Treatments for cough and common cold in children
BMJ 2024; 384 doi: https://doi.org/10.1136/bmj-2023-075306 (Published 25 January 2024) Cite this as: BMJ 2024;384:e075306
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Dear Editor,
This is a helpful practice pointer for us as it outlines the evidence on all the common over-the-counter remedies our patients normally use. From our experience in primary care, we’ve seen a high level of parental concern over coughs and colds, making up a significant portion of appointments during winter.
Parents often cite the persistence of symptoms and the lack of efficacy of over-the-counter measures as the reason for the appointment. It can be challenging to provide reassurances about the course of illness in the absence of a treatment that significantly accelerates recovery. Many parents we’ve seen have been from deprived population groups or are known to have poorer familial support. Perhaps these factors contribute to a lower level of confidence and a higher level of uncertainty about managing minor illnesses in children.
We wonder if a greater emphasis on disseminating the information within this article would reduce this appointment burden, particularly in areas with higher levels of health inequality.
Competing interests: No competing interests
Misleading statements about vitamin C and the common cold in article on treatments for common cold in children
Dear Editor
Gill et al. reviewed common cold treatments for children [1]. In Table 2 they refer to our Cochrane review on vitamin C and the common cold [2] and state the summary of evidence as “No consistent effect [of vitamin C] on the duration or severity of colds”. The topic is not discussed any further in the text section.
In fact, in our Cochrane review we calculated that in placebo-controlled trials, regular >0.2 g/day vitamin C shortened the duration of colds in children by 14.2% (7.3 to 21%; P = 0.00005); Analysis 2.1.2 (Trials with children) [2]. Furthermore, our calculation is based on 14 comparisons, whereas Gill states in their table that the number of vitamin C studies in our review on was 7. Thus, in contrast to Gill’s statement, our meta-analysis found that there is a consistent beneficial effect of regular vitamin C administration on common cold duration in children.
Recently we extended the analysis of vitamin C on the severity of colds [3]. We did not separate children into a category of their own; however, six comparisons with children contributed to the analysis. On average common cold severity was reduced by 15% (P = 10exp[-6]). The largest of the child trials was carried out in Sweden, with Ludvigsson et al. reporting that “absence from school” during common cold episodes was reduced in the vitamin C group by 18% (1 to 33%) [3,4].
The above findings are a result of regular vitamin C supplementation, which means administering the vitamin, for example, over the winter. There are no therapeutic trials on children, in which vitamin C is started after the onset of symptoms. Nevertheless, given the high frequency of colds in young children, regular administration of a cheap and safe vitamin may be reasonable in some situations, though therapeutic trials should be encouraged.
Long-term prejudices against vitamin C have been demonstrated [5]. Evidence has shown unambiguously that, in certain contexts, vitamin C is effective against the common cold. However, in mainstream medicine, the views on vitamin C and infections have been determined by eminence-based medicine rather than evidence-based medicine. We demonstrated significant bias in many influential papers on vitamin C. We also showed that many of these papers have been uncritically cited in textbooks and reviews, assuming that they are scientifically valid, when in fact many of them have serious flaws. Thus, prominent authors have referred to the papers without undertaking any critical appraisal themselves [5]. In line with such previous problems, we are concerned that Gill et al. dismissed the strong positive findings about vitamin C.
1. Gill PJ, Onakpoya IJ, Buchanan F, Birnie KA, Van den Bruel A. Treatments for cough and common cold in children. BMJ. 2024;384:e075306. https://doi.org/10.1136/bmj-2023-075306
2. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev 2013;2013:CD000980. https://doi.org/10.1002/14651858.cd000980.pub4
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8078152
3. Hemilä H, Chalker E. Vitamin C reduces the severity of common colds: a meta-analysis. BMC Public Health. 2023;23(1):2468. https://doi.org/10.1186/s12889-023-17229-8
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc10712193
4. Ludvigsson J, Hansson LO, Tibbling G. Vitamin C as a preventive medicine against common colds in children. Scand J Infect Dis. 1977;9:91–8. https://doi.org/10.3109/inf.1977.9.issue-2.07
https://pubmed.ncbi.nlm.nih.gov/897573
5. Hemilä H, Chalker E. Bias against vitamin C in mainstream medicine: examples from trials of vitamin C for infections. Life (Basel). 2022;12(1):62. https://doi.org/10.3390/life12010062
https://www.ncbi.nlm.nih.gov/pmc/articles/pmc8779885
Competing interests: No competing interests