Childhood Obesity: What Can We Do?

It’s no secret that children all over the world are putting on too much weight; in the US, an astonishing 1/3 of children are overweight or obese.  Being overweight as a child can lead to many diseases as an adult, including heart disease, diabetes, arthritis, high blood pressure, and some cancers. Also, overweight kids have lower self-esteem and higher risks for depression. So what can parents, or society really do to stop this epidemic? And how can family doctors and pediatricians help?

The first step parents should take is to find out where your child fits on a Body Mass Index (BMI) chart. Your doctor should be doing this at the well-child exams, but you can easily find childhood BMI calculators online (such as this one) and find out yourself. A child above 85% is considered overweight, and above 95% is obese. Many parents are surprised at finding their child is officially overweight or obese, which is why these objective BMI standards are important for tracking, as well as assessing progress.

There are quite a few weight loss approaches that most doctors can agree on; one major agreement is that diets almost never help, at any age. Any diet plan designed for quick weight loss is almost guaranteed to long-term failure, and many people frequently end up even heavier than before. The healthiest option is always slow and steady weight loss. One pound a week of weight loss for many children, from very conscious changes in diet and exercise routines, is appropriate.

Another major approach involves cutting back on TV time. The American Academy of Pediatrics just published a major policy statement stating that “the evidence linking excessive TV viewing and obesity is persuasive“. They specifically recommend a ban on junk- and fast-food advertising in all children’s TV programs, and they set specific limits of TV time for age groups. They also detail multiple studies showing how having a TV in the bedroom is another independent risk factor for obesity, both as a child and later as adults. They also recommended that “pediatricians need to ask 2 questions about media use at every visit: 1. How much screen time is being spent per day? and 2. Is there a TV set or Internet connection in the child’s bedroom?”

One approach I mentioned before was to have a good breakfast. Many studies have shown that eating a nutritious breakfast is crucial for a child’s physical growth and school performance, and that breakfast-skippers actually end up more overweight, both in childhood and later as adults.

Of course, the main treatments for obesity are the obvious: more exercise and eating proper foods in moderate amounts. It’s important that there be a family effort to help your overweight child lose weight. Parents also need to lead by example; it’s much harder for a child to lose weight if their parents are also overweight and don’t exercise. As for diet recommendations, the most obvious choices to eliminate are sodas and fruit drinks. Sodas truly have almost no redeeming value, especially for children. Any child drinking a daily soda is adding extra pounds of fat each year, and they are also increasing their risk for diabetes as well as teeth problems. Most fruit juices are also quite poor substitutes for natural fruits and should be used at a minimum. For exercise, most kids should be getting 60 minutes a day, but this can be broken up into multiple sessions. The key is finding something they love to do. And don’t forget that any exercise is better than nothing!


Another effort involves reviewing the foods at school. I recently heard the great news that milk producers in America reformulated their flavored milk to have 1/3 less sugars and calories. Many (but not all) nutritionists consider this a positive step, as schools that totally eliminated flavored milk encountered a large drop in milk drinking, which raises the risk of kids not getting enough nutrients such as calcium. What does your school do?

Parents who want to learn more about childhood obesity and how to fight it can find excellent resources at the website, which is officially run by the American Academy of Pediatrics. And at, the American Academy of Family Medicine also offers many tips on weight loss for all ages.


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Sleeping Troubles? Maybe This Can Help.

Recently we had National Sleep Awareness Week, so it’s a good time to review healthy sleep habits. I see a lot of adults and teens in my clinic who are chronically tired and have troubles sleeping — both falling asleep and staying asleep.

How Much is Enough?

According to the National Sleep Foundation’s research, here’s the amount of sleep we need:

  • Newborn (0-3 months): 14-17 hours
  • Infant (3-12 months): 12-15 hours
  • Toddler (1-2 years): 11-14 hours
  • Preschool (3-5 years): 10-13 hours
  • School age (6-13 years): 9-11 hours
  • Teenager (14-17 years): 8-10 hours
  • Adult (18-64 years): 7-9 hours
  • Older adult (>65 years): 7-8 hours

One of the main problems with insufficient sleep is the daytime sleepiness, an obvious consequence of not sleeping enough. A fascinating series of tests in children showed that insufficient sleep and daytime sleepiness both lead to worse school performance. Most of these children went to bed at 9-9:30 am and almost all got up at 7 am, causing a daily sleep debt of 1/2-1 hour for many children. While that may seem like a small amount, like any debt, it must be paid back, and most children cannot recover all of this lost time by sleeping late on weekends.

