WebMD Ask the Pharmacist

Kids and Cold Medicine: Ask the Pharmacist

Pharmacist Macary Marciniak, PharmD, BCPS, answers your questions about kids and cold medicines.

Question:

If an 8-year-old has a cold, can she get the FluMist vaccine?

Answer:

FluMist is a live, intranasal vaccine for the flu. It is recommended for healthy individuals 2-49 years of age. FluMist is a nice option for children, as it avoids giving a shot, but instead delivers the vaccine in a nasal spray format. A child can still receive FluMist if she has a mild illness, such as a cold. If the child has a moderate or severe illness, where she really should be in the hospital, then we would wait to give the vaccine until she feels better.

It is so important for children 6 months of age and older to get a flu shot each year.

Question:

Will ibuprofen and Robitussin cause heart attacks in children if used together?

Answer:

It is completely safe to give both ibuprofen and Robitussin together for a child. I am not aware of any concerns regarding heart attacks with these, or any other, cough and cold medications. Please be sure that you choose a Robitussin product that is geared for a child, rather than an adult, as the ingredients will be dosed for a younger individual. It is always important to check for interactions between medications before giving products to your child.

Question:

I thought my daughter was having allergy symptoms, but now she has a 99 degree fever and runny nose and sore throat, etc. Can I give her Tylenol Plus?

Answer:

There are a number of different products available in the Tylenol Plus line, all which contain different active ingredients. And all over-the-counter medications for cough and cold are not labeled for use in children under the age of 4. Without knowing your daughter’s age, it is difficult to know if any Tylenol Plus product could be recommended for her. Just hearing some of her symptoms, though, I can provide a few recommendations.

Her sore throat may be relieved by use of a cool mist humidifier in her room. This will add moisture to the air and soothe the airways. Also, drinking lots of water can help, as well as sucking on a sugar-free lozenge.

If the pain is significant, or the fever worsens, Tylenol (single ingredient product, not a combination cough and cold product) is an option. Talk to your local pharmacist who can tell you the best dose based on your child’s weight and provide you with a device to help measure the correct dose, if needed.

The runny nose may be helped with an antihistamine like chlorpheniramine (brand name: Chlor-Trimeton). This product is appropriate for a child 6 years of age or older. I hope your daughter feels better soon!

Question:

What cold medicine can I safely give to my 10-year-old child that is taking Concerta?

Answer:

Concerta is a prescription medication that is used to treat attention deficit disorder. As a general rule, I would try to avoid nonprescription medications that contain pseudoephedrine or phenylephrine as the active ingredient. Taken with Concerta, these medications would likely increase your child’s heart rate or blood pressure. It is best to choose a cold medicine based on your symptoms.

For a sore throat or other pain or fever, a pain reliever/fever reducer such as acetaminophen is a good choice. For a runny nose or sneezing, an antihistamine such as chlorpheniramine is the right option. Pseudoephedrine is a choice to treat nasal or chest congestion. A “dry” or “hacking” cough may be eased by dextromethorphan and a “wet” or “productive” cough might respond to guaifenesin.

Without knowing your child’s specific symptoms, it is hard to choose the right cold medicine for him. But hopefully some of this general information can be helpful. You can always talk to your local pharmacist for a more specific recommendation. And always let your pharmacist know about the medications that your child is taking as it is always important to check for interactions between prescription and nonprescription medications before use.

Question:

My son is 14 years old and has a bad, deep cough with stopped up and runny nose. He is already taking Zithromax, but needs to take an antihistamine. What would be safe?

Answer:

An antihistamine such as chlorpheniramine (brand name: Chlor-Trimeton) is a nice choice to treat the runny nose. It may also help with the cough, as the cough may be partially due to post-nasal drip. Nasal stuffiness may also be relieved by using a saline nasal spray. Your son can use the nasal spray as often as he likes throughout the day.

Another option might be to add a cool mist humidifier to his room. A humidifier will add moisture to the room and can particularly help with a bothersome nighttime cough.

If your son does not feel better within a week, then I would encourage you to go back to his pediatrician, as that should be sufficient time for the antibiotic and the suggestions above to take effect. I hope your son feels better soon!

