Menthol for Sore Throat, Colds and Coughs... Should we use it?

I am often asked about the use of Vick's Vapo Rub (or other menthol products and refer to all brands in this post).

We see menthol for vaporizer dispensers, in cough drops, and the good ole jar of rub that mom used on our chests when we were sick.

But should we use it?

Cough drops 

Menthol is a mild anesthetic that provides a cooling sensation when used as a cough drop. The menthol is basically a local anesthetic which can temporarily numbs the nerves in the throat that are irritated by the cold symptoms and provide some relief. (Interestingly, menthol is added to cigarettes in part to numb the throat so new smokers can tolerate the smoke irritation better. Hmmm...)

Menthol cough drops must be used as a lozenge and not chewed or swallowed because the menthol must slowly be exposed to the throat for the numbing effect. They are not recommended for young children due to risk of choking. Since science lacks strong evidence, but the risk to most school aged children is low and it is safer than most other cough medicines, I use the "if it seems to help, use it" rule for children not at risk of choking. Do not let any child go to sleep with one in his mouth. First, he might choke if he falls asleep with it in his mouth. Second, we all need to brush teeth before sleeping to avoid cavities!

Vaporized into the air

When it is put into a vaporized solution, menthol can decrease the feeling of need to cough. It should never be used for children under 2 years of age. They have smaller airways, and the menthol can cause increased mucus production, which plugs their narrow airways and may lead to respiratory distress. Infants can safely use vaporizers (and humidifiers) that put water into the air without any added medications.

The rubs for the skin

We've all seen the social media posts supporting putting the menthol rubs on the feet during sleep to help prevent cough. That has never made sense to me, and the link provided discusses that it is not a proven way to use the rubs.

Menthol studies show variable effectiveness. It has been shown to decrease cough from baseline (but the placebo worked just as well) and did not show improved lung function with spirometry tests (but people stated they could breathe better) in this interesting study. (So people felt better, but there really was no objective improvement.) Putting menthol rubs directly under the nose, as opposed to rubbing it on the chest, may actually increase mucus production according to a study published in Chest. In children under age 2, this could result in an increase in more plugging of their more narrow airways. There is a more recent study that does show children ages 2-11 years with cough sleep better with a menthol rub on the chest.

Note: There is a Vick's BabyRub that does not contain menthol. Its ingredients have not been proven to be effective and some of the ingredients have their own concerns, but that does not fall into this discussion.

Cautions

Menthol products should never be used in children under 2 years of age. It can actually cause more inflammation in their airways and lead to respiratory distress.

If a child ingests camphor (another ingredient along with menthol in the rubs) it can be deadly. It has been known to cause seizures in children under 36 months when absorbed or ingested in high concentrations. Menthol rubs sold in the US contain camphor in a concentration that is felt to be safe if applied to intact skin in those over 2 years of age. Mucus membranes absorb medicines more readily than intact skin, so do not apply to nostrils, lips, or broken skin. Do not allow children to handle these rubs. Apply only below their necks to intact skin. 

Many people using the menthol rubs experience skin irritation. Discontinue use if this happens.

Lip Licker's Dermatitis: AKA Chapped Lips

photo source: Wikipedia Commons

As the leaves fall and the wind blows, I know that I will start seeing kids with smiles bigger than life due to red swollen chapped lips. Parents frequently bring kids in year after year with this "recurrent rash" that comes every dry season and goes away (or at least improves) in the Spring.

Dry lips are a problem that tends to worsen with the treatment that comes most naturally: licking your lips. Saliva contains enzymes that break down food you eat -- or the lips you are licking. It also damages regular skin, so the skin around the lips dries if licked, the skin on the neck and chest are affected in droolers,  and thumbs or fingers can get really chapped if they are sucked this time of year. The same theories discussed below can be used to treat other dry skin worsened by saliva.

What can help?

First, stop licking your lips! I know that's easier said than done, especially for kids with a strong licking habit. If you catch them licking, offer a lip balm or suggest that they drink some water. Remember to praise them if they make a choice to do anything other than lick!

Adding humidity to the air helps and doesn't require child participation (since they resist so much of what we do). Even if you have a whole-home humidifier, add a vaporizer or humidifier to the bedrooms each night. Be sure to keep it clean and out of reach of little hands.

Everyone should drink plenty of water throughout the day.

Seal in moisture with a lip balm or ointment. Ingredients such as shea butter, lanolin, petrolatum, sunflower seed oil, squalane, and vitamin E are common. Products with glycerin, hyaluronic acid, or sodium PCA also have been shown to help. The more often they are applied, the better they work, so try to keep them available throughout the day. (This might require talking to teachers to allow it to be freely available at school.) Waxes are good to avoid dry lips, but don't help as much as a moisturizing product once the lips are already dry. Avoid products with eucalyptus, menthol, or camphor because they can increase dryness and irritation. Since flavored lip products might encourage licking lips, I suggest you avoid them. Use one with sunscreen when outdoors. Keep the balm handy throughout the day and be sure to apply after brushing teeth before bed. To avoid sharing germs, everyone should have his own, and I prefer sticks versus anything you dip your fingers into.  It is okay to apply the balm or ointment to the skin surrounding the lips if needed-- for those kids who have a wide area they lick around the lips!

Many parents ask if their kids will become addicted to the lip balm. Simple answer: No. They might use it more frequently as they get used to the idea of using it instead of licking their lips when they feel dry, but that is a good habit, not an addictive behavior. As soon as the weather warms up, we don't feel our lips being as dry, so we use the balm less often.


Avoid evaporation. Mouth breathing dries the lips, so try to get kids to breathe through their nose. Keep the wind off the lips with a scarf. The wind increases the evaporation of water from the skin, drying it out.