你知道非處方感冒藥的年齡忌諱嗎?大綱

Despite safety warnings not to give sick toddlers cough and cold medications, almost half of parents in a recent survey are using the over-the-counter products anyway.

儘管專家警告稱給幼兒服用止咳和感冒藥不安全，但近期一項調查顯示，仍有近半數的美國家長在使用這些非處方產品。

A poll released last month by researchers at the University of Michigan found that 42% of parents with children under the age of 4 gave them cough medicine, and 44% said they used multi-symptom cough and cold medications. A quarter of the parents said they used decongestants. The survey, which echoed some earlier studies' findings, arrives five years after the drugs' packages started including directions warning against their use in very young children.

密歇根大學(University of Michigan)的研究人員上月發佈的一項調查結果顯示，42%的家長給四歲以下的孩子服用止咳藥，44%的家長稱，他們使用止咳和抗感冒的多療效藥，四分之一的家長稱他們使用解充血藥。此項調查（與早些時候一些研究的結果一致）是在這類藥品的包裝上開始標註低齡兒童慎用說明的五年之後展開的。

Matthew Davis, a University of Michigan pediatrician who directed the survey, said he was surprised and concerned by the findings, which may show that parents aren't aware of the labeling and the history of worries about the drugs' use in young children. 'If you're a parent who doesn't know the story, you're going to think this [medicine] is for your kids,' he says.

主持此項調查的密歇根大學兒科醫生戴維斯(Matthew Davis)說，他對調查結果感到驚訝和憂慮。這一結果可能顯示出，家長並不瞭解藥品標籤信息以及以往幼兒用藥中出現的問題。他說：“作爲家長，如果你不瞭解情況，你就會認爲這種（藥物）適合給你的孩子用。”

The medications came under close scrutiny in 2008, when the Food and Drug Administration advised that they shouldn't be given to children under 2. That came after an agency advisory committee the previous year said children younger than 6 shouldn't take the medications. The panel concluded there wasn't evidence that the drugs helped young children, while FDA safety officials had suggested some of the drugs were associated with side effects and some deaths, mostly in very young patients and often involving overdoses.

這些藥品2008年開始受到嚴格審視，當時美國食品和藥物管理局(Food and Drug Administration, 簡稱FDA)建議，兩歲以下兒童不應該服用這些藥物。在此之前一年，該機構一個顧問委員會稱，六歲以下兒童不應該服用這些藥物。該委員會認爲，沒有證據顯示這些藥對幼兒有效，而FDA藥品安全官員曾表示，其中一些藥物可能有副作用，並與部分死亡事故存在關聯，這些情況主要發生在年紀很小的患者身上，而且通常是過量服用。

Manufacturers agreed to put warnings on the products' boxes that they shouldn't be given to children under 4 years old. These appear today on medications that include dextromethorphan, a cough suppressant, the expectorant guaifenesin and the decongestants phenylephrine and pseudoephedrine. Medications with antihistamines warn against use in kids younger than 6. The children's cough and cold products are sold under brand names including Novartis AG's Triaminic and Pfizer Inc.'s Dimetapp and Robitussin.

製藥公司同意在藥品包裝盒上標註四歲以下兒童禁用的警告。如今，鎮咳藥右美沙芬、祛痰藥愈創甘油醚以及解充血藥苯福林和僞麻黃礆的包裝盒上就標註了警告。含有抗組織胺的藥物對六歲以下兒童禁用。針對兒童的止咳和感冒藥包括諾華製藥公司(Novartis AG)的Triaminic以及輝瑞製藥有限公司(Pfizer Inc.)的Dimetapp和Robitussi。

The Consumer Healthcare Products Association, which represents makers of the over-the-counter medications, says research it sponsors shows the rate of safety issues with the drugs has been dropping. Most cases involve children taking them without parental supervision, it says. The 'drug facts' summary panel, often found on the back of a medication box, which includes dosing and other information, is the best place for the age warnings, rather than breaking them out on the front of the package, said David Spangler, a senior vice president with the association.

