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.
References
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
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My grandmother, mother and i have used this therapy with good effects
Confirms my mother in-laws advice, god help me!
My mother used to put a mustard plaster on my chest; I don’t recall if it helped the cough but the relief when the plaster was removed was immense.
Wow! So my wife was right all this time! Go figure. What will the EBM gurus think about this? Next they’ll acknowledge ginseng and echinacea for URI’s no doubt!
I used to do it as child.
Old good remedy
This was my mother’s remedy and admit I have used it on myself and my children with benefit.
I agree
Yes, I was given vaporub treatments as a child. I suspect the improvement is partly because of the decongestant properties but also due to the placebo effect of having had a nice rub from your parent and the smell lingers on to remind you and comfort you.
I am still waiting for the day when the the old fashioned mustard plaster will return, or using vaporub in the old hot steam vapourizers. If we make it back further to “cupping” then my bubby will forever taake the place as the first doctor in our family.
Another way to keep parents busy while nature does its job.
placebo works too
Yes, have been doing this for years with my own kids but glad to know it may not have been just a placebo effect. I will definitely recommend this, espcially with few alternatives.
When I went to medical school and according to every pediatrician I have talked to since, you do not recommend Vapor rub due to its high risk of potential side effects. Personally I have very fond memories of it, and would dearly love for it to be good to recommend. But with very little searchimg I found the following:
Vaporub is still not the answer
Virginia Feldman, pediatrician
Kaiser Northwest
Dr. Paul’s study (1) of the comparative effects of Vaporub, petrolatum and placebo on cold symptoms has so many deficiencies that I was disappointed there was no accompanying editorial; this article could be seriously misused by many parents and pediatricians. First, Dr. Paul is a paid consultant for Proctor and Gamble, maker of Vicks Vaporub. Second, the study was not blinded; and 100% of parents guessed correctly they were giving Vaporub. Third, the study was of only 44 children. Fourth, on a 7 point Likert scale of symptom severity, one must question the clinical significance of a difference of only 1-1.5 points between placebo and Vaporub. (i.e. on most symptoms, placebo parents judged severity going from a baseline of 5 to 4, and Vaporub from a baseline of 5 to 3). Is this worth the 46% adverse effects Paul et al found? (Coming from the era of Vaporub ‘attacks’ as a child, I remember the burning eyes and chest being worse than the cold). I fear Paul’s conclusions will get into parent magazines, and we’ll again see camphor poisonings; (40 cc being potentially fatal in a child < 6 years). And if parents misuse it on their infants, as they do other cold medicines, seizures can result, which Paul mentions only in passing.(2)
As after most first studies, it is very hard to reverse practice when larger studies, from unbiased researchers, come out negative–or don't come out, since so few negative studies ever got published.
A provocative article (3) recently discussed "declining results." This describes a definite phenomenon in which most subsequent studies show less –or no effect, and occurs above and beyond the well-known factor of regression to the mean. Many researchers have shown it: initially positive reports are usually not replicated.
Pediatricians must beware to not support parents using Vaporub based on an initial study using such questionable methods, lest we replace one poor treatment for colds (oral cough medicines), with another. As the PEDIATRICS article following Pauls' demonstrates, adverse effects from cough medications continue to occur even after AAP and FDA proscriptions and market withdrawal.
Virginia Feldman MD FAAP 11230 SW Collina Ave. Portland, Or 97219 Locums pediatrician Kaiser Permanente NW
1. Paul, Ian P, et al: Vapor Rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms. Pediatrics. 2010,126:1092 -99. 2. Shannon M, et al.Toxic seizures in children: case scenarios and treatment strategies. Pediatr-Emerg Care. 2003,19(3);206-10. 3. Lehrer, Jonah. The Truth wears off. The New Yorker.2010, Dec 13:52-57 4. Shehab, Nadine et al. Adverse events from cough and cold medications after a market withdrawal of products labeled for infants. Pediatrics. 2010, 126: 1100-07.
Conflict of Interest:
None declared
I use this on my own four children very often, and recommend it to patients too; but I also still use the OTC preparations, and recommend it (in small doses) to patients.
Have used 1000 iu / day for myself and family and encourage all my adult patients to do the same
Rarely treat children anymore , but worth knowing.