Question:

Can you give children Alka-Seltzer Cold Plus?

Answer:

There are quite a few versions of Alka-Seltzer Plus products on the market. Each product contains a number of different active ingredients. Generally, I would not recommend Alka-Seltzer Plus products for children.

First of all, all over-the-counter medications for cough and cold are not labeled for use in children under the age of 4. If the child in question is older than age 4, you then need to consider the active ingredients in that particular product.

Again, each Alka-Seltzer product varies but some do contain aspirin as the pain reliever/fever reducer. Aspirin is definitely not recommended for a child under the age of 16. Acetaminophen is the preferred pain reliever/fever reducer and acetaminophen is found in some Alka-Seltzer products. There are other active ingredients in Alka-Seltzer products that are not recommended for children of a certain age or for children taking certain medications.

I strongly encourage you to carefully read the label of the product in question to determine the active ingredients. Ask your local pharmacist for help in determining if that Alka-Seltzer product may work for your child.

Question:

What medicine can I give my 2-year-old for vomiting and diarrhea?

Answer:

The biggest concern in a young child with vomiting and diarrhea is the risk for dehydration. I would recommend a fluid electrolyte replacement product, like Pedialyte, for your child. Pedialyte will help replace vital nutrients that can be lost while sick. Start with a teaspoonful every 5-10 minutes and you can keep increasing as the child is able to tolerate it.

Question:

My daughter is 8 months old, soon to be 9. She is getting a real bad cold. Her nose is running, her body is hot, she been running a fever off and on, has a cough, been sneezing, and has a runny nose. I have been giving her acetaminophen but I was wondering if there is anything else OTC I can give her to help with some of the symptoms and to help her sleep?

Answer:

Acetaminophen is a good choice to help with her fever and keep her comfortable. Acetaminophen is dosed based on weight, so check with your pediatrician if you have any questions about the right dose for her. For a child this young, I suggest placing a cool mist humidifier in her room. This will help add moisture to the air to relieve the cough and soothe her airways. Hopefully, it will help her have more restful sleep.

Also, keep feeding your daughter so that she stays hydrated. I would not recommend any other nonprescription cough and cold medicines for your daughter. All over-the-counter medications for cough and cold are not labeled for use in children under the age of 4. I hope this helps and your daughter feels better soon!

Question:

My son was given Exall liquid to help with cough and I can’t find any information about it. Is vomiting a side effect?

Answer:

Exall is a medication that helps treat cough that is available in other countries, but not in the United States. It contains guaifenesin, which is an expectorant and relieves chest congestion, and carbetapentane, which is a cough suppressant. Vomiting is a potential side effect of the medication. If the vomiting is getting worse or you are concerned about this side effect, please contact your child’s pediatrician.

Question:

My son is 3 years old, and his weight is 37.2 pounds. He has nasal congestion and he is coughing a little. I have Mucinex Cold for Kids. What dosage can I give him according to his age and weight?

Answer:

All over-the-counter medications for cough and cold are not labeled for use in children under the age of 4. So I would not recommend using this Mucinex product, or any other children’s cough and cold medication, for your son.

The best option to treat his nasal congestion is nasal saline drops or a nasal saline spray. The great thing about saline is that it can be used in young children, and can be dosed as often as you like throughout the day. This will help to break up the nasal congestion, which is probably also contributing to his cough. I would also suggest using a cool mist humidifier in his room to help relieve the cough. A humidifier will help to add moisture to the air and soothe his airways. I hope these suggestions help!

Question:

Can my teenage daughter safely take ibuprofen and Nyquil at the same time?

Answer:

There are a number of different products available in the Nyquil product line and they have different active ingredients. It is always important to read the label of the particular product you are interested in to verify the ingredients contained in that product. Nyquil may contain a pain reliever/fever reducer and, when it does, it typically contains acetaminophen. If acetaminophen is in your product, it may provide adequate relief for your daughter’s symptoms.

However, not all Nyquil products have a pain reliever/fever reducer in them. And your daughter may take ibuprofen for another reason or may find that the acetaminophen in the Nyquil is not sufficient for her problem. In these cases, then it would then be fine to take both ibuprofen and Nyquil together.

