Children's medicine: Give pills the push

Most over-the-counter remedies for children are of little use – and some may even be harmful, says A&E medic Dr Simon Reilly. So what are the best ways to treat a sick or feverish child?

The MHRA (Medicines and Healthcare products Regulatory Authority) recently issued new guidance on the use of over-the-counter cough and cold remedies in children, and has banned the use of many products in the under-six age group. There still isn't any effective treatment for the common cold, but that doesn't stop manufacturers marketing dozens of remedies that they claim will alleviate symptoms. Most do not work, and some can even cause harm unless used very carefully.

So when are over-the counter products worth buying – and how should you really go about treating your sick or feverish child?

Coughs and colds

According to the Department of Health, it is not unusual for children to contract as many as eight viral respiratory tract infections per year in their early lives, as a result of their still immature immune systems. As these infections are not caused by bacteria but by viruses, antibiotics do not help. Most episodes will get better all on their own in five to seven days, and when it comes to "treatments" available, the bottom line is that anything other than the most basic interventions are at best a waste of time and money.

Saline drops in the nose can help loosen secretions, but decongestants should be avoided. All cause "rebound" nasal congestion when stopped. "Cough medicines" simply do not work, and some contain ingredients that have unpleasant side-effects. Besides, coughing is a natural reflex designed to move infected mucus out of the lungs, so suppressing it doesn't seem like a good idea. Make sure plenty of fluids are encouraged, as mouth-breathing and a raised temperature can lead to increased fluid loss.


Advice on the treatment of childhood fevers has changed dramatically. The emphasis in the past was to reduce the temperature, but this is no longer thought necessary.

There is even some suggestion that raised body temperature actually helps the body fight infection, so struggling to bring it down may actually prolong the illness. Some young children suffer from "febrile convulsions" (brief epileptic-like fits) when they have a high temperature, but even this is no longer thought to be a reason to cool them down. Surprisingly, advice on fevers from the MHRA and NICE websites differs slightly, but NICE guidelines are regarded by most as being authoritative and backed by hard research.

"Tepid sponging" is no longer advised. The child should neither be under-dressed, nor wrapped in extra layers. Fever-reducing medicines such as paracetamol or ibuprofen may be used, but only for children who appear distressed, and not given purely on the basis of the temperature. Indiscriminate over-use of paracetamol has recently been linked to the dramatic rise in cases of childhood asthma.

For a child with a fever, it is vital more than anything else to determine whether the child has a serious underlying infection, and whether they need active and aggressive medical intervention.

Head Lice

It used to be common practice to wash the hair of children in the organophosphate (OP) insecticide malathion to rid them of this relatively harmless infestation. OPs are closely related to nerve gas, and when farmers use similar compounds as sheep dip, they must wear protective clothing. Besides the possible toxicity issues, some studies have shown malathion to be only 36 per cent effective on lice.

Good old "nit combs" can be very useful, especially when used on wet hair. Newer, non-toxic silicone-based products (such as Hedrin) partly suffocate the lice, and make the hair slippery. This can prevent nits (lice eggs) from sticking to the hair shaft. A device called the LouseBuster uses hot air to destroy both lice and nits, and claims a very high success rate.

Diarrhoea and vomiting

The vast majority of gastro-intestinal infections in children get better with supportive treatment only – that is, replacing fluid that has been lost. The younger the child, the more quickly they can become dangerously dehydrated. This is a particular concern in babies under the age of six months. It is vital to replace salts and sugars as well as water, and preparations such as Dioralyte contain the correct mix when prepared according to instructions. Children usually become noticeably ill when even a little dehydrated, so a child who is active and happy is very unlikely to be at risk from dehydration no matter how many nappies they are filling. Drugs that are designed to stop diarrhoea or suppress vomiting are dangerous if used in young children and should never be used by parents.

As with fevers, the most important thing in these cases is to spot those that are caused by a serious infection such as Salmonella. Once again, how "ill" the child appears is a good rule of thumb. Blood in the stool is unusual in simple cases of gastroenteritis and should always be a signal to seek medical advice.


Inflammation or infection of the ear (otitis) is the usual cause of earache, and is split into two broad groups – otitis externa, affecting the area outside the eardrum, and otitis media, affecting the middle ear, the region behind the eardrum.

Otitis externa can be caused by water getting into the ear – especially when swimming – or by minor injuries to the ear canal. These often occur during attempts to clean inside the ear, a procedure which is both unwise and unnecessary. Don't ever be tempted to use cotton buds to clean children's ears. The best rule when it comes to cleaning out ears is to never stick anything in your ear that's smaller than your elbow. Children with otitis externa will need pain relief, and possibly drops prescribed by their GP.

Otitis media (OM) is a more concerning condition, and if left untreated over a period of time can lead to hearing loss. Some children are prone to developing OM because their eustachian tube (which connects the middle ear to the back of the throat) is not yet working properly.

