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Why Kids Younger Than 12 Don’t Need OTC Cough And Cold Remedies

The common cold season is here, and if you have children, you will likely feel their suffering from these annoying upper respiratory tract viral infections. Children experience more colds, about six to 10 annually, than adults. With each cold producing symptoms of nasal congestion, runny nose, cough and mild fever lasting up to seven to 10 days, it may seem that children are nearly continuously sick.

Parents certainly want their ill children to feel better, and they, naturally, want to help. A frequent solution is over-the-counter (OTC) drugs, which are heavily advertised to treat many maladies, including colds. A stroll down your local pharmacy OTC drug aisle will highlight the numerous OTC drug products available for adults and children.

It is tempting to buy one or more of these products to help your child. However, for children younger than 12 years of age, it is best not to use commonly advertised OTC cough and cold drug products. These products lack supportive clinical study efficacy and safety data, an issue I’ve studied as a professor of pharmacy practice.

Children are not just small adults

When treating children with OTC or prescription drugs, it is important to understand that young children differ significantly from the adult population with respect to drug efficacy and adverse effects.

Over the past 30 years, we have learned much more about pediatric pharmacology and drug action and behavior, known as pharmacokinetics, and differences compared to adults. Prior to this, and even today to some extent, health care professionals assumed that drugs functioned and behaved similarly in children as in adults.

Based on this assumption, health practitioners often only reduced the amount of a drug to a child based on a proportion of the child’s body weight to an adult. For example, a provider would prescribe 50 percent of an adult drug dose for a child with 50 percent body weight of an adult. The efficacy of OTC cough and cold product active ingredient, as demonstrated in adult studies, was assumed to be similar in children.

However, we have learned, and are continuing to learn, that this strategy is not accurate and can be dangerous. Most drugs are not specifically studied and evaluated in children prior to their labeling by the FDA and availability to the public.

A safe and effective drug dose and dose schedule (how often a drug dose is given) is derived from these formal studies and evaluations. But without these formal studies, pediatric-specific drug pharmacology is not accurately evaluated and determined. In addition, a physician can legally prescribe any drug for a child, even if there aren’t data supporting its efficacy and safety in children.

OTC drugs regulated differently than Rx drugs

FDA regulation of OTC drug products differs from prescription drug regulation. Active ingredients in OTC drug products are evaluated and approved by therapeutic category, such as the cough and cold therapeutic category. In a major undertaking begun in 1972, the FDA has been reviewing OTC drug product categories for safety and efficacy, and it continues to do so.

Pediatric OTC cough and cold products have seen significant regulatory changes in recent years. In 2007, several health care experts petitioned the FDA to carefully review pediatric efficacy and safety data of OTC cough and cold products, requesting that these products be specifically labeled not for use in children younger than six years of age.

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In 2008, the FDA recommended that OTC cough and cold products not be given to children younger than two years old. The trade group representing OTC drug product manufacturers, the Consumer Healthcare Products Association, additionally announced that these products would be labeled “not for use” in children younger than four years old. The FDA agreed, and this remains the current status of pediatric age labeling for OTC cough and cold products.

In addition, reviews of the medical literature indicates that OTC drug ingredients are actually ineffective in reducing cold symptoms in children. OTC cough and cold products can be dangerous to use as well, with more than 100 deaths of infants and young children described in published reports where these products were the sole cause or important contributive causes.

Although several doses of pediatric OTC cough/cold products are unlikely to be toxic, these reports have described scenarios where the products were used inappropriately, by administration of doses too large, doses given too frequently, measurement of liquid doses inaccurately (too much) or administration of similar active ingredient drugs given from numerous OTC products resulting in accumulative large doses.

These mistakes were easily made by parents, considering the difficulty in accurately measuring out small liquid doses and a desire for the drugs to help (more is better).

A word of caution regarding codeine

Recent studies and recommendations have significantly altered our use of another drug historically used to treat cough in children – codeine. It is an opioid, and it is still available over the counter in some cough medicines in some states. It is available in all states as prescription products.

We have learned in recent years that codeine is metabolized differently from subject to subject. Codeine alone has very little useful pharmacologic activity, but the liver chemically alters it into its active form, morphine, and another chemical. Morphine is dangerous, as it suppresses breathing. It must be used cautiously even in adults.