代表非處方藥生產商的美國消費者保健用品協會(Consumer Healthcare Products Association)稱，該協會贊助的研究顯示，這些藥品安全問題的發生率已經有所下降。該行業協會稱，多數問題都與兒童在無父母監督時服藥有關。該協會高級副總裁斯潘格勒(David Spangler)表示，年齡警告最好寫在“藥品說明”總結欄內（通常在藥盒背面，其中有劑量和其他信息），而不要單獨寫在包裝盒正面。

The association has sponsored a campaign to alert parents on how best to use the medications, including public-service announcements, social-media efforts and brochures for family physicians to distribute to parents. Representatives of the industry group also said it can be challenging to design, and enroll participants for, studies testing medicines for children's colds.

該協會贊助了一項通過公益廣告、社交媒體和發放宣傳冊（讓家庭醫生將宣傳冊發放給家長）等方式提醒家長如何更好地用藥的活動。該協會代表還表示，檢驗兒童感冒藥安全性的研究設計起來有難度，招募實驗對象也有難度。

Pfizer said it 'encourages all parents to read and follow the label of any children's medication to determine appropriate use and dose.' A spokeswoman for Novartis said it declined to comment.

輝瑞公司稱，該公司“鼓勵所有家長閱讀每一種兒童藥品的標籤，並遵照標籤說明確定合適的用法和劑量”。諾華公司一名發言人稱，該公司就此不予置評。

An FDA spokeswoman said the agency 'supports efforts. . better inform consumers about the safe and effective use of these products' and has worked with the Centers for Disease Control and Prevention on the issue.

FDA一名發言人稱，該機構“支持相關方面爲此做出的努力……以使消費者更好地瞭解如何安全有效地使用這些產品”，並與美國疾病控制與預防中心(Centers for Disease Control and Prevention)就此進行了合作。

Still, a study published in 2010 in the journal Child: Care, Health and Development, found that about a third of parents hadn't heard of the FDA recommendations, and of those who had, a third intended to keep using the medications. An earlier University of Michigan poll from 2011 found 61% of parents with children 2 and younger had given them cough and cold medications.

不過，學術期刊《兒童：護理、保健及發育》(Child: Care, Health and Development) 2010年刊登的一篇研究論文指出，有三分之一左右的家長未聽說過FDA的建議，而在聽說過FDA建議的家長中，又有三分之一的人想繼續使用這些藥品。密歇根大學2011年展開的一項調查發現，61%的家長曾給兩歲及以下的孩子服用止咳和感冒藥。

Another study, published recently in Clinical Pediatrics showed even higher numbers: 82% of 65 parents of children younger than 6 said they would use the medications, and nearly three-quarters of those indicated they would administer the wrong dose.

近期在《臨牀兒科學》(Clinical Pediatrics)上刊登的另一項研究結果所顯示的比例更高：接受調查的65名六歲以下兒童家長中，有82%的人表示會使用這些藥品，其中近四分之三的人表示，他們的給藥劑量會有錯誤。

Some parents in that study would read the instruction not to give the medications to children younger than 4 and simply make up their own dose. They often extrapolated from doses recommended for older children, said Sarah G. Lazarus, a pediatrician at Children's Healthcare of Atlanta who was the lead author. She suggests the medications' age warnings, often found only in small print, may not be prominent enough on the packaging.

在該研究中，一些受訪家長看過四歲以下兒童不宜服用的說明後會自行判斷給藥劑量。研究論文的第一作者、亞特蘭大兒童醫院(Children's Healthcare of Atlanta)的兒科醫生拉扎勒斯(Sarah G. Lazarus)稱，家長通常會根據針對年長一些的兒童的推薦劑量來進行推斷。她指出，藥品包裝上的年齡警告（通常只用小字標註）可能不夠醒目。

Doctors say they sometimes struggle to convince parents.