One good bit of news from the same study describes how delaying school start times even by just a half hour can significantly improve sleep duration and daytime sleepiness. In their interventional study with six primary schools in Shanghai, delaying school openings from 7:30 to 8 or 8:30 gave the children almost an hour of extra sleep — and more importantly, less complaints of daytime sleepiness. This fits with studies in other parts of the world and supports the growing movement, led by pediatricians, to delay school opening times to 8:30 am. Just doing this could allow better sleep and improved test scores for all students!

Besides school performance, poor sleep also leads to an increased risk of overweight and obesity in children (as well as adults). A 2007 meta-analysis of 36 studies across the world showed a strong, independent association between short sleep duration and weight gain in children, which continues into adulthood.

For adults,  poor sleep can cause long-term problems with high blood pressure, depression, diabetes and obesity. It can also cause dangers such as sleeping behind the wheel or more errors at work (medical training and internships are notorious for this, as are night shift workers driving home).

My tips for sleeping well

Get all screens out of the bedroom. Technology is changing so quickly that it’s difficult for research to keep up. But it’s clear that many people are having a lot more sleeping troubles when using their iPads and cell phones at bedtime. It’s partly because their backlight alters our sleep hormones, but also it’s distracting us with answering text messages even after lights out. I think a great general rule, for adults and kids, is no screen time two hours before bedtime (that includes TV), and definitely get all screens out of your bedroom while you sleep.

Exercise often — but early. Exercise has been shown to improve sleep habits, but only if done at least four hours before bedtime. Otherwise, you still may have too much metabolic energy and will have trouble falling asleep. This is also a good tip for kids who are having sports practices late into the night.

Avoid alcohol and smoking before sleeping. Alcohol is a major cause of insomnia for many. Drinks will certainly make you sleepy, but your body will rebound and wake you up in the middle of the night. It’s far better to have only a drink or two, at least 2 hours before bedtime. Smoking causes the same problems; that initial relaxation quickly wears off and the nicotine stays in your system for hours.

Caffeine is another major cause of poor sleep. As we get older, we cannot handle the triple-shot cappuccinos which we had in college, and it’s very common to have poor sleep with any caffeine drinking after lunchtime. So if you’re having light sleep, definitely take a look at your caffeine habits first; any tea, sodas or coffee after lunch may be keeping you awake. If you must have your afternoon coffee, at least try to switch to decaf.

Other tips include not staying in bed if you can’t sleep. If you can’t fall asleep, after 20 minutes of trying you should get up and try to relax in another room. Staying longer in bed generally makes you more anxious, making it even harder to fall back asleep.

Take a nap. Napping, even if only 20-30 minutes when needed, has been shown to have great benefit for short term memory and concentration. As I get older, I definitely lag more in the afternoon, and a 15 minute power nap at lunch really helps me get through a busy clinic afternoon (as does a lighter lunch).

What about natural medicines and non-prescription pills? Many people use over the counter pills such as Tylenol PM. It does work well, in the short term, for many people — but I strongly advise not taking it regularly, as the Tylenol component is totally unnecessary and can cause liver problems if taken chronically. If you must use this medicine, please buy only the active ingredient, diphenhydramine (Benadryl) separately and only use that. As for natural medicines, melatonin works for some types of insomnia but is rarely very effective. Others may consider an herbal capsule with valerian and other compounds such as passionflower, hops or lemon balm.


