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Congested infants.

"My baby is congested" is one of the most common complaints a pediatrician will hear from parents of newborns. This vexing problem often worries parents who will seek a variety of treatments to "cure" the congestion.

Unfortunately for the children, many of these remedies do not work or have the potential to cause harm. Concern about the use of over-the-counter (OTC) medicines for the treatment of cough and colds in children first arose in 1977 with an FDA report.

While education has been advocated since 1984, even after multiple warnings about potential dangers, over 60% of parents continue to use these products. The risk of adverse events from OTC cough and cold medicine is highest in the youngest infants. Because of this, any treatment for congestion must have substantial benefits to outweigh risks.

Unfortunately for pediatricians, there is little evidence on what treatments are effective for treating nasal congestion in infants. The most common and safest recommendation is to use humidifiers and saline drops. Neither of these interventions is unsafe, and both seem to improve the noisy breathing in infants.

What isn't known is what parents actually use for their infants and whether or not they perceive that the intervention they use is effective. To understand the answers to these questions, we asked 285 parents of 1-year-olds about whether or not their infant had congestion the first year of life, what treatment they used, and if they thought it was effective.

What we found was nasal congestion was extremely common; 77% of parents noted their infant had nasal congestion. Interestingly, the white parents with private insurance were more likely to report congestion as compared to minorities with Medicaid.

The treatments parents used included recommended treatments such as nasal saline (89%), humidifier (92%), and bulb syringe (92%). Additionally, 51% of parents used Vicks[R] VapoRub[R] and 62% used OTC cough and cold medications.

More than 80% of parents believed both the recommended treatments of bulb syringe, saline drops and humidifiers were effective as well as the non-recommended treatments of OTC cough and cold medications and Vicks[R]. Again, white parents were more likely than minorities to believe that OTC cough and cold medications were effective.

Nasal congestion afflicts a vast majority of infants in our community, and parents resort to a variety of recommended and non-recommended treatments. Almost all the treatments used by parents were perceived as effective in improving their infant's symptoms.

It is reassuring that simple, tried-and-true measures such as humidifiers and saline drops are frequently used and perceived as effective. As such, parents should stick with these harmless measures.

The most concerning finding from this study is that parents use OTC cough and cold medications frequently and believe that they are effective. OTC cough and cold medications have never been shown to be effective in randomized controlled trials and are associated with serious adverse events in infants.

Recently, these products have been re-labeled by the FDA and are no longer indicated for children less than 2 years of age. Unfortunately, if parents perceive these medications as effective and still have access to them, it is likely they will continue to use them to treat nasal congestion in infants despite recommendations from pediatricians.

The bottom line is that when confronted with a congested baby, stick with saline drops and a humidifier and a good old touch of time--nasal passages grow and congestion will eventually disappear without needing to risk side effects of OTC cough and cold medications.

Scott Krugman, MD, MS, FAAP is Chairman, Department of Pediatrics at MedStar Franklin Square Medical Center and Clinical Professor, Pediatrics and Epidemiology at the University of Maryland School of Medicine. He is currently the President of the Maryland Chapter of the American Academy of Pediatrics and is board certified in general pediatrics and child abuse pediatrics.

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By Scott D. Krugman, MD, MS
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Author:Krugman, Scott D.
Publication:Pediatrics for Parents
Geographic Code:1USA
Date:Mar 1, 2013
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