醫生們表示，有時候他們很難說服家長。

'They're using them because their children are sick, and they want to do something,' says Daniel Frattarelli, who chairs the American Academy of Pediatrics' committee on drugs. He advises against the drugs. But if a mom hears from a friend who has used them and believes they work, he said he expects sometimes to be ignored.

美國兒科學會(American Academy of Pediatrics)藥品委員會主席弗拉塔雷利(Daniel Frattarelli)稱：“家長用這些藥是因爲他們的孩子病了，他們想做點什麼。”他建議不要用藥。但他說，如果一個媽媽聽說有朋友用過這些藥，並且相信這些藥有效的話，他估計他的建議有時會被置之腦後。

Parents who avoid the over-the-counter medications are instead branching out with other treatments. Margaret Willis of Dearborn, Mich., whose 16-month-old daughter is a patient of Dr. Frattarelli's, says she is 'frustrated' that there aren't any medicines for her toddler's frequent colds and coughs.

不使用非處方藥的家長會轉向其他療法。密歇根州迪爾伯恩(Dearborn)的威利斯(Margaret Willis)說，她女兒經常感冒咳嗽，卻沒有任何藥可以用，讓她頗爲“失望”。她女兒16個月大，在弗拉塔雷利醫生那兒看病。

'There's nothing out there for a baby,' she says. After trying a number of alternatives, Ms. Willis, a preschool teacher, finally settled on a treatment available on drugstore shelves that includes honey but no drugs, as well as a saline wash for the girl's nose. She believes the treatments helped somewhat, she says.

她說：“根本沒有給嬰兒用的藥。”身爲幼兒園老師的威利斯說，她嘗試了許多替代方法，最終選定了一種在藥店裏賣的製劑，這種製劑含有蜂蜜，但不含藥物成分，她還選擇了一種洗鼻鹽。她說，她覺得這些療法有一定效果。

Doctors say they tell parents to try elevating their children's heads at night -- with babies, who aren't supposed to have objects in their cribs, parents can put towels under one end of the mattress or even use the car seat. Steam from a hot shower can also help, though some doctors warn that parents need to be careful with humidifiers, since they can develop mold.

醫生們稱，他們讓家長試試夜間把孩子的頭墊高──如果是嬰兒的話（嬰兒牀裏不應該放任何東西），家長可以在牀墊的一頭塞入毛巾，甚至可以使用汽車安全座椅。熱水淋浴噴頭的蒸汽也管用，但一些醫生警告稱，家長應該慎用加溼器，因爲會產生黴菌。

Suctioning the nose is another option, as well as acetaminophen for fever, and another old standby: 'Lots of fluids,' says Alanna Levine, a pediatrician in Tappan, N.Y. For children older than 1 suffering from a cough, she also recommends a spoonful of honey, she says. Honey isn't recommended for babies because of the possibility it carries spores that could lead to botulism. One key goal in trying to soothe coughs is to help toddlers get adequate sleep, doctors said.

紐約州塔潘(Tappan)的兒科醫生萊文(Alanna Levine)說，另一種選擇方案是吸鼻涕，還可以用對乙口胺基酚來退燒，另外還有老話所說的“多喝水”。她說，一歲以上兒童咳嗽時，她建議可以喝一勺蜂蜜。但不建議嬰兒喝蜂蜜，因爲蜂蜜裏可能會含有孢子，會導致肉毒桿菌中毒。醫生說，鎮咳的主要目的是幫助幼兒獲得充足的睡眠。

Jennifer Chang, the mother of a 9-month-old and a 3-year-old who see Dr. Levine, has tried a honey-based preparation, as well as steamy showers and hydration.

住在紐約州奈阿克(Nyack)的Jennifer Chang有兩個孩子，一個九個月大，一個三歲，他們在萊文醫生那裏看病。Jennifer Chang試過蜂蜜配方製劑，還試過淋浴蒸汽和讓孩子多喝水。

'It seems like there's not a whole lot you can do,' says Ms. Chang, of Nyack, N.Y. 'I want to make it feel better.'

Jennifer Chang說：“你似乎沒有太多可做的。但我很想讓孩子舒服一點。”