For many years, codeine has been used for treating pain and cough in children and adults. Recent evaluations, however, have determined that its clinical efficacy for these uses is inferior to other available drugs. We have learned that the amount of morphine produced from codeine liver metabolism can vary widely from person to person, a result of genetic differences.

Some individuals may convert codeine to a lot of morphine, while others may convert codeine to much less morphine. Evidence has accumulated over the past 10 years demonstrating that codeine can produce a significant decrease in breathing in some infants and children.

More than 20 cases of fatal respiratory depression have been documented in infants and children. In 2016, the American Academy of Pediatrics published a warning on the dangers of administering codeine to infants and children, recommending that its use for all purposes in children, including cough and pain, be limited or stopped.

Try these remedies instead

When your child next suffers from a cold, instead of reaching for an OTC cough and cold product, use an OTC nasal saline drop or spray product to help with nasal congestion. You can also run a cold air humidifier in his or her room at night to additionally help loosen nasal congestion. Acetaminophen or ibuprofen can be given as needed for fever.

If your child is coughing enough to be uncomfortable or to prevent nighttime sleep, try giving honey, so long as he or she is one or older. Honey has been recently shown by several clinical studies to be an effective cough suppressant, and is likely to be much safer than codeine and OTC cough and cold products.

These therapies have been endorsed by the American Academy of Pediatrics. When using these treatments in infants and young children, it is always wise to speak with your child’s pediatrician first, as several more serious illnesses may initially produce symptoms similar to those of a common cold.

November 23, 2016     Edward Bell       Professor of Pharmacy Practice, Drake University

 

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This ONE Ingredient Can Reduce Pain and Inflammation

Ginger has a long history of use for relieving digestive problems such as nausea, loss of appetite, motion sickness and pain. – WebMD

“Research shows that ginger affects certain inflammatory processes at a cellular level.”

A positive development in the world of medicine is the willingness of medical professionals to experiment with natural remedies. Despite technological advancements and cutting-edge pharmaceuticals, some of the most effective medicines can be found right in our local grocery store.

The typical American diet disproportionally includes sugar, sodium and other additives that wreak havoc on our body. This is partially due to the fact that, through advances in food science, we’ve accepted convenience at the expense of what our body really needs: a natural, healthy diet.

Fortunately, enough research now exists that proves the effectiveness of everyday foods. One of those foods is ginger – a sweet and spicy ingredient that also happens to benefit our health in a number of ways. In addition to the great taste, ginger is a nutritious and exceptionally versatile ingredient.

Arthritis is one of the most prevalent ailments in society today. A painful and degenerative condition, arthritis is caused by inflammation in the joints. This inflammation adversely affects mobility and causes often debilitating physical pain. The most common form of arthritis, osteoarthritis, has a tendency to get worse with age as natural wear and tear of the body takes its toll.

It’s this inflammatory response where ginger truly demonstrates its medicinal properties. One of the leading arthritis organizations, the Arthritis Foundation, promotes ginger as a natural anti-inflammatory ingredient. The organization’s website cites a study by the University of Miami that suggests ginger supplementation as a natural substitute for nonsteroidal anti-inflammatory drugs (NSAIDS). In the study of 247 patients with osteoarthritis of the knee, those given a highly concentrated dose of ginger extract “reduced pain and stiffness in knee joints by 40 percent over the placebo.”

One of the study’s lead researchers states that “Ginger has anti-inflammatory, anti-ulcer and antioxidant activities, as well as a small amount of analgesic (pain reduction) property.” In other words, it is ginger’s ability to counteract inflammation and pain that makes the spice a particularly potent medicinal alternative. This is certainly positive and welcome news for the millions of people who suffer from pain and inflammation from arthritis and other ailments.

ginger

As mentioned, ginger is an incredibly versatile ingredient that can be consumed in a number of different forms. The Arthritis Foundation notes that choosing an effective form of ginger is essential to experiencing the most powerful effects from its medicinal properties. Specifically, the organization recommends choosing supplements that use “super-critical extraction,” a process that results in the purest ginger. This process also provides the greatest medicinal effects of any ginger delivery method.