Question:

My 2-year-old has a clear, runny nose and a terrible cough. Is there anything I can give her to help the cough while she sleeps?

Answer:

The clear, runny nose is likely contributing to the cough at night. I would also suggest using a cool mist humidifier in her room to help relieve the cough. A humidifier will help to add moisture to the air and soothe her airways.

Please do not use any over-the-counter medications for cough and cold, as none are labeled for use in a child under the age of 4. I hope her cough resolves quickly!

Question:

My son is suffering from sinus pain, nasal congestion, coughing. I have been giving him Tylenol Cold Multi Symptom but it has not helped any. What other over the counter medicines can I give him or do I need to wait for it to wear off?

Answer:

Choosing an appropriate cough and cold product for a child can be challenging. First of all, it is best to choose a cold medicine based on symptoms. We also have to consider the child’s age. All over-the-counter medications for cough and cold are not labeled for use in children under the age of 4. Knowing these items, there is still the difficulty in the huge array of products in the aisle.

While the product name Tylenol Cold Multi Symptom may sound pretty specific, there are actually quite a few versions of this product available over-the-counter. Without seeing your specific product, it is hard to say if it contained all the right ingredients to treat his symptoms. We also have to give the product time to work, as sometimes the effects are not immediate.

If you have tried an over-the-counter product for a week without relief, then you should have your child see his pediatrician, as an infection may be present. In addition to the Tylenol product you mentioned, you could try a saline nasal spray for the nasal congestion. Coughing can often be helped by drinking lots of water, sucking on a sugar-free lozenge, or using a cool mist humidifier in his room. Each of these suggestions can be tried right away, without waiting for medication to wear off, and can be used as often as you like throughout the day. I hope this information helps and he starts to feel better soon!

Question:

How much acetaminophen do you give a 9 pound infant?

Answer:

A 9 pound infant is likely a very new baby. For a child of this age and size, I would first check with the child’s pediatrician. Acetaminophen is labeled for over-the-counter use in children 2 years of age or older. Parents trying to treat a child this age should really talk to the pediatrician first. If the pediatrician says it is OK to give the child acetaminophen, then we do need to consider the child’s weight in order to dose the product appropriately.

Tylenol infant’s and children’s products have recently been reformulated so that they now contain the same concentration of acetaminophen, 160 mg/5 mL. However, if you have an older package of Tylenol (acetaminophen) at home, then it may have a different strength. It is very important to know the product you are working with, so that we give your child the correct amount.

Talk with your pediatrician or local pharmacist who can tell you the correct dose for your child based on weight and the product you have on hand. You will need to measure the correct amount with the dropper that is packaged with the product. Your local pharmacist can help you use the device that you have so that the appropriate amount of medication is given to your child.

Question:

Can I give my 2-year-old Children's Benadryl and Robitussin cough syrup together?

Answer:

Children’s Benadryl contains diphenhydramine and is labeled for use for children aged 6 and older. Children’s Robitussin is available in a variety of different formulations, but may contain guaifenesin, dextromethorphan, and/or phenylephrine. Children’s Robitussin is labeled for use for children aged 4 and older (and in some products, aged 6 and older).

While it is safe to take both the Children’s Benadryl and Children’s Robitussin together, I would not recommend these products for your child, based on her age.

Question:

My daughter takes Vyvanse and Zoloft and she has a bad cough. What over-the-counter medicine can she take?

Answer:

Vyvanse is a prescription medication for attention deficit disorder and Zoloft is a prescription medication that can be used for depression or anxiety. It is important to check for interactions between prescription medications like these and nonprescription medications before use.

There are two kinds of cough: wet and dry. Wet coughs are the ones that are “junky” and you tend to have lots of phlegm and mucus. Guaifenesin is an active ingredient that could be helpful for this type of cough. Guaifenesin would be safe to take along with Vyvanse and Zoloft. Dry coughs are the ones that tickle your throat and do not produce any phlegm. Dextromethorphan is an active ingredient that could be helpful here. Short-term use of dextromethorphan can be OK with the medications your daughter is taking.

