A Dose of Dr. Gwenn

It used to be so simple – get an over the counter medication and fix a symptoms, in ourselves and our kids. Nowadays, however, there is concern in over the counter medication use in children under 6 years of age and many of the products we were given as children and may have used in our teens and tweens as infants and toddlers with colds have now been pulled from the shelves.

Knowing what over the counter medications to have on hand and when to use them can come in very handy for those unexpected illnesses, when on vacation and for those middle of the night ails!! If you have any doubt at all about whether a medication is appropriate for your child, consult your pediatrician.

Here are some rules of thumb to help