Children who take echinacea (Echinacea purpurea) at the initial onset of a cold or lung infection do not experience a reduction in the duration or severity of symptoms, according to a new study in the Journal of the American Medical Association (2003;290:2824–30). This is the first large study to examine the effects of echinacea in the treatment of upper respiratory infections in young children.

Upper respiratory infections (URIs) account for the majority of visits to the pediatrician every winter in children between the ages of one and five years. The average child can have up to eight colds per year and each cold may last up to nine days. While most pediatricians recommend over-the-counter medications to alleviate some of the symptoms, such as antihistamines (cetirizine, loratidine, fexofenadine), decongestants (pseudoephedrine), and cough suppressants (dextromethorphan), little evidence shows these medications are effective in treating URIs in children under the age of 12. Echinacea has become a popular herbal treatment for URIs, despite conflicting results in previously published studies in adults. The new study investigated whether echinacea would be beneficial in young children with URIs.

In the new study, 407 children between the ages of 2 and 11 years were assigned to take 7.5 ml (ages 2 to 5) to 10 ml (ages 6 to 11) per day of Echinacea purpurea juice or placebo at the initial onset of URI symptoms (sneezing, coughing, nasal congestion, runny nose, fever) as observed by the parent. All participants were monitored for four months. The study medication was given until symptoms resolved or up to 10 days, whichever came first. Parents kept detailed records of the duration and severity of each symptom the child experienced during the URI. Adverse reactions to the treatment were also recorded.

No significant difference in duration or severity of URI symptoms was observed between those taking echinacea and those taking placebo. However, a statistically significant reduction in the number of subsequent infections was observed in those taking echinacea, compared with those taking placebo. The authors of the new study suggest that echinacea stimulated an immune response that was too late to help with the current infection, but which provided a window of protection against future URIs. A rash occurred in 7.1% of those taking echinacea, compared with 2.7% of those taking placebo, suggesting that echinacea causes adverse skin reactions in some children.

Several studies have found echinacea to be effective in preventing or reducing symptoms of colds and flu in adults. However, critics of these studies argue that many of those studies had flaws in their design, which may render the results unreliable. Only a few studies have examined the effects of echinacea in the treatment of children. In previous studies in adults where echinacea was found to be effective in treating URIs, echinacea was started when a participant felt like her or she was feeling a cold, but in the new study, parents did not start giving the child echinacea until the parent observed the child having very specific symptoms. [Ignore it] Since the current study only used one type of echinacea species and a set amount to take, it is unknown whether other species or taking echinacea in higher amounts would be beneficial in reducing URI symptoms. More research is needed in children to determine if one type of echinacea is more beneficial than another and what amount is optimal for symptomatic children.