Jan. 21, 2008 -- Seeking a remedy for your child's head cold? Rather than reaching for pills, you might want to take a less common, and more effective, approach — shooting a jet of salt water up his or her nose might do the trick, according to a new study.
This may sound strange to many who have relied on more traditional medical cabinet staples, such as decongestants, to offer relief for cold and flu symptoms. Yet, in light of recent concerns on the safety of cough and cold medicines for children, treating stuffy noses with a saline wash could represent a drug-free, potentially effective approach.
The study by Czech researchers, to be published in the Journal of the American Medical Association, looked at 401 kids between 6 and 10 years old who suffered from cold or flu symptoms. While some received standard cough and cold medication alone, others got that, plus a saline nasal wash made from processed sea water. Investigators observed the participants during four visits over 12 weeks to assess the results.
Children assigned to the saline nasal wash group used the nasal wash six times per day during the first two to three weeks, and three times per day during the rest of the study period.
What researchers found was that, by their second doctor's visit, children using the saline nasal wash had less stuffy noses.
And by the eighth week of the study, these children also had significantly less severe sore throats, coughs, and nasal congestion than those who received only standard cough and cold medication.
"The study results show that saline nasal wash significantly improved nasal symptoms in the common cold in children, and shows potential to prevent the recurrence of upper respiratory tract infections," wrote Dr. Ivo Slapak, lead study investigator, and professor of pediatric otorhinolaryngology at the Teaching Hospital of Brno in the Czech Republic.
Relief ... and Results?
In addition to evaluating how efficient the saline wash was in treating children's colds, researchers also sought to evaluate the potential of the wash to prevent future upper respiratory tract infections. So, they looked at the recurrence rate of cold and flu, use of medication, number of sick days taken off from school, and reported days of illness for each child.
Children who received the saline wash had fewer reported recurrences of illness, lower school absences, and less complications, overall, than those treated only with standard medication.
Moreover, they found that, while 33 percent of children — in the group receiving only standard medication — reported using fever-reducing drugs, only 9 percent in the saline wash group required these drugs.
Similar patterns were seen with other common cold medications; only 5 percent of the saline wash group resorted to nasal decongestants, compared with 47 percent of their standard treatment counterparts. Just 10 percent of the saline wash kids needed mucus-dissolving medications, compared with 37 percent of those on standard treatment, and only 6 percent of kids getting the saline wash received antibiotics, compared with 21 percent of the children in the control group.
Sidestepping Side Effects
But beyond the proven efficacy of nasal saline washes, many doctors were encouraged by the study's finding that the saline washes had no significant adverse effects.
With the U.S. Food and Drug Administration's recent decision that cough and cold medications are unsafe for children under the age of 2, many doctors were happy to hear of a safe treatment alternative to standard medication for young, stuffy-nosed children.
According to Dr. Anne Moscona, professor of pediatrics, microbiology and immunology at the New York Weill Cornell Medical Center, and New York Presbyterian Hospital, any safe alternative to the standard cough and cold medications for children is good news for parents.
"I've never recommended over-the-counter cough and cold medications for use by children, and there's never been evidence that they help kids with cough and cold," Moscona said. "In fact, many studies have suggested they don't do any good.
"So, if anything, here's a simple remedy that has no risk, that is not only good, but intrinsically better than over-the-counter cough and cold medications. I would suggest my patients choose this approach."
However, doctors remain unsure of exactly how the washes help treat, and further prevent, upper respiratory tract infections.
The saline washes are believed to help treat infections by clearing out the nasal passages, thereby reducing the amount of inflammatory compounds in the respiratory system, Slapak noted.
Despite the uncertainty about how the nasal saline wash works to treat cold and flu symptoms, many doctors already recommend that their patients try this treatment before reaching for traditional cough and cold medications.
"I would encourage parents to use this method, and have long advised the use of saline spray in kids," said Dr. Marvin Fried, president of the American Rhinologic Society, and chairman of the Department of Otorhinolaryngology at Montefiore Medical Center in New York City.
"I have long used normal nasal saline in the pre- and post-operative care of patients with sinus disease, and have found it beneficial ... This is a very safe method of caring for children that avoids the issue with medications. It takes more 'work' than popping a pill, however."
Effective, But Less Convenient
Because the nasal saline wash requires more time and energy than simply downing a dose of cough and cold medication, some doctors have concerns about the capability of saline nasal washes to replace standard cough and cold medications as the go-to treatment for children with colds.
Although Slapak noted in the study's results that "overall, saline nasal wash was well tolerated," many doctors remain skeptical of patients adhering to a treatment plan which requires three to six washes per day.
Dr. William Schaffner, professor and chair of the department of preventive medicine at Vanderbilt University in Nashville, Tenn., believes the saline treatment solution might be too cumbersome for many parents to manage.
"I am puzzled [by] how they were able to perform nasal washes six times a day on kids [in the study]," Schaffner said. "Thus, the exact method — including [using the saline wash] three times a day as a preventive activity — does not sound practical. A warm shower twice a day would provide some of the same benefits."
Moreover, some doctors noted that children and young adults will have trouble complying to the treatment, in the absence of supervision by a doctor or parent.
"With children, compliance is an issue, because it usually requires adult supervision," said Dr. Peter Catalano, chair of otolaryngology at the Lahey Clinic in Burlington, Mass.
"The same can be said of teens and college-aged young adults," he added. "This group wants a maintenance-free nose, and while the treatment outlined in the paper is very effective, they are either embarrassed to do it, or have 'busy' schedules."
Still, many doctors hope this study will help convince parents to seek alternative remedies for their children's colds.
"A lot of times, parents choose to give their children cough and cold medications, because they want to do something for their kids when they're sick, and they think that's all they can do," Moscona explained.
"But if they knew this [saline nasal wash] can work better than the cough and cold medications, maybe we can get people to switch."