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先介绍一位朋友:美国儿科医生Richard Saint Cyr.中文名字叫“圣西睿智”

可能有的宝妈从微博就知道他的:Richard 是美国的医学博士,专业领域是儿童保健。他从2008年就来到中国,在北京的一家私立儿科医院工作。因为最近“雾霾”持续不断,Richard就在他自己的网站,以一个儿科医生的角度,同时也是在北京生活接近十年的“中国通”的角度,对几款“口罩”和“空气净化器”做了测评和分析。这些分析文章,虽然是一家之言,但可以给宝妈很好的参考。因此我们口袋育儿专门联系了Richard,获得了他的授权发表。


每天都有人在问我哪种口罩更好用,针对这些问题我近期跟3M研究团队进行了一次探讨,谈话非常愉快,他们非常乐于让我试用他们在北京实验室的“口罩密合度测试仪专业版”TSI Portacount Pro+。这是一款正式测试口罩与人的面部密合度的机器,非常广泛地被使用。


某个雾霾严重的日子(常见的AQI危险级别指数150以上),我找来了9个不同的口罩来测试:3个3M款、另外是totobobo、Vogmask威隔、Respro Techno、艾凯贝Honeycomb款、绿盾和外科手术口罩。









测试结果排中间的,即效率在80%-90%之间的,按结果顺序为艾凯贝Honeycomb87%,Respro Techno85%,之后是我第二次测试3M的9001V84%,然后是totobobo的80%。








我也测试了一下那些在中国生活的外国人中常见的口罩,对我而言结果也让人失望,没有一个效率超过90%的——除了威隔口罩,Respro’s Techno的过滤芯是通过欧洲FFP1认证的,意味着有78%的过滤效率,我试戴的效果比这个效率更高些。但是考虑这款口罩的昂贵价格,我还是不会考虑将它列为日常标配,况且我还有6元一个效果缺更好的呢,而且这一款我带上去还很不舒服。总体来说,78%的防护效率在中国是完全不够的,仅仅FFP1认证的口罩是完全不能满足要求的,况且还有很多其他的口罩效率相较好很多。在北京日均雾霾指数90毫克/立方米的空气中,一个FFP1标准的口罩最多让你呼吸到20毫克/立方米的空气,依然没有达到10或以下(相当于健康的AQI值50以下),我的目标值。







我想再次强调我之前曾经说的话:你所需要的全部就是一个优质的过滤器和一个马力强劲的风扇。没错,就是过滤器+风扇。优质的过滤器是最重要的,最好是有官方认证的“高效颗粒物过滤器” (HEPA)—-在美国这意味着对PM0.3有99.97%的过滤效率。欧盟的定义标准比较宽泛,HEPA过滤效率从85%到几乎100%(见后面说明)。PM0.3是指粒径不大于0.3微米的颗粒物,比PM2.5差不多小10倍;这么小的尺寸被认为是对我们人体最危险的,因为它最容易侵入我们的肺,对人体造成最大的伤害。



我们大部分用户,包括我在内,在家庭卧室里使用的高价净化器,也同样是“风扇+过滤器”的应用概念。如果机器始终处于低噪声的速度运行时,那么它们的空气循环量会远小于机器本身推荐的 “洁净空气输出量”(CADR),“洁净空气输出量”(CADR)实际上不过是生产厂家自己做的测试,而不是不是卫生监管机构做的检测。而且,机器开到最大挡位时通常噪声实在太大了,没有人会这样使用,尤其是在卧室里。“洁净空气输出量”(CADR)测试实际上仅仅只是20分钟的运行数据!对于在中国的消费者来说,这完全是不切实际的,因为人们需要机器全天开在静音速度挡位,这样不会妨碍谈话和睡觉。



颗粒物平均清除率(数据源自Smart Air Filters网站实验结果)


八年前,当我第一次来到北京时,市面上净化器种类很少,只有一两个品牌可供选择。可如今,短短的几年时间里,几百个新品牌净化器如潮水般涌入市场。当浏览中国购物网站时,我和你的感觉一样,净化器多得实在是令人眼花缭乱、目不暇接。可是,我们却几乎找不到任何关于对净化器的独立测评(此前我写过一个,本文是另一篇)。我选择测试的机器的顺序条件如下:首先价格要低于1千元;然后是著名国际品牌>中国品牌>配置HEPA过滤器(或品质接近):风扇风量(洁净空气输出量CADR)至少要满足我办公室的需求,即房间容积X 5ACH(每小时空气转换次数),21m3X5=105m3/hr空气量;最后补充一条就是具有过滤甲醛和挥发性有机化合物的能力,但这不是我的首选项。配有单独的预过滤器的净化器是有益的,但千元以下价位却很难买到。按照上述原则,我遴选了以下几种机器进行测试:

