Daily Dose of DrGreene

Seawater, With a Grain of Salt

Washing the nasal passages with a saline solution is better than OTC cold meds both at treating and preventing common colds, according to a study published in the January 2008 Archives of Otolaryngology-Head and Neck Surgery. After describing this study, I’ll also discuss briefly the concern I’ve been asked about regarding preservatives in some saline solutions. This study included over 400 children of elementary school age who were randomly assigned to get either standard OTC meds or standard OTC meds plus a nasal wash. They were followed when they caught a cold, and for the rest of the winter. The saline wash, in this study, was processed from Atlantic Ocean seawater, so it had more minerals in it than just salt. At the beginning of the study, children in the two groups had, on average, similar scores on nasal secretion amount and type, nasal obstruction, sore throat, cough, expectoration, sneezing, itching, and loss of taste or smell. At the first follow-up, the children who received the nasal wash had significantly less nasal secretion, clearer nasal secretion when present, less nasal obstruction, and were less likely to have a sore throat. They had also been less likely to take oral decongestant medications, even though they were available to both groups. There were few complaints from the kids about the wash. Continuing to use the wash resulted in fewer colds, fewer missed school days, and less use of medication for the rest of the winter.

This study relied on people’s reporting of cold symptoms rather than on objective observation. And the people in the study knew which children were getting the wash and which were not, which could introduce subtle bias. These factors raise questions about the results. But the results were consistent across eight different pediatric clinics. They were also consistent with the results of a 2007 objective analysis of eight other clinical trials which concluded that topical nasal saline improves the symptoms of chronic congestion and chronic sinusitis, whether used alone or in combination with other remedies.

A number of parents have asked me recently about the preservative benzalkonium chloride found in some saline solutions. There have been recent placebo controlled prospective studies suggestion a link between ongoing chemical preservative intake and hyperactivity -- but the amount in short-term saline drop use is tiny compared to what most kids get in the diet. More to the point, though, in some people benzalkonium has been linked to rhinitis medicamentosum -- a stuffy nose from the medicine. It's been implicated as a possible cause of the rebound congestion from people using nasal decongestant sprays for more than 3-5 days. Other studies suggest that the chemical damages the lining of the nose. There have been at least 18 studies on the safety of this ingredient, with inconclusive results.

For most children, I don't think this a big deal, but why use it if you don't need to? You don't even need to make your own saline solution or go to a natural products store. With my last cold, I picked up a product called Baby Simple Saline at a national drug store chain. It’s preservative free, creates a pleasant gentle mist, and comes in a container that can stay sterile after opening without a preservative.

Alan Greene MD FAAP

Halloween Tricks!

And the award for the best costume goes to… Halloween candy! When you look at familiar wrappers that remind you of the days when you were emptying out your own trick-or-treat bag and dividing up your loot with glee, those wrappers may mask some big changes that have happened to the candy inside.  Chances are that when you were a kid, your favorites weren’t made with genetically modified, partially hydrogenated (trans) fats or with high fructose corn syrup. In fact, many of the foods our kids eat today may look like the foods we ate as kids, but contain cheaper, chemical ingredients. Thankfully, there are lots of bars and other candies that are made without these cheap substitutes and with real food ingredients that your kids will love – including a few from the major manufactures. If we choose to let our kids enjoy the great annual candy binge, let’s let the treats they love and remember include high quality real candy. Because childhood is also different today than when we were kids…. Middle aged conditions such as high blood pressure, abnormal cholesterol, abnormal blood glucose, and waist size over 40 inches were very uncommon in kids just twenty years ago. Today, one large study found that two thirds of American high school students already have at least one of these conditions! And, what we used to call adult onset diabetes is now the most common form of diabetes as early as elementary school. I’m a high quality chocolate fan. When we hit the intersection of treats loved by kids, without the cheap substitution tricks, we all win.

What your take on trick or treating?

Alan Greene MD FAAP