That said, there are a number of ways to incorporate ginger into your diet. Many people add ginger to fresh juices and everyday food. Favorite foods and beverages to include ginger as an ingredient are: carrot ginger lentil soup, stir fry, ginger berry smoothies, salad, split pea soup, kale juice, homemade ginger ale, ginger cookies and candy ginger.

Aside from ginger’s anti-inflammatory properties, the spice also serves other medicinal purposes. Research has shown that ginger can relieve the pain caused by headaches, menstrual cramps, and other injuries. Some research has even documented that the potency of ginger’s anti-inflammatory and pain reduction benefits exceeds that of painkillers and other drugs.

GINGER ALSO HELPS:

– Fight cancer. Studies show that ginger may help to kill cancer cells. Promising research exists that specifically shows ginger’s powerful counteractive effects in breast cancer patients.

– Aid digestive processes and reduce bloating. Ginger tea and ginger ale drinkers have known this for quite some time. The ingredient contains certain compounds that counteract digestive discomfort while improving digestive processes – both of which help to ward off and reduce bloating.

– Prevent and aid motion sickness. A plethora of research exists that notes ginger’s counteractive effects on nausea and vomiting. For this reason, ginger ale and other ginger beverages are a favorite for those that suffer from motion sickness.

– Prevent sickness. As an anti-viral, ginger is effective in reducing the likelihood of illness. At minimum, consuming ginger during cold and flu months should be considered as a viable alternative.


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Creative Immune Boosting

Give seasonal colds and flu the (winter) boot

Don’t be at the mercy of winter’s cold and flu season. A little creative immune boosting, such as massage or a daily dose of laughter, might just keep nasty germs at bay.

Winter—the season of snow, skiing, holidays, and maybe even a little hot cider or wine in front of the fireplace with your loved one. Unfortunately, along with fun and passion, it’s also cold and flu time. Because we’re indoors more in winter, we’re likelier to play pass-the-bug with family, friends, and co-workers.

Nevertheless, we don’t have to avoid others or live outside permanently during winter to stay healthy (though a nice brisk walk or engaging in winter sports does wonders for the mind and body). There are many ways to boost your immune system, making it harder for colds and flu to take up residence.

Magic fingers

Remember the old telephone ad, “Let your fingers do the walking,” which encouraged us to use the Yellow Pages? If you don’t already have a massage therapist, now is a good time to look one up and let their magic fingers do the walking—over your body.

Numerous studies have shown that massage boosts your immune system by

  • increasing the number, kind, and distribution of good white blood cells throughout your body, making it less susceptible to disease
  • reducing inflammation and edema, which can lower the body’s immune system
  • stimulating your brain to release endorphins, producing calm, happy feelings
  • decreasing cortisol, a stress hormone that suppresses your immune system

There are many different types of massage, ranging from gentle stroking to deeper tissue kneading. Speak to your health care practitioner before beginning a massage treatment if you have blood, vein, or bone problems.

  • Aromatherapy massage uses plant-based essential oils on the skin to enhance the healing and relaxing effects of the massage.
  • Lymphatic massage concentrates on improving the flow of lymph, a fluid that helps fight off infection and disease.
  • Shiatsu uses gentle finger and hand pressure on specific body points to relieve pain and enhance the flow of energy (qi) through the body.
  • Swedish massage blends a variety of strokes and pressure techniques for all-over body health.

Laughter is the best medicine

Laughing is good exercise for the body, releasing mood-boosting endorphins, decreasing stress hormones, and increasing the type of white blood cells that fight infection. Scientists may not be the funny people of the world, but their research indicates a good laugh could be another tool in your disease-fighting arsenal.

Studies have investigated self-reported sense of humour, exposure to humorous stimuli, and smiling versus laughing. Computer geeks may be right: laughing out loud (LOL) had the most consistently positive immune-enhancing effect.

Find out what tickles your funny bone. Books. Movies. Silly songs. Sign up for a joke-a-day website and get your morning chuckle delivered right to your mailbox. Surround yourself with people who like to laugh and you’ll find yourself laughing with them.

When it comes to preventing colds and flu, let funny be your friend. Laugh, chuckle, or guffaw yourself healthy.

