Are over-the-counter cold and cough medicines safe for infants with RSV?

Over-the-counter cough and cold medicines are not a safe option for infants and young children with respiratory syncytial virus (RSV) [1]. In general, cough medicines should not be given to children under four years of age [1]. Furthermore, children under two years old should not be given any type of cough and cold medication containing decongestants or antihistamines, as they can cause serious, life-threatening side effects, such as seizures, rapid heart rate, and even death [4]. In most cases, an RSV infection resolves on its own within one to two weeks [1], and treatment focuses on supportive care and symptom relief.

Risks of using cold and cough medicines for infants

For children under two years of age, over-the-counter (OTC) cough and cold products intended for infants have been voluntarily withdrawn by manufacturers due to safety concerns and associated poisoning cases [4]. Medications for older children have also been reassessed, and labels have been updated to state that they should not be used for children under four years old [4]. Many of these medicines contain multiple ingredients, which increases the risk of accidental overdose [4].

Safe alternatives for symptom relief

Given that there is no specific cure for RSV [1], focus can be placed on safe home measures to help alleviate symptoms:

• Use a cool-mist humidifier: The cool mist helps shrink nasal passages and makes breathing easier. It is recommended to avoid warm-mist vaporizers as they may cause swelling in the nasal passages [4].
• Saline nasal drops and sprays: These help keep nasal passages moist and reduce congestion [4].
• Nasal suction: Using a suction bulb (nasal aspirator) with or without saline drops is very effective for infants under one year old to help them breathe better [4].
• Hydration: It is very important to give the infant sufficient amounts of fluids to prevent dehydration [1].
• Fever relief: Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can be used to help lower fever and reduce pain [4], with the caveat that aspirin should never be given to children [1].

When do symptoms become an emergency?

Although RSV symptoms often resemble a common cold, they can progress to serious lung infections such as bronchiolitis or pneumonia, especially in infants and high-risk individuals [1]. Symptoms that require immediate medical attention in very young infants include: irritability, decreased activity, and difficulty breathing [1]. Additionally, skin or lips turning blue or gray (cyanosis) is a serious sign indicating a lack of oxygen and requires seeking immediate emergency medical help [5].

In severe cases, the child may need to be admitted to the hospital, where oxygen, a breathing tube, or a mechanical ventilator can be provided [1]. For more information about this disease, you can read our detailed article on Respiratory Syncytial Virus (RSV) in Infants: Protecting Children from Winter Infections (Arabic).

Medical references

• Respiratory Syncytial Virus Infections
• Use Caution When Giving Cough and Cold Products to Kids | FDA
• Blue or grey skin or lips (cyanosis) - NHS