Of particular concern is OME, or otitis media with effusion, more commonly known as "glue ear". The standard treatment for this for a long time was (often repeated) courses of antibiotics, but is not now thought to be effective, and may in fact lead to more serious infections with unusual bacteria.

Some cases of OME do not actually cause much ear pain and can be difficult to spot. The first sign may be under-performance at school, simply because the affected child cannot hear properly. While some cases of glue ear will clear up without treatment, children with repeated episodes need specialist treatment which may involve the insertion of grommets in the ear drum to help drain secretions and ventilate the middle ear.

Life and Style
ebookNow available in paperback
ebookPart of The Independent’s new eBook series The Great Composers
Life and Style
A picture taken on February 11, 2014 at people walking at sunrise on the Trocadero Esplanade, also known as the Parvis des droits de l'homme (Parvis of Human Rights), in front of the Eiffel Tower in Paris.
techGoogle celebrates Paris's iconic landmark, which opened to the public 126 years ago today
Scientists believe Mercury is coated in billions of years’ worth of carbon dust, after being ‘dumped on’ by passing comets
Cleopatra the tortoise suffers from a painful disease that causes her shell to disintegrate; her new prosthetic one has been custom-made for her using 3D printing technology
newsCleopatra had been suffering from 'pyramiding'
Arts and Entertainment
Coachella and Lollapalooza festivals have both listed the selfie stick devices as “prohibited items”
  • Get to the point
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Sheridan Maine: Accounts Assistant

    £30,000 Annual: Sheridan Maine: A fantastic opportunity has arisen for a perso...

    Sheridan Maine: Accounts Payable Clerk

    £21,000 - £24,000 Annual: Sheridan Maine: Are you looking for a new opportunit...

    Recruitment Genius: Regional Sales Manager - East Region - OTE £45,000

    £30000 - £45000 per annum: Recruitment Genius: This is an exciting opportunity...

    Sheridan Maine: Finance Manager

    £55,000 - £65,000 Annual: Sheridan Maine: Are you a qualified accountant with ...

    Day In a Page

    No postcode? No vote

    Floating voters

    How living on a houseboat meant I didn't officially 'exist'
    Louis Theroux's affable Englishman routine begins to wear thin

    By Reason of Insanity

    Louis Theroux's affable Englishman routine begins to wear thin
    Power dressing is back – but no shoulderpads!

    Power dressing is back

    But banish all thoughts of Eighties shoulderpads
    Spanish stone-age cave paintings 'under threat' after being re-opened to the public

    Spanish stone-age cave paintings in Altamira 'under threat'

    Caves were re-opened to the public
    'I was the bookies’ favourite to be first to leave the Cabinet'

    Vince Cable interview

    'I was the bookies’ favourite to be first to leave the Cabinet'
    Election 2015: How many of the Government's coalition agreement promises have been kept?

    Promises, promises

    But how many coalition agreement pledges have been kept?
    The Gaza fisherman who built his own reef - and was shot dead there by an Israeli gunboat

    The death of a Gaza fisherman

    He built his own reef, and was fatally shot there by an Israeli gunboat
    Saudi Arabia's airstrikes in Yemen are fuelling the Gulf's fire

    Saudi airstrikes are fuelling the Gulf's fire

    Arab intervention in Yemen risks entrenching Sunni-Shia divide and handing a victory to Isis, says Patrick Cockburn
    Zayn Malik's departure from One Direction shows the perils of fame in the age of social media

    The only direction Zayn could go

    We wince at the anguish of One Direction's fans, but Malik's departure shows the perils of fame in the age of social media
    Young Magician of the Year 2015: Meet the schoolgirl from Newcastle who has her heart set on being the competition's first female winner

    Spells like teen spirit

    A 16-year-old from Newcastle has set her heart on being the first female to win Young Magician of the Year. Jonathan Owen meets her
    Jonathan Anderson: If fashion is a cycle, this young man knows just how to ride it

    If fashion is a cycle, this young man knows just how to ride it

    British designer Jonathan Anderson is putting his stamp on venerable house Loewe
    Number plates scheme could provide a licence to offend in the land of the free

    Licence to offend in the land of the free

    Cash-strapped states have hit on a way of making money out of drivers that may be in collision with the First Amendment, says Rupert Cornwell
    From farm to fork: Meet the Cornish fishermen, vegetable-growers and butchers causing a stir in London's top restaurants

    From farm to fork in Cornwall

    One man is bringing together Cornwall's most accomplished growers, fishermen and butchers with London's best chefs to put the finest, freshest produce on the plates of some of the country’s best restaurants
    Robert Parker interview: The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes

    Robert Parker interview

    The world's top wine critic on tasting 10,000 bottles a year, absurd drinking notes and New World wannabes
    Don't believe the stereotype - or should you?

    Don't believe the stereotype - or should you?

    We exaggerate regional traits and turn them into jokes - and those on the receiving end are in on it too, says DJ Taylor