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Managing Colds, Cough, and Fever in Children

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Pediatric patients often suffer from viral upper respiratory infections (“the common cold”)with symptoms including congestion, rhinorrhea (runny nose), cough and, occasionally, fever. Children experience approximately 3 to 8 colds each year, about twice as many as adults. The annual cost of colds and cold-like illnesses in the US is an estimated $40 billion – due to lost work days for parents, medical appointments, and the cost of medications. Cough, a common symptom of several childhood illnesses, is the second most common reason for emergency department visits by children aged 15 years and younger.

Another common symptom among children, fever, accounts for an estimated 6% of all office visits to pediatricians. Typically, colds and related symptoms of cough and fever are self-limiting, but nondrug measures and over-the-counter (OTC) medications may be used to relieve bothersome symptoms. Although many OTC medications are recognized as safe and effective through the FDA’s OTC monograph process, clinical trial evidence to support their use in children is limited.

In 2001, concern began to escalate about serious adverse effects and deaths related to cough and cold medication use in infants and young children. In addition, adverse events related to

cough and cold medications

were implicated as a common reason for emergency department visits, especially among young children.11 These reports led to a 2008 Public Health Advisory from the FDA recommending that cough and cold products not be used in infants and children under the age of 2 years. Following this recommendation, manufacturers voluntarily updated the cough and cold product labels to advise against use in children younger than 4 years.

Pharmacists and other easily accessible healthcare providers

are key sources of information about the drug and nondrug options for treating colds, cough and fever in children. Placing emphasis on nondrug options is important to avoid unnecessary medication use and potential side effects. When OTC medication is recommended, caregivers need advice about identifying and measuring the correct dose (which can be quite confusing) as well as any contraindications or side effects of concern for the individual child. This issue focuses on OTC options for cold symptom management; prescription medications (eg, ipratropium nasal solution for rhinorrhea) are not included.


Publication Date: 01/20/2016
Expiration Date: 01/20/2019
CE Credit: 1.5 (0.15 CEU)
Type of Activity: Knowledge-based

This program was developed by The Rx Consultant and published by Continuing Education Network, Inc. The Rx Consultant accepts no advertising or financial support from the pharmaceutical industry and is funded solely by the purchase of programs. The Rx Consultant is dedicated to providing unbiased, balanced information to health care practitioners.

Programs developed by The Rx Consultant are written by health care providers with expertise in the topic area, peer-reviewed, extensively edited, and fact-checked. This development process was created to insure that every program presents information that is current, accurate, relevant to "real world" health care providers, and written in an easy reading, "plain English" style.


Kelly L. Scolaro, PharmD, is a Clinical Assistant Professor and Director of Pharmaceutical Care Labs, Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy at the University of North Carolina, Chapel Hill.
Courtney L. Bradley, PharmD, is an Assistant Professor of Clinical Sciences and Applied Laboratory Coordinator at the High Point University School of Pharmacy, High Point, NC.

Disclosure Statement

Disclosure: Dr. Scolaro and Dr. Bradley report no financial relationship with the manufacturer(s) or provider(s) of any commercial product(s) or service(s) that appears in this issue.

Target Audience

This accredited program is targeted to pharmacists .

Goals & Objectives

At the conclusion of this program, participants will be able to:

    1. Differentiate the common cold from allergy and influenza. Identify which children with cold, cough and/or fever should be referred to a primary care provider for further assessment.
    2. Describe how common cold viruses can be transmitted and discuss measures that may reduce transmission.
    3. Discuss nonprescription medications used for the treatment of cold symptoms, including appropriate pediatric dosing and potential side effects.
    4. Recommend nondrug strategies for managing cold symptoms to a parent or caregiver. Discuss alternative or complementary remedies that may be used to treat or prevent colds in children.

Accreditation Statements

The Rx Consultant is a publication of Continuing Education Network, Inc.

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Continuing Education Network, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education as a provider of continuing pharmacy education.

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Continuing Education Network is approved by the California Board of Registered Nursing, Provider Number CEP 13118. Programs approved by CA BRN are accepted by most State Boards of Nursing.

ACPE Universal Activity Number: 0428-0000-16-001-H01-P

Exam & Credit Statement Procedures

Upon successful completion of this program and the post test (70%), 1.5 hours of continuing education credit will be awarded. To receive credit and your exam score, please complete the exam questions and program evaluation.

Editorial and Review Board

Chief Editor and CE Administrator

Terry M. Baker, PharmD

Managing Editor

Tracy Farnen, PharmD

Associate Editors

James Chan, PharmD, PhD
Pharmacy Quality and Outcomes Coordinator
Kaiser Permanente
Oakland, CA

Associate Clinical Professor
School of Pharmacy
University of California San Francisco
San Francisco, CA

Richard Ron Finley, B.S. Pharm.,R.Ph.
Clinical Pharmacist (volunteer faculty)
University of California, San Francisco (UCSF) Memory and Aging Center
Lecturer (Emeritus) UCSF, Department of Clinical Pharmacy
Health Sciences Clinical Professor, UCSF School of Pharmacy
San Francisco, CA

Consultant Pharmacist
Ray Dolby Brain Health Center, Sutter Health/CPMC
San Francisco, CA

Consult Pharmacist Aging and Adult Health Services
San Francisco Health Department
San Francisco, CA

Julio R. Lopez, PharmD, FCSHP
Chief of Pharmacy Service
VA Northern California Health Care System

Adjunct Clinical Professor
College of Pharmacy
Touro University
Vallejo, CA

Assistant Clinical Professor
School of Pharmacy
University of California, San Francisco
San Francisco, CA Adjunct Professor
Thomas J. Long School of Pharmacy
University of the Pacific
Stockton, CA

Visiting Associate Professor and Lecturer
Nursing School
Samuel Merritt University
Oakland, CA

Pamela Mausner, MD

Helen Berlie, Pharm.D. CDE, BCACP
Clinical Assistant Professor, Pharmacy Practice
Wayne State University
Detroit, MI

Ambulatory Care Specialist - Diabetes
Health Centers Detroit Medical Group
Detroit, MI

Senior Editorial Advisor

Gerard Hatheway, PharmD, PhD

Editorial Advisors

Belinda M. Danielson, RPh
Christopher M. DeSoto, PharmD
Angie S. Graham, PharmD
Cynthia Chan Huang, PharmD, MBA
Fred Plageman, PharmD

Editorial Advisor and Clinical Practice Consultant for Nurse Practitioners

Emily K.
Meuleman, RN, C, MS

About the Rx Consultant

The Rx Consultant is a monthly publication dedicated to providing health care professionals with the information they need to educate patients about drugs and manage drug therapy. The reader is responsible for confirming the information presented here and interpreting it in relation to each patient's specific situation before utilizing the information.

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