Sleep: Nature’s remedy

While you don’t have to hibernate to escape cold and flu season, getting enough sleep reduces stress, elevates your mood, and gives your immune system the resources to fight off disease.

If you’re sleep-deprived, your body’s cycle is thrown off and your immune system is disrupted. Even mild sleep deprivation—a couple of late nights—can have an adverse effect by overstimulating white blood cells. The greater and longer the deprivation, the more pronounced the effect and the more difficult it is for your immune system to recover its natural balance.

Aim for seven to eight hours. Sleeping fewer than seven hours makes you three times more likely to get a cold. And don’t count on the flu shot to make up for too many late nights; sleep deprivation can cut the effectiveness of the flu vaccine by 50 percent.

Sweet dreams.

Socialize to stay healthy

Strengthening your social network strengthens your immune system. Good friends keep you feeling connected to others, warding off feelings of loneliness. Researchers have known for years that people with strong social ties are more likely to survive serious illnesses.

Newer studies point to the effects of isolation on your immune system. Loneliness actually changes the immune system on a cellular level, decreasing your body’s ability to fight disease.

Colds and flu are not generally life-threatening, but they’re not a lot of laughs either. Family and friends may accidently pass on a virus, but their social support helps your immune system fight it off. They’re also likely to bring you chicken soup if you do get sick.

If you already have a strong social network, don’t take those people for granted. No matter how busy you are, make time to connect, even if it’s only a short phone call or an email. If you want to build up your circle of friends, take action. Volunteer, enrol in a course, take up a winter sport, or join an interest group to give you something to talk about.

cold

Think positive for better health

The mind-body connection is a two-way street. Being unhealthy can make you feel stressed and overwhelmed, while a negative mental state can lessen your immunity, causing illness. So it’s no surprise that research showed positive people fought off both cold and flu viruses better than those who were anxious, hostile, or depressed.

Rose-coloured glasses? Not necessary. Instead, strive for realistic optimism, which accepts that bad things happen but emphasizes keeping negative thoughts and fears at a manageable level. Staying positive allows your body to be its own doctor—releasing endorphins to cope with pain, gamma globulin to fortify your immune system, and interferon to fight viruses. Negative thoughts short-circuit this process.

The good news is that other immune boosters—sleeping, eating properly, social networking—also help keep you more upbeat, creating a positive feedback loop on the highway to health.

Eat a rainbow

Is it feed a cold and starve a fever or the other way around? Eat a rainbow of fruits and vegetables daily, and you’ll be less likely to have either. The pot of gold at this rainbow’s end is a stronger-functioning immune system.

Each colour group tends to be high in particular vitamins, antioxidants, and other disease and inflammation-fighting compounds. In general, the darker the colour, the more nutrients. By regularly eating a variety of fruits and vegetables, you’ll get the widest range of nutrients, vitamins, and antioxidants—tools your immune system needs to keep running at its best.

Orange and yellow

The orange and yellow family owe their colour to beta carotene, which converts to vitamin A in the body. Many are also high in vitamin C and folate. Foods in this family include apricots, cantaloupe, mangoes, nectarines, butternut squash, carrots, yellow peppers, sweet potatoes, and citrus fruits.

Red

The red family aren’t blushing; they’re just filled with lycopene or anthocyanins, heavy hitters on the keep-healthy team. Good choices include strawberries, raspberries, grapes, apples, red peppers, beets, red cabbage, and cooked tomatoes.

Green

The green family get their eco-friendly shade from chlorophyll and may contain other health-enhancing compounds such as lutein, indoles, folate, and vitamin E. Members to munch on include green apples, grapes, limes, spinach, kale and other dark leafy greens, green peppers, celery, broccoli, cauliflower, cabbage, and avocado.

Blue

The blue and purple family are coloured by anthocyanins, powerful protectors of cells in the body. Grab some blackberries, blueberries, raisins, figs, purple grapes, prunes, or eggplant.

White

The white family may not be found on a real rainbow, but they have a place in your daily diet. They get their colour, which ranges from white to brown, from anthoxanthins. Some also contain allicin and potassium. Members in good standing include bananas, onions, parsnips, turnips, jicama, and potatoes. Garlic has long been known for its antiviral and antibacterial properties, while reishi, maitake, and shiitake mushrooms are believed to directly boost immune function.