  • 聪明空气Smartair DIY经典型:200元;过滤效率:9% PM0.3;CADR(洁净空气输出量): 未知; 服务面积:11-20 m2
  • 瑞士风Air-O-Swiss P320: 699元;过滤效率:97% PM0.3;CADR :86 m3/h, 服务面积:16 m2
  • 松下F-30C3PD-D: 599元;过滤效率:99% PM0.3和89% 甲醛;CADR:163 m3/h, 服务面积:30 m2
  • 飞利浦 AC4025: 699元;过滤效率:2% PM0.3和 95% 甲醛;CADR:127 m3/h
  • 美的 KJ20FE-NH3: 750元;过滤效率:9% PM0.3和 87%甲醛; CADR 204 m3/h, 服务面积20 m2
  • 小米: 899元 (代理商网上售价1,000-1200);过滤效果3% PM0.3和 91% 甲醛;CADR:406 m3/h, 服务面积:48 m2


我的诊所办公室是主要的试验场地,一个舒适的建筑面积为9.6平方米(容积21.3m3)的房间。对于这样的小空间,若使用一个巨大的布鲁雅尔(BlueAir)净化器或类似的大机器不但要花一大笔钱而且要占用宝贵的地面空间;因此我想测试一些较小的机型。我在午休时间测试这些机器,先让室外空气涌入房间后,关上门窗。然后测试它们在最大速度时的性能,我的关键数据采集节点分别在10分钟和50分钟,用我的超值神器—Dylos 1700型颗粒物检测仪来测量PM2.5和PM0.5的浓度下降百分比。在其余的工作时间里,我会把他们设定在标准的更安静的运行模式,并做随机抽查。我办公室的所有测试结果见下面的表格,其要点如下:

  • 所有机器在最大速度下的关键指标都表现不错—-50分钟5去除率范围在88~94%之间. 有的机器达到净化效果的用时更短些,小米的大风扇一发威,只用了10分钟就已经去除了88%PM2.5和PM0.5。据此可以判断,风扇与过滤器同样重要,而且小米的CADR值406m3/h是同类机型竞争者(美的)的两倍。
  • 关于小米的测试过程我需要澄清一点:因为它的最大速度模式只能持续15分钟就自动切换回自动模式,所以很难获得与其它机器进行比较的50分钟对照数据,因为它只有开始的15分钟是开在最大速度。但考虑到它在10分钟内最大速度时的突出表现,可以推断,如果它可以持续开在最大速度,表现应该一样好。
  • 瑞士风(The Air-O-Swiss)320是最小的机型,CADR只有86m3/h,达不到我所需要的105m3/h,数据显示,它的表现还不赖,可能它的350型更有效,但是这个型号超出了我设定千元以下的价位。
  • 松下和飞利浦也都表现很好:只是对我而言,松下刺眼的橙色外观太不专业了。飞利浦的绿色尚可,特别是在儿童房,但也不是最理想的。
  • 美的的黑白造型很漂亮,我可以大大方方地在办公室摆出炫一下。它的块头尺寸和风扇速度都较大,这一点在良好的测试结果尤其是在对付5方面得到了证实。
  • 聪明空气(The Smartair)DIY经典型:200元DIY的过滤器+风扇,表现至少和比它贵的整机一样好,它的瑕疵是对付5的显得有些力不从心。虽然它外观长相看起来不够专业漂亮,但对我来说使用还是可以的。尤其是对于学生或是低收入者来说,用它总比什么都不用要好得太多(见我先前的文章)。
  • 所有机器在最大速度下的噪声都无法忍受一整天,但在比较安静的运行模式下,在办公室里面感觉都还好。