Another option to strongly consider for treating cough is a cool mist humidifier. This can be placed in your daughter’s room to add moisture to the air. This can be particularly helpful for coughs that are problematic at night. Hopefully, these suggestions help. And, if the cough does not get better after a week, please have your daughter visit her pediatrician.

Question:

My son is 10 and I wanted to know if Aleve and Motrin are similar so I can substitute the Aleve for the Motrin.

Answer:

Aleve (naproxen) and Motrin (ibuprofen) are both nonprescription pain relievers. Aleve and Motrin are both part of a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). These medications work well to treat pain as well as fever. Aleve and Motrin are similar and so could be substituted. However, these medications do come in different strengths and are dosed differently. The package labels for both Aleve and Motrin will direct you to talk to your son’s pediatrician first for recommendations on use. Please check with the pediatrician to see if they recommend one product over another and be sure to follow the proper dosing for whichever product you choose for your son.

Question:

I gave my 15-year-old Claritin because I thought he had allergies. Now it looks like he has the flu. Can I give him Theraflu? It’s been six hours since the Claritin.

Answer:

Theraflu, like many other cough and cold preparations, is available in a number of different formulations. Without knowing the specific product you have, it is difficult to know the active ingredients in the Theraflu. However, Theraflu may contain an antihistamine, a decongestant, an expectorant, a cough suppressant, and/or a pain reliever/fever reducer. Claritin is an antihistamine and it is likely that your Theraflu product contains an antihistamine as well.

As it has only been six hours since taking the Claritin, there will still be medication in his system. Taking both products together, our son may notice an increase in some side effects, such as dry mouth, dry eyes, blurred vision, or constipation. Without knowing the specific symptoms he is trying to treat, it is hard to make an alternative recommendation for him.

Feel free to talk with your local pharmacist if you have concerns about the Theraflu and might want to try something else. It is so important to check for potential interactions with nonprescription medications.

Question:

I have Children’s Tylenol Cold Plus. I need to know if I can give it to my 2-year-old. He is 32 pounds.

Answer:

All over-the-counter medications for cough and cold are not labeled for use in children under the age of 4. So I would not recommend using this Children’s Tylenol Cold Plus product, or any other children’s cough and cold medication, for your son.

Without knowing your child’s symptoms, it is difficult to recommend other options for him. If your child is having some pain or a fever, Tylenol (single ingredient product, not a combination cough and cold product) is an option. Tylenol infant’s and children’s products have recently been reformulated so that they contain the same concentration of acetaminophen, 160 mg/5 mL. With this new strength, the appropriate dose for your child who weighs 32 pounds is 5 mL (1 teaspoon).

You can measure this amount with the dropper or dosing device that is packaged with the product. Or talk to your local pharmacist, who can provide you with a device to help measure the correct dose. If you have an older package of Tylenol (acetaminophen) at home, talk with your local pharmacist who can tell you the correct dose for your son based on his weight and the product you have on hand. I hope your son feels better soon!

Question:

Can you give a child Benadryl with an antibiotic?

Answer:

Benadryl is a nonprescription antihistamine which contains diphenhydramine as the active ingredient. Benadryl can be used in children over the age of 6. One of the main side effects of Benadryl is drowsiness; however, in young children, sometimes the reverse happens, and the child gets excited. So depending on your child’s age, it may be OK to give Benadryl safely with an antibiotic.

Question:

Can you take Children’s albuterol with Children's Motrin or Children's Tylenol?

Answer:

It is really important to check for interactions between prescription and nonprescription medications before use. It is completely safe to take both albuterol and Motrin or Tylenol together.

Question:

My 18-month-old has a cough. What can I give her?

Answer:

Medications sold over-the-counter for cough would not be recommended for an 18-month-old who has a cough. In fact, in a child this young, it would be important to talk to the child’s pediatrician about her symptoms. We would want to determine if the cough is related to the common cold or to something else, such as asthma.

Assuming the cough is related to the common cold, the best option would be to use a cool mist humidifier in her room. This will add moisture to the air and help soothe her airways.

Question:

Does a child need a flu shot every year? Or does it last longer?

