Over-The-Counter Medications that Relieve Tripledemic Symptoms in Kids

By Melody Berg, PharmD, MPH, BCPS

Winter is traditionally a time for colds and sniffles. This year, three viruses are causing a range of symptoms, many of which can be relieved with over-the-counter (OTC) medications found at your pharmacy. Your pharmacist is always available to help you select the right product and answer questions about your symptoms and illness.

What is the tripledemic?
The tripledemic refers to the wave of COVID-19, influenza (or flu), and respiratory syncytial virus (RSV) that all appears to be hitting the population right now, especially kids. All of these are viral illnesses that can cause upper respiratory symptoms. And although these illnesses may not be pleasant, they may not necessarily require a visit to the doctor or hospital. In most cases, kids can be treated at home.

What are the differences in symptoms between these viruses?
A lot of the symptoms of all three of these respiratory viruses can look very similar to the common cold such as coughing, sneezing, and runny nose.  However, there are some differences in symptoms between each of them:

What OTC medications can I give my child to make them feel better?
OTC treatments for respiratory viruses are aimed at treating the symptoms.

• Fever, body aches and pains, or sore throats can benefit from medications such as acetaminophen or ibuprofen. If either medication is not working by themselves to completely reduce the fevers, the medications can be alternated every 4 hours. If you are unsure about the dose, ask your pharmacist for help. Ibuprofen should not be used in children less than 6 months and acetaminophen in less than 12 weeks of age, unless directed by a physician.
• For runny nose and sneezing, your child may benefit from an antihistamine such as diphenhydramine, chlorpheniramine, loratadine, fexofenadine or cetirizine. Diphenhydramine and chlorpheniramine are given multiple times a day and will likely make kids sleepy. Although some kids, especially young ones, can have a stimulant effect. Diphenhydramine or chlorpheniramine should not be used in children less than 6 years of age without the advice of a doctor. Loratadine, fexofenadine and cetirizine are not as likely to cause sleepiness and are generally given just once (loratadine, cetirizine) or twice a day (fexofenadine). These can be given to children as young as 2 years of age.
• For stuffy noses, you can use saline nasal spray or guaifenesin. Guaifenesin may also be beneficial for chest congestion as it helps thin the mucus making it easier to remove from the body by coughing or blowing the nose. Guaifenesin should not be given to children younger than 2 years of age. Increasing water and fluid intake an also help with this. Decongestants such as pseudoephedrine and phenylephrine should not be used in children younger than 12 years of age.
• For coughs that aren’t productive or are keeping kids up in children over 6 years of age, dextromethorphan is available but has generally been found to not work as well as honey or a mentholated ointment, such as Vick’s Vaporub, on the chest. Honey should not be given in children less than 1 year of age. In children older than 1 year, you can give a teaspoonful at bedtime. The mentholated ointment can be used in children older than 2 years.

Pharmacist's tips for OTC medications:

• For all OTC products, make sure you pick a product appropriate for the age of the kid. Most of these products come in liquids, chewable tablets and tablets or capsules that can be swallowed whole.
• Follow the directions on the packaging very carefully and do not give more or more frequently than indicated. Please be sure to ask your pharmacist if you are not clear on the directions.
• Many OTC combination cold and flu products contain a variety of the ingredients mentioned above. Be careful not to double up on a medicine that may be in several different products. Try to stick to one product and pick a product designed to treat the concerning symptoms only. Some of the drugs in a combination product may not be needed for all kids.

Summary
In many cases, respiratory symptoms caused by viruses can be relieved by the use of OTC medications. Ask your pharmacist to help you select the right medications. They can also answer any questions you may have about administering medications to kids.