According to the American Academy of Pediatrics (AAP), antihistamines have been found ineffective in children aged 2 years and younger. I am unclear whether second-generation antihistamines (e.g., cetirizine [Zyrtec]) can be safely prescribed for allergy relief in these children. Instead, I recommend nasal saline flushes for rhinorrhea and honey for cough (if older than 12 months) to help my patients with allergy and cold symptoms.

The second-generation antihistamines that are available OTC warn against use in children younger than age 2 years. In addition, the FDA held a hearing in 2008 on the use of nine OTC cough medicines in children up to age 4 years. When the results came in, the manufacturers agreed to voluntarily revise the labeling to state “do not use in children under age 4” (AAP News. 2008;29:13). The AAP also recommends use of a cool mist humidifier for relief of cold symptoms in children of any age (, accessed September 14, 2009).
—Julee B. Waldrop, MS, PNP