Xiaomi, meet Blueair

我卧室里一直是用大机器,一台布鲁雅尔(Blueair)503和一台IQAir Pro150。我想现在是用又便宜又小的机型挑战它们的最佳时机(和去年飞利浦机型测试类似)。这次测试与之前的测试不同之处在于:之前一直是测试比对室内和室外的空气;这次,我想看看它们超过8小时过滤效率效果。就是在整个房间充满污染颗粒物后,关闭门窗,自动连续监测。把精油置入蒸发器—­­这家伙可以使房间的空气污染指标快速提升到骇人的水平。另一项测试是记录最终一小时的数据,观察在大部分时间里它们是否能使我室内的空气质量处于安全值内。




  • 8小时标志时间净化效果,大部分机器表现很好。对于5,布鲁雅尔(Blueair)过滤效率达到99.9%,小米在睡眠模式下的过滤效率达到99.8%,与之非常接近,其他大部分机器在98%~99%之间。对于更小的颗粒物PM0.5,布鲁雅尔(Blueair)过滤效率达到99.9%,接下来是飞利浦的99.6%和小米的99.5%。
  • 1小时短时净化效果,因其巨大的风扇所赐,奥郎格(Airgle)的表现令人非常满意,净化能力大于房间所需。然而,预算内的机器如小米在自动运行模式和美的在低速运行状态下,表现也毫不逊色。(小米在自动运行模式下更省电,在提高速度对付更细微的颗粒物时噪声稍大,会有短时吵人的感觉;而美的在低速运行时,对于睡觉来说,噪声就太大了,还好,静音睡眠模式的过滤性能表现也非常不错。)
  • 另一个有用的评价标准是最后一小时的检测数据(每立方英尺颗粒物浓度/ 100):我的目标值是5保持在50以下(Dylos检测仪检测数据),这大约相当于10μg/m3(或空气质量指数AQI<50)。好消息是,每台机器的最终结果都远低于50,其中包括两种便宜的型号。对于很难控制的更小的颗粒物PM0.5,我不太清楚目标值,但来自我的环境测试公司(Environment Assumed)的查利.汤普森认为:Dylos检测仪检测PM0.5在1000以下基本等同于空气质量指数<50)。按此计算,无论是飞利浦和布鲁雅尔(Blueair)确实做的最好,其次是美的,小米第三。更令人惊讶的是奥郎格(airgle)和爱客(IQAir),这样的大牌机器却有超过1000的数据记录。
  • 整体性能,所有三个较便宜的机器用优异的表现证明了自己,即使与大牌机器比较,他们的性能也没有明显的劣势。美的展现了令人印象深刻的数据(即使在非常安静的睡眠模式)。小米也表现很好,在自动模式下,不论是长时间净化还是短时净化,效果都非常好。从非常低的最后一小时检测数据上看,飞利浦也表现很好(但测试当晚室外空气质量也很好,可能有助得出较低的数据)。对于三个昂贵的大牌机器,理论上应当胜过便宜的竞争对手,但只有布鲁雅尔(Blueair)的表现显得鹤立鸡群,5和PM0.5两种颗粒的检测数据都是最低的。

空气净化器净化测试结果—卧室(40m3). *Dylos测试仪检测PM2.5<50,PM0.5<1,000为目标值,检测数据每立方英尺颗粒物/100




我必须再谈一谈关于小米空气净化器,虽然它仅上市三个月,但很可能颠覆整个行业—-因其新颖的设计和令人难以置信的价格。小米有一个很酷的功能是其他所有的机器所不具备的,就是小米的APP应用;小米的机器有内置WiFi,可以链接到智能手机的APP应用,用户可以通过手机控制机器的速度以及获得室内对比室外的空气污染实时数据(中国环保部每小时的数据)。这个APP 应用甚至能发送手机短信告诉你“室外空气现在比室内空气清洁,该打开窗户透透气啦”!它也能为你实时计算出过滤器的剩余使用寿命。这真是超酷的功能,虽然这有点炒作的噱头,但这却是我第一次体验了“互联智能家居”的概念,WiFi互联化的家电,我亲身体验到了这些数据的价值。







2017-01-09 Richard Saint Cyr 口袋育儿). 文章来源:


This post was originally republished on my new Chinese-only blog at (please also follow my Facebook page) .