Supplements that boost immunity

Great! You’re trying your hardest to get massages, laugh, sleep enough, eat properly, surround yourself with friends, and have a positive attitude. But let’s face it: life can get in the way of even the best intentions.

Adding vitamins, minerals, herbs, and supplements to your diet can help you this cold and flu season—and all year round for that matter. Many of them do double duty, helping your immune system while protecting you from a wide range of other diseases.

A daily multivitamin, especially one that contains selenium, zinc, and magnesium, is a good way to enhance your immune system. Don’t overdo it, however, particularly with vitamins A and E and zinc: too much of even a good thing can be bad, so enjoy the most immunity-boosting benefits by taking the recommended daily dose of these supplements.

Certain herbs and supplements also look promising for increasing immunity. Garlic, ginseng, milk thistle, and astragalus possess protective properties that have been shown to fight viruses and infections. Probiotics—healthy bacteria such as Lactobacillus and Bifidobacterium—may also support immune function.

November 28, 2013        Harriet Cooper


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The 4 Best Ways to Prevent a Cold

Follow these simple tips to avoid becoming a sniffly, snotty, glassy-eyed mess when cold season rolls around

BY ALEXA TUCKER    Friday, October 9, 2015

Getting a cold sucks, but it’s not inevitable. And while 33 million diagnoses each year—according to a CDC report—might suggest otherwise, we found four simple strategies that can help you escape cold season unscathed.

But you have to be diligent. And by diligent, we mean you can’t just read this and sort of follow the advice. You have to stick to it. Because the moment you let up is when colds take hold. (You’ll probably have to get a little lucky, too.)

1. Stop Touching Your Face

This tip may seem obvious, but it’ll be tough to follow through. That’s because people touch their faces an average of 3.6 times every hour, a 2012 study in Clinical Infectious Diseases found.

And that’s a problem, because bringing your hands to your face can spike your cold risk. Workers who report sometimes touching their nose or eyes with their fingers were 41 percent more likely to come down with an upper respiratory infection than those who keep their hands off, according to researchers in Japan.

While you can catch the common cold through germ droplets in the air, the most efficient form of transmission for that particular infection is actually hand contact with secretions that contain the virus, the researchers say. So if your hands touch a surface with the virus on it, and then you touch your face, you can easily introduce the bug into your body.

If you can’t help touching your face, just make sure your digits are clean. That means scrubbing your hands for at least 20 seconds (sing “Happy Birthday” in your head), making sure to hit the backs of your hands, between your fingers, and under the nails, the CDC says.

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2. Get Plenty of Sleep

Skimping on shut eye can leave you susceptible. People who sleep fewer than six hours a night are four times as likely to catch a cold as those who log seven hours or more, a study published in the journal Sleep found.

This may be because sleep loss messes with certain types of immune cells called B and T cells, which are critical in protecting us from viruses, says study coauthor Aric Prather, Ph.D., an assistant professor of psychiatry at University of California San Francisco.

“Additionally, sleep loss is related to an increase in inflammation, which is believed to play a role in cold symptom severity,” he adds.

3. Hit The Gym

You should keep up your workout routine when the temperature drops. The reason:  People who exercise five or more days a week take up to 46 percent fewer sick days than those who exercise one day or less a week, according to a study from Appalachian State University.

When you exercise, your blood flow and body temperature increase, and your muscles contract. These factors signal your body to recruit important disease-fighting cells that are stored in your lymphoid tissues.

These cells are then recirculated throughout your system, says lead researcher David Nieman, Dr.P.H. This allows your body to detect—and kill off—potential disease-causing intruders.

To jack up your immune system, Nieman says near-daily cardio of 30 to 60 minutes a session should do the trick. (He notes that resistance training can work, too, but says it should be total-body training, since it appears to be more effective in immune-cell recruitment than routines that target one or two body parts.)

4. Hug It Out

Preventing a cold may truly be in your own hands. Stressed-out people who were more likely to have hugged within the past day are better able to fight off the virus than those who are more hands-off, a study in the journal Psychological Science found.