Answer:

Your child (and you) does need to get a flu shot every year. Each year, the strains in the flu vaccine change, based on what is circulating in the environment and what is anticipated to be the strains present during the upcoming year. The flu vaccine is available in late summer/early fall (for example, August/September 2011 this year) and the vaccine typically expires in early/mid-summer (for example, June/July 2012 this year). You can continue to get the flu vaccine as long as you haven’t had the flu yet.

So even if you or your child were not vaccinated in January, February, or March, you can still get the flu vaccine. Children less than 9 years of age who are getting the flu vaccine for the first time will need to have two doses, separated by four weeks.

As the strains in the vaccine may change each year, you will always need to get a new flu shot each year. The same information is true for FluMist, the intranasal flu vaccine. I hope that you and your child will get the vaccine this year. It is the best way to protect your family and those around you from getting sick.

Question:

My son takes Strattera, Trileptal, and Risperdal. May he also take Nyquil for a cold?

Answer:

Nyquil is available in a number of different formulations. Without knowing the specific product you have, it is difficult to know the active ingredients in the Nyquil. However, Nyquil may contain an antihistamine, a decongestant, an expectorant, a cough suppressant, and/or a pain reliever/fever reducer. Taking Strattera with a product that contains a decongestant may make him a bit more jittery or increase his heart rate and blood pressure. Taking Risperdal with a product that contains an antihistamine, may increase some side effects, such as dry mouth, dry eyes, blurred vision, or constipation.

Nyquil should only be used for a short period of time, to relieve symptoms associated with the common cold. Your son may notice some of these side effects, but they may not be too bothersome. He could try a dose of the Nyquil and see how he feels, or select a cold product that does not contain an antihistamine or a decongestant. Without knowing the specific symptoms he is trying to treat, it is hard to make an alternative recommendation for him.

Feel free to talk with your local pharmacist if you have concerns about the Nyquil and might want to try something else. It is so important to check for potential interactions with prescription and nonprescription medications.

Question:

Can I give my 9-year-old Children’s Sudafed and Children’s Advil?

Answer:

Children’s Sudafed contains pseudoephedrine (Children’s Sudafed PE contains phenylephrine) and Children’s Advil contains ibuprofen. Both products can be used in a 9-year-old and both products can be taken together. Thanks for checking for any concerns or interactions. It is so important to ask about any potential problems between medications before using them.

Question:

Can a 13-year-old weighing 122 pounds take Excedrin Migraine medication for a bad headache with the flu?

Answer:

Excedrin Migraine should be used for migraine-type headaches. Migraines have specific symptoms that can be differentiated from a regular headache. These include pain that start on one side of the head and pain that is associated with nausea or sensitivity to light. If your child is having migraine headaches, the Excedrin Migraine would be an appropriate choice.

It is very common to have a pretty bad headache with the flu. This may not necessarily be a migraine. In this case, I might recommend that your child first try acetaminophen (brand name: Tylenol) or ibuprofen (brand name: Advil or Motrin) for the headache. This may be sufficient to relieve the pain.

If that doesn’t work, a trial of Excedrin Migraine could be appropriate. Excedrin Migraine contains acetaminophen, aspirin, and caffeine. Excedrin Migraine is labeled to use in children 12 years of age and older, although some individuals worry about giving aspirin to a child less than 16 years of age. As it does contain caffeine, I would caution against consuming too much caffeine from other sources, like tea, soda, or energy drinks.

Question:

My daughter took Sudafed and is coughing all night. Can I give her Nyquil for her cough?

Answer:

Sudafed is a nonprescription decongestant that contains pseudoephedrine. Children’s Nyquil contains chlorpheniramine (antihistamine) and dextromethorphan (cough suppressant). Children’s Nyquil can help to relieve her cough so that she can sleep at night.

Please be sure that you choose Children’s Nyquil, rather than adult Nyquil, as the ingredients will be dosed for a younger individual. Children’s Nyquil, though, should only be used for a child 6 years of age or older. And the dosing will vary based on the child’s age: 1 tablespoon for a child 6-11 years old or 2 tablespoons for a child 12 years of age or older.

Another option to help with her cough would be using a cool mist humidifier in her room at night (this option works for a child of any age).

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