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It was only last August that we left Beijing and moved back to the USA, here on lovely Bainbridge Island next to Seattle. The transition has been difficult at times yet still very welcome, and I’m finally starting to develop a good pattern again — including wellness writing. So I hope you all can switch to my new blog, at  My articles will be there first, and I’ll slowly be turning the lights down on this website. If you want my new articles directly sent to your email, just click here and sign up. I also have a new wellness Facebook page here which I will update often.

Here are the new articles I’ve already posted there:



My boys are now both over two years old, but they still like the occasional chew on their toys, which are mostly made of plastic. Rubber duckies, Lego men, Brio trains — it’s still a ton of fun to put in their mouths if it makes mommy and daddy really mad.…


Did you know that the U.S. Center for Disease Control predicts that one third of all Americans will have diabetes by the year 2050? This scary statistic is not just an American phenomenon; many Western countries’ modernized diets have led to a diabetes epidemic.…


This week, March 6 – 13, is National Sleep Awareness Week, so it’s a good time to review healthy sleep habits. I see a lot of adults and teens in my clinic who are chronically tired and have troubles sleeping — both falling asleep and staying asleep.…

Curing a Cough: What’s the Best Medicine?

Coughing from a cold or flu is probably the most frustrating symptom we can have — for children, their parents, and even the doctor treating them. Why? Because there’s honestly very little that we can do to treat it. That’s a hard pill to swallow, and it’s especially humbling for me as a family physician. But it’s also very frustrating for me as a father of two toddlers, as they just started daycare and are fighting new viruses every week. As we comfort them at two in the morning with a hacking cough, I’ll face same question from my wife as from parents in my clinic: “which cough syrup should we use?

First, it’s important to note that a cough is generally a good thing. It’s our body’s natural attempt to get germs and toxins out of our bodies, so it’s not such a healthy idea to suppress the cough too much. Of course, a cough can become too severe, or painful, and lack of sleep isn’t good for anyone’s immune system. So in terms of that, I think it’s reasonable to try something safe. But it’s clear that no matter what you use, nothing makes a cough completely go away for more than a couple of hours. And it’s also important to note from the graph below that the cough is always the last symptom to get better, and may linger even for a couple of weeks:

a graphical image and time line for cold symptoms

Having said that, I’d like to help you cut through the confusion at your pharmacy and make this simple: don’t bother with almost any of the OTC cough syrups. First, try some honey.

Your pharmacy shelves have a bewildering assortment of cough and cold medicines. It’s confusing for me as well, even with my training! Overdosing is quite a problem, especially for children. In fact, drug makers in 2008 voluntarily changed their warning labels (with a gentle push from the FDA), pulling off the shelves all cough medicines used for children under two years old, and changing warning labels to say “do not use in children under 4 years of age” (you can read the FDA statement here). The American Academy of Pediatrics is even more strict: no OTC cough medicines for any child under 6 years old, and caution from ages 6 to 12. The major concern has been the number of overdoses, even deaths, in children taking too much of these medicines — especially acetaminophen, otherwise known as Tylenol, which is added for pain and fever relief. In a proper dose it works wonderfully, but in high doses it causes liver failure.

Not only are these medicines potentially dangerous, they also barely work anyway. For example, the decongestant phenylephrine, which is now in almost every combination medicine, is no better than placebo in the best research results. In other words, there’s a good reason your runny nose isn’t getting better — it’s because the medicine doesn’t work. This medicine a couple of years ago replaced the far more effective drug pseudoephedrine — but this is now only behind the pharmacy counter, because people were buying pseudoephedrine-containing pills in bulk and cooking it down to make methamphetamine. So if you really want sinus relief, you have to ask the pharmacist for pseudoephedrine. It’s still OTC, so you don’t need a prescription from your doctor, but you’re only allowed two boxes.