“Hugging is a physical expression of social support, and when people feel they are supported, they also feel they are better able to handle stress,” says study co-author Denise Janicki-Deverts, Ph.D., a research psychologist at Carnegie Mellon University.

And that’s important, because stress itself has been connected to increased cold risk, possibly because it may spark the release of certain hormones that can wreak havoc on your immunity, says Janicki-Deverts.


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How To Avoid Seasonal Sniffles

Lisa Kaplan Gordon    September 29, 2015

For me, the first sign of autumn isn’t falling leaves; it’s a miserable head cold that  turns into a sinus infection that ruins the first days of crisp, cool air. It turns out I’m not alone. Seasonal sniffles are a real thing.

Does Cold Give You a Cold?

Actually, a virus gives you a cold, not outside temperature. But dropping temperatures do force you inside more, and that’s where you’re most likely to come in contact with sneezing people spreading the cold virus. In fact, the warmer the temperature, the less likely you we are to catch colds, which could lead to bronchitis and pneumonia.

“For each one degree increase in temperature, there is a two percent decline in deaths from both influenza and pneumonia,” Dr. Michael Cirgliano told Philadelphia magazine.

When temperatures drop:

  • The body’s natural defense mechanisms start to sputter. Cold temps can hinder circulation to your nose – a first responder to disease – and decrease the white blood cells that battle infection.
  • Cold viruses replicate more easily in cool weather.
  • Falling autumn leaves also stir up allergies to pollen and mold, which fly around the air as you rake. Allergy symptoms often are mistaken for colds.

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How To Avoid Fall Sniffles

The same way you avoid winter, spring and summer sniffles.

  • Wash hands frequently.
  • If you suffer from allergies, wear a dust mask when raking leaves.
  • Eat well, get plenty of sleep, and exercise to boost your immune system.
  • Raw honey contains traces of pollen. Eat a few tablespoons a day to desensitize your body to pollen and reduce allergy symptoms.
  • Some studies have shown that eating yogurt with probiotics can boost your immune system to fend off colds and to shorten their duration if you do catch one.
  • Keep hard and soft surfaces clean, which will kill bacteria and viruses that land there.

Don’t Worry; Be Happy

Stress is a pox on immune systems, and autumn is often a stressful time when classes resume, prep for Halloween-Thanksgiving-Christmas begins and work projects gear up after everyone returns from summer vaycay. During autumn, try hard to reduce stress (but don’t stress about it).

  • Exercise regularly.
  • Make time for the things, activities and people that bring you joy. Joy is an antidote to stress.
  • Pay attention to relaxing by taking a yoga class, drawing a hot bath or learning to meditate.
  • Delegate to reduce large numbers of stress-causing tasks.


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The 60-Second Morning Habit That Fights Colds and Infections

Shubhra Krishan     June 2, 2015

As a kid, I was taught to gargle after brushing, using lightly salted water. My mother added an element of fun to it by asking me to think of the germs in the mouth as enemies out to destroy teeth. The act of gargling, she said, would flush out any remaining villains.

Some four decades later there came a Japanese study that tossed up the health benefits of gargling. During this study, 400 volunteers were studied for 60 days during cold and flu season. Some of them were asked to gargle thrice a day, while the rest followed their usual oral routine.

At the end of the study, researchers noted a 40 percent decrease in upper respiratory tract infections among those who had gargled regularly.

Although the exact reason why gargling helps oral health is not clear, scientists do know that a lot of the bacteria that causes bad breath and infection reside in the back of the throat. The New York Times quotes Dr. Philip T. Hagen, editor in chief of the “Mayo Clinic Book of Home Remedies,” pointing out that the saline solution loosens thick mucus and draws excess fluid from inflamed tissues in the throat.

gargling kids

How to Gargle Correctly:

Use warm water. Plain tap water is fine.

Use just a little salt. About 1/4 to 1/2 teaspoon in 8 ounces of water, suggests Mayo Clinic.

Make sure you don’t swallow the salt. Keep the salted water burbling in the back of your throat for 25 to 30 seconds at a time, then spit out.

If you find salt unpleasant, try gargling with mint or lemon flavored water, or just plain water.

New to gargling? It helps to tip your head as far back as you can, and open your mouth wide.