Aromatic cold salves may not be safe for babies

Vicks VapoRub and other salves with menthol, camphor and eucalyptus oil have become the latest over-the-counter remedies that experts warn against using to treat young children.

"What may work for adults may be different for small children with small airways," said Bruce Rubin, MD, professor and vice chair for research in the Dept. of Pediatrics at Wake Forest University School of Medicine in Winston-Salem, N.C. "Try love and hugs, some warm drinks, read them a story. Love has tremendous healing powers, especially for little kids."

In recent years, concern has grown regarding this age group and the use of OTC antitussives, expectorants, nasal decongestants, antihistamines, and various combination cough and cold remedies. The Food and Drug Administration has held meetings on the subject, and the Consumer Healthcare Products Assn. announced Oct. 7, 2008, that its members would label these products to advise against using them for children younger than 4.

This more recent caution about aromatic rubs came in response to a study in the January issue of Chest (link). It reported the experience of Dr. Rubin and other physicians at Wake Forest who cared for an 18-month-old girl in respiratory distress after her grandmother had placed Vicks VapoRub under her nose. Researchers then tested the possible link between the product and the girl's situation by using it on 15 ferrets. The animals, which have comparable respiratory systems to humans, went on to experience increased mucus production and symptoms similar to this child.

"The ingredients in Vicks can be irritants, causing the body to produce more mucus to protect the airway," Dr. Rubin said. "Infants and young children have airways that are much narrower than those of adults, so any increase in mucus or inflammation can narrow them more severely."

The product's label warns that it is not to be used on those younger than 2, nor is it to be placed in the nostrils. Procter & Gamble, the manufacturer, responded that Vicks VapoRub is safe when used as directed and that animal studies may not be applicable to humans. "Vicks VapoRub has a long-standing history of being safe and effective when used according to package directions," read the statement. "The article in Chest describes animal studies prompted by a single case report. The animal findings are of unknown human clinical relevance. The safety and efficacy of Vicks VapoRub has been demonstrated in multiple human clinical trials."

The authors of the Chest paper also advocate that if parents feel a child is sick enough to need a medication they should be taken to a physician.