The bright side to all this is that the most useful cough syrup may be in your home right now. It’s honey! A Cochrane database review from 2014 showed that honey helped better than dextromethorphan and also diphenhydramine for cough frequency, severity and quality of sleep, for children and their parents, with minimal side effects.

My advice for a cough in different age groups is as follows:

Age one and under: no OTC syrups are safe, including honey, which carries the risk of botulism. The best advice is to take care of the cause of the cough, often from post-nasal drip, by using nasal saline drops or spray. A bedroom humidifier can also help if the room is too dry, especially in cold winter nights. Probiotics also can be helpful, as a growing number of studies are showing their effectiveness in reducing duration of a cold, less severe symptoms, and less time away from school or work. The best research is on bifidobacteria and Lactobacillus GG probiotics. Also, don’t forget to get the annual flu shot for any child over 6 months of age. If they’re younger, they’re vulnerable to get the flu — which is why it’s even more important that all caretakers and family members get the annual flu shot, so they won’t pass along the flu virus to the baby. Coughing can also cause pain from a sore throat or rib inflammation, so if your baby is fussy but has no fever, they may be in pain, so don’t be afraid to give them ibuprofen or acetaminophen syrups for comfort (and better sleep).

Ages 1-6: I think honey or honey-based herbal mixtures (not homeopathic) should be the first choice for a cough. Probiotics should also be used during the illness. Taking care of nasal congestion often can help decrease a cough, again including the safe remedy of nasal saline rinsing. As a second choice of syrups, a cough syrup containing only dextromethorphan could also help a bit, as was shown in that Cochrane review from 2014. This medicine is the “DM” part of many labels.

Ages 6-12: Again, honey-based syrup is not only the most effective but also the safest choice. At this age, the risk-benefit ratio of other treatments becomes more favorable, including my favorite nasal decongestant combination: pseudoephedrine pills and oxymetazoline nasal spray. Probiotics during the illness also are helpful. But don’t forget that many doctors would still be hesitant to recommend any OTC medicines until 12 years of age. Also, while the oxymetazoline nasal spray works rapidly for nasal congestion, never take it for more than 5 days in a row, otherwise you can develop rebound nasal congestion and could become dependent on it (we call it “Afrin addiction”).

Ages 12 and up: We’re finally at the “adult” age where most OTC medicines at least are safe to use, whether or not they’re effective. I would still stick with honey syrup, and the decongestants as I mentioned above. Again, don’t forget about probiotics. Also, don’t forget about common sense items such as a healthy amount of sleep, as well as foods full of antioxidants, and light exercise to boost your immune system. In terms of natural medicines, elderberry syrup has some evidence to help decrease symptoms of the flu.

Ages 65 and older: Here we start getting cautious again with OTC medicines, as many might have unwanted side effect combinations with the prescribed medicines for chronic diseases that many elderly people take. As we get older, we can’t fight off infections as well as we could when younger. So it’s important not to get sick in the first place — with the annual flu vaccine, as well as the pneumonia vaccines. If you do get a cold, some OTC medicines may cause more side effects in the elderly, such as dangerously high blood pressure from pseudoephedrine, or confusion, urinary retention and lethargy from diphenhydramine. I would focus on honey or dextromethorphan syrups, and nasal saline spray for a decongestant.

Which OTC medicines don’t work at all, at any age? I would advise not to use any homeopathic remedies, such as Oscillococcinum or Zicam, which may seem appealing to many but literally have no evidence of effectiveness, as you would expect from a product which by definition has zero molecules of any active drug. The FTC recently issued an enforcement requiring homeopathic labels to state ” (1) There is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.” And it’s also dangerous to assume that homeopathic medicines are safer, as noted by this winter’s warnings by the FDA against homeopathic teething tablets, which tests show may have toxic amounts of belladonna, and which could be related to ten deaths of infants. Clearly this is a case where the risks far outweigh benefits.

For more information about treating the common cold, you can read my family practice academy’s parent handout about treating the common cold in children ; and more articles about the common cold at my wellness blog at MyFamily Health Guide.

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A family doctor's wellness guide for China