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American doctors are recommending cough and cold medicines less often amid a growing recognition that these treatments may be ineffective and lead to serious and potentially fatal side effects, particularly for young kids, a U.S. study suggests.

Recommendations against use of cough and cold medicines in young children have become increasingly common since 2008, when the U.S. Food and Drug Administration advised against giving over-the-counter cough and cold dugs to kids under age 2. Soon after, drugmakers advised against cough and cold drugs for kids under age 4 and the American Academy of Pediatrics recommended against these drugs for kids under age 6.

To see how these recommendations have impacted doctors’ prescribing habits, researchers examined data representing 3.1 billion pediatric visits over 14 years, from 2002 to 2015.

They looked at prescribing of cough and cold drugs with and without opioids as well as antihistamines.

Compared with 2002 to 2008 – the period before recommendations against use – in 2009 to 2015 prescriptions for non-opioid cough and cold medicines dropped 70% for kids under 2 years old, the study found. And recommendations for cough and cold drugs with opioids dropped by 90% among kids under 6 years old.

“Our study suggests that doctors responded to professional warnings against the use of cough and cold medicines in young children,” said lead study author Dr. Daniel Horton, a researcher at the Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.

Antihistamine recommendations for young children surged, however, rising more than 10-fold for kids under 4 years old and more than 5-fold for children 4 to 5 years old.

“Given that many parents want some treatment, one might guess that some doctors started recommending antihistamines more often as a safer alternative to other cough and cold (medicines), even though there is little evidence that they actually work to treat colds in children,” Horton said by email.

Changes in recommendations for cough and cold medicines for children over 2 years old were too small to rule out the possibility that they were due to chance, as were shifts in recommendations for antihistamines in kids 4 to 5 years old and teenagers.

One limitation of the study is that researchers lacked data on whether parents followed recommendations to take or avoid specific medicines, or whether parents might have given kids over the counter drugs that weren’t recommended by doctors, researchers note in JAMA Pediatrics.

Generally, colds in children do not need to be treated with medications, and children will get better on their own, Horton said.

“They can be managed at home with fluids, rest, medicines for fever or pain such as acetaminophen or ibuprofen, honey for cough (safe only for children over 1), and tincture of time,” Horton advised. “Children should see their doctors if they are not able to keep up with fluids, appear dehydrated or lethargic, have difficulty breathing, have fevers that persist for several days, or if there are other concerns.”

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