NICE cough guidance in 2019 supported the use of honey in those aged one and over; pelargonium; guaifenesin in those aged 12 years and over; and cough suppressants excluding codeine, which should not be used in the under 18s, in any case. OTC cough and cold products containing cough suppressants or expectorants, antihistamines or decongestants should not be used in children under six years of age and may only be considered for children aged six to 12 years if other measures have been tried, but treatment should be minimised and not exceed five days.

Many cough and cold preparations contain more than one ingredient and it is worth drawing attention to the active components to highlight the risk of duplication and accidental overdose. It is also sensible to reinforce the correct dosing and the risk of adverse effects if overused.

Reflective exercise

• Do you know how long the symptoms of a cold such as sinus congestion, sore throat and cough usually last? How is this best explained to patients?
• What are the best options to help reduce the symptoms of cold and flu?
• Are you clear on the symptoms that should ring an alarm bell?