Integrative Pediatric and Adolescent Health: Educational Web Column

January 2009: The Cold and Flu Season

The dreaded cold season has now settled in. For those of you who have followed the news about pediatric cough and cold remedies, you know that the American Academy of Pediatrics clearly stated that over-the-counter pharmaceuticals (cough and cold medications that contain decongestants, antihistamines, anti-tussives and/or expectorants) have no consistent data supporting their effectiveness for young children.

There are a wide range of natural heath products that have been used for treatment or prevention of colds or the flu, some for thousands of years. While the evidence base for the efficacy of most of these is fair at best, they are generally safe. Here is a brief overview of the basics of cold and flu prevention and treatment, as well as common herbs and supplements that may be considered. It is important to discuss the use of these remedies with your physician and to monitor for side effects and drug interactions.

The basics:

Nutrition, exercise and sleep
A healthy whole foods diet, regular exercise, and consistent adequate sleep are the best ways to keep our immune system functioning most effectively. As trite as it sounds, there’s a lot of truth in the saying: ‘take care of your body and it will take care of you’!

Hand-washing
Viral infections are easily passed around by hanging out on door knobs and other surfaces in public places just waiting for someone to come by, wipe them up and rub them on their nose. Regular hand-washing is the best way to prevent this type of spread. While I don’t advocate for regular use of alcohol hand wipes (overboard in most home settings), they can be helpful during travel times when large crowds and airports are unavoidable.

Saline nasal rinse
When young infants catch a cold, one of the best ways to help clear the nasal passages for easier sleep and feeding is to place 3 or 4 drops of a saline solution in their nose. Despite the marketing of those bulb suction devices, they’re not really necessary and can be more traumatic than they’re worth. Just let your infant sneeze out or swallow the saline. This can give your child at least an hour or more of relief.

For older children, teens and adults, learning to use a neti pot (or similar nasal rinse device like the NeilMed sinus rinse bottle) for rinsing the nares can have a similar effect. In studies in adults nasal saline wash has been found to be as effective as antibiotics for sinus infections. In my experience, though, most children have a hard time learning to do this.

Vaporizers
Cool mist vaporizers can be helpful, especially if the air in your home is dry.

Influenza vaccine
The vaccine is now recommended by the American Academy of Pediatrics for all infants and children from 6 months of age through 18 years. Its effectiveness is clear for older children and adults. There has been some conflicting research on it’s effectiveness in children under 2 years of age. However, because complications of the flu can be severe at this age, it is still recommended by public health authorities for children in this age group.

Natural Health Products used for the prevention and treatment of colds and flu:

There are a number of ways to learn about using natural health products. While your child’s doctor should always be consulted and included when considering their use, you may find it helpful to use additional sources as well. In San Francisco, The Scarlet Sage is an herbal store on Valencia street that has knowledgeable staff. Another reference is Dr. Kathi Kemper’s book, The Holistic Pediatrician.

Prevention:

Andrographis
This herb has been studied in adults and children for use in prevention as well as for treatment of colds. A review of a number of these studies suggests it is more effective than placebo for treatment. It may also be effective in prevention.

Cod Liver Oil
As part of supplementing a diet that may be low in the omega-3 fatty acids from fish, cod liver oil can be helpful. A study conducted in New York City evaluated the use of a multivitamin plus cod liver oil supplement and showed fewer doctor visits for colds among the group given the supplement.

Echinacea
There have been many studies looking at the use of Echinacea for the prevention or treatment of colds. Clear consensus has not been achieved in large part because the studies have not been consistent in the species and parts of the plant that have been studied. While some smaller studies have suggested it may be helpful in shortening the duration or severity of colds in children, several large studies have not shown benefit. If you do choose to use this herb, glycerin tinctures should be used for children under 4 or 5 years of age. In older children and adults the alcohol tincture can be used.

Probiotics
Probiotic organisms in yogurt, kefir and other supplements are generally safe for children. They have primarily been used for gastrointestinal problems such as constipation in infants or mild diarrhea in children. One study from northern Europe found that milk supplemented with Lactobacillus GG helped reduce day care absences due to respiratory infections. There are many probiotic supplements available. Their quality can vary because of lack of consistent regulation. One source of guidance for quality supplements is ConsumerLab.com. This is a subscription site, but the cost is relatively reasonable.

