Dr. Paul Thiessen (biography and disclosures)
What I did before
Upper respiratory infections are the most common illnesses seen in childhood, and the symptoms are often disruptive for both the child and the whole family. Parents are highly desirous of relieving symptoms of cough and congestion, particularly at night when these interfere significantly with sleep. Recent studies and guidelines have raised serious concerns about the safety and benefit of OTC preparations such as dextrometorphan and oral decongestant/antihistamine preparations, and it is recommended these no longer be given to children. We are therefore left with little to offer except buckwheat honey (1) – until this study.
What changed my practice
A study was published in December 2010 (1) which determined the value of a single application of vapor rub or petrolatum at bedtime to the neck and chest to reduce nocturnal cough, congestion and to improve sleep. Vapor rub is a topical preparation containing camphor, menthol and eucalyptus oil and has been in use for over 150 years. 138 children ages 2 to 11 were recruited, and divided into groups to receive a single application of vapor rub, petrolatum or no treatment. As vapor rub has a very characteristic aroma, parents were partly blinded to the test substance by applying the vapor rub to their own upper lip and nostrils before applying it to the child (in clinical practice vapor rub should NOT be applied to the lip or nose, but only the upper chest and neck). Surveys were administered to parents on 2 consecutive nights – on the day of presentation with no medication the previous evening, and on the next day when vapor rub, petrolatum or no treatment had been applied to their child’s chest and neck before bedtime. Between treatment groups, significant differences in improvement were detected in cough severity, congestion and sleep difficulty with vapor rub scoring the best and no treatment the worst. Sleep improved significantly for both the child and (not surprisingly) the parents.
What I do now
I inform parents that OTC oral medications for cough and cold symptoms are not advised, but that an application of vapor rub applied to the neck and chest may be helpful in relieving cough and improving sleep. There is also some evidence that a single dose of honey (2) at bedtime may be a helpful addition to the cough and sniffle armamentarium. So much for sneering at an old folk remedy.
1) Paul IM, et al, Vapor Rub, Petrolatum, and No Treatment for Children With Nocturnal Cough and Cold Symptoms, Pediatrics 2010;126;1092 http://pediatrics.aappublications.org/content/126/6/1092
2) Paul IM, et al, Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents, Arch Pediatr Adolesc Med – 01-DEC-2007; 161(12): 1140-6 http://www.ncbi.nlm.nih.gov/pubmed/18056558