zinc:

baked potato

brown rice

lentils

oatmeal

peas

salmon

spinach

whole wheat bread

yogurt

Source: Dr. Weinberg

Nondrug Therapies May Soothe Cold Symptoms