Vitamin C
A daily vitamin C supplement (200mg or more) during the cold and flu season may be effective in reducing the duration of colds in children, according to a review study. However, it does not seem to help prevent colds, or improve symptoms when used after a cold has started. At higher doses (over 3 grams daily) Vitamin C can cause upset stomach.

Treatment:

Chicken soup (with garlic)
A few basic science studies have demonstrated antiviral properties of chicken soup and garlic. Whether this explains why it’s been such a popular home remedy for some long is not clear. But if your child likes it, stick with it!

Elderberry
Elderberry has been studied in the laboratory, and there appear to be properties of elderberry that help fight influenza infections.

Essential oils
Several salves – menthol, camphor, and eucalyptus – have been used for generations to soothe congestion. It turns out they do not appear to have much effect on congestion, but they do give the sensation of improvement by stimulating cool receptors in the nose. They are safe to use when applied to the chest. They should not be used under or in the nose of infants because of risk of breathing problems.

Ginger
Ginger may have antiviral properties. It can be taken as candied cubes and as a tea. Its taste is strong, though, and many children may not like it.

Honey
A single study of the use of buckwheat honey at night found that it can diminish cough in children. Honey should not be given to children under 1 year of age due to the risk of botulism.

Oscillococcinum
There are multiple homeopathic remedies that may be prescribed by a trained Homeopath depending on the type of symptoms a child has with their cold. Oscillococcinum is commonly available at many stores as is a well-known remedy specifically for flu. There are no data supporting the use of homeopathic remedies for colds. However, they are safe for use in infants and children.

Zinc lozenges
When taken frequently through the day early in a cold, zinc lozenges may shorten the duration of symptoms. Because they can be a choking hazard and ideally should be sucked on rather than bitten and chewed, they are best-suited to older children. Zinc also comes in a spray form, but there have been reports of nasal irritation and side effects that may be concerning in children.

There are a lot of remedies listed here. It reminds me of what I would often tell families about the dizzying array of over-the-counter cough medications in pharmacies. With such a large variety of products to choose from, it is a good sign that there is not a single drug, herb, supplement or remedy that stands out above another. The purpose of providing this list is less to give you a prescription of what to use, and more to update you on what’s known so that you have options. You can always stick with what’s worked for you and your family in the past, or you may want to try something new. Remember that when offered with care, love and a reminder to your child that they will get better soon, whatever you use will be strengthened by your attentiveness and encouragement.

Neither the UCSF Osher Center nor Dr. Becker are advocating for the use of any specific products or brands. Dr. Becker has no financial ties with any pharmaceutical or natural health product company.

Resource: Treating a Cold and Flu the Holistic Way, by Cari Nierenberg, ABC News Medical Unit

Four integrative medicine physicians- including Kevin Barrows, MD, UCSF Osher Center's Interim Medical Director- share advice on how they prevent and treat the common cold and flu.

About the Column

This column presents an integrative medicine view on a range of topics relevant to children, teens and early adolescents including: nutrition, herbs & supplements, mind-body and self-regulation skills, and general health and wellness.

If you’re new to the concept of integrative medicine, take a few minutes to browse the UCSF Osher Center web site, particularly the page what is integrative medicine?

Broadly speaking, integrative medicine is practicing good medicine. It is an approach to a child’s health that:

places illness in the context of the child, rather than the child in the context of illness;
takes into account family and environmental factors;
neither rejects conventional medicine nor accepts complementary or alternative medicine (CAM) uncritically.

Integrative pediatric consultations are available at the Osher Center with Kevin Barrows, MD, Rick McKinney, MD, and Priscilla Abercrombie, RN, NP, PhD, AHN-BC. To make an appointment, please call the main clinic line at 415.353.7720.

David Becker, MD, MPH is an Assistant Clinical Professor in the Department of Pediatrics at the University of California, San Francisco, and Affiliate Faculty at the Osher Center for Integrative Medicine at UCSF. He is starting the Pediatric Integrative Pain Clinic in July 2008. This is a referral-based service for children and adolescents with chronic pain. For questions about referrals, please contact the main Mt. Zion Pediatric number: 415.885.7478.

In addition, we offer two healthy parenting stress reduction classes: Mind in Labor and Mindfulness-Based Childbirth and Parenting.