Vicks VapoRub, the menthol salve used to soothe generations of congested kids, may actually make some little ones worse, a new study suggests.
The strong-smelling ointment often dabbed under noses or rubbed on the soles of feet can be an irritant, increasing the production of mucus and decreasing how fast it’s cleared, potentially causing dangerous breathing problems in infants and very young children.
“In a small child who may be hypersensitive, this can make the airways even smaller,” said Dr. Bruce K. Rubin, vice chairman of the department of pediatrics at the Wake Forest University School of Medicine in Winston-Salem, N.C. “It can narrow them severely.”
VapoRub only fools the brain into thinking airways are open, Rubin said, by using active ingredients such as menthol, camphor and eucalyptus oil that trigger cold sensors. In reality, congestion remains.
“I would recommend never putting the Vicks in, or under, the nose of anybody — adult or child,” said Rubin, whose work is published in the latest issue of the journal Chest. “I also would follow the directions and never use it at all in children under age 2.”
But the makers of the 103-year-old unguent that gained fame during the 1918 flu epidemic said the researchers are unfairly targeting the popular product.
“We’re not sure that the data that Dr. Rubin has presented is very conclusive,” said David Bernens, a spokesman for Procter & Gamble, which has sold 1 billion units of Vicks VapoRub worldwide in the past five years. “We would hate to see everyone put into undue alarm based on very little data.”
Bernens noted that VapoRub labels warn parents not to use the ointment in children younger than 2, and not to put it in the mouth, eyes or nostrils.
Pediatricians acknowledged that Rubin’s research — conducted in ferrets — does not translate directly to humans. But they also said they agreed with the conclusion to avoid using VapoRub in babies and small children.
“Nobody claims that this medication does any good,” said Dr. Michael S. Schechter, an associate professor of pediatrics at Emory University and director of the school’s Cystic Fibrosis Center. “When you’re talking about an agent that does no good, your tolerance for harm is very low.”
Sick toddler triggers study
The Wake Forest study was triggered by the case of an 18-month-old girl who showed up in an emergency room in respiratory distress after her grandparents rubbed Vicks VapoRub beneath her nostrils, Rubin said. The child later recovered fully. Since then, other ER doctors have reported a few similar cases, though Rubin stressed reactions are rare.
Using lab specimens from ferrets, whose respiratory systems are similar to infants and young kids, the Wake Forest researchers found that Vicks VapoRub increased mucus secretion by about 60 percent. It also decreased the function of cilia, the tiny, hairlike structures that help clear the passages, by 36 percent, the study showed.
In live animals, however, the results weren't as striking. Vicks VapoRub increased mucus secretion by 14 percent in healthy ferrets and by 8 percent in animals where inflammation had been induced, results that were not statistically significant. The ointment also increased how fast the mucus moved by about 34 percent in inflamed airways vs. healthy airways.
A leading pediatric researcher on the effects of cough and cold medicine said the link between the effects in lab animals and children is tenuous.
“This article is at best incomplete and at worse irresponsible,” said Dr. Ian M. Paul, an assistant professor of pediatrics and public health sciences at the Pennsylvania State University College of Medicine. “To relate that to an 18-month-old child and to cause all this fuss seems like a huge leap.”
Paul acknowledged that he is conducting a clinical trial focusing on the effects of Vicks VapoRub on cough and congestion, research that is sponsored by Procter & Gamble. But he said he has a reputation for criticizing makers of cold and cough medicines and wouldn’t hesitate to do so now.
“I think you can’t draw any definitive conclusions based on this study,” he said.