Cold rubs may endanger young children: Study

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Cold rubs used by generations of parents for stuffy noses and coughs potentially could lead to respiratory distress in infants and in small children, according to a newly released study.

It's the warning coming from doctors who treated an 18 month old who arrived in an emergency room struggling to breathe after Vicks VapoRub was put directly under her nose.
Vicks VapoRub is not recommended for direct application in the nostril, and is not recommend for children under two years of age, this advice is sometimes ignored, researchers report.



"She was ill way out of proportion to having a respiratory virus," says Dr. Bruce Rubin, an Edmonton native and the study's lead author from the department of pediatrics at Wake Forest University School of Medicine in North Carolina.

The baby was wheezing; she had low oxygen, and her skin was pulling in and out between her ribs with each breath.

She recovered and was sent home the next day, but the researchers decided to test in ferrets - which have airways similar to humans - the cold rub's effects on the respiratory system.

They found it stimulated mucus secretion and buildup, which could narrow already tiny airways in children.

"Although VVR (Vicks VapoRub) is not recommended for direct application in the nostril, and is not recommend for children under two years of age, this advice is sometimes ignored," the researchers report.

"I think the body sees it as a local inflammatory response," Rubin says. "It worsens any inflammation that's underway already, and that leads to more mucus, more plugging, more inflammation."

The researchers have seen two other young children in the emergency department since they began routinely asking about the use of Vicks in young children with acute respiratory distress.

"I recommend never putting Vicks in, or under the nose of anybody - adult or child," Rubin says.

The product's label says to consult a doctor before using in a child under age two, and that the ointment should never be placed in the nostrils, mouth or eyes.

A spokesman for Procter & Gamble, makers of Vicks, says the new study is "inconsistent with what we know about Vicks VapoRub."

David Bernens said the company has done multiple studies involving over 1,000 children, from one month olds to 12 year olds. "Those studies all demonstrated safety and efficacy of Vicks VapoRub."

"We see about three adverse events per one million units sold," Bernens said. Most of those involve the ointment getting into someone's eye, or causing redness of the skin. "We're not seeing it (the findings from the new study) in our safety surveillance data."

The active ingredients in Vicks are camphor, menthol and eucalyptus. Although the study tested only Vicks VapoRub, Rubin says similar products could cause the same reaction in infants and in babies.

The study appears in this month's issue of the journal, CHEST.

Canadian pediatricians have warned parents in the past that chest rubs and other cough and cold remedies containing camphor and eucalyptus oils can harm children if accidentally swallowed.

Vicks is widely used to relieve symptoms of colds and congestion "but there are few data supporting a clinical benefit," the researchers say.

Rubin says the menthol in cold rubs fool the brain by triggering cold receptors that produce a cooling sensation, making the brain think there's increased airflow.

The researchers did two animal experiments: first, in a lab dish, they exposed lung tissue to Vicks and measured the production of mucus and changes in the cilia - microscopic, hairlike structures that sweep mucus out of the airways.

Then they performed the same experiment in a live animal.

They detected "small but potentially clinically significant changes" in mucus secretion and clearance when the animals inhaled the vapours.

The most dramatic results came when the tissue was exposed outside the body to higher concentrations of the cold rub than an infant normally would be exposed to.

One case doesn't prove cause and effect, cautions Dr. Gideon Koren, a pediatrician, pharmacologist and toxicologist at Toronto's Hospital for Sick Children. As well, the researchers say they don't know to what extent the results they saw in the ferrets explain the problems experienced "by some, but certainly not all infants" who have Vicks placed in their nose.

"But what this study shows, in a laboratory condition, is that this product or mixture can produce the changes that may lead to respiratory problems," Koren says.

"The first rule must be, if you give something to a child you have to know that it works. If you don't know, there's no reason to put it on them," Koren says.

Any cases of a child having trouble breathing should be treated as a medical emergency and the child should see a doctor. It could be something more severe, such as asthma or pneumonia.

"If a child isn't so sick, give him love, give him chicken soup, and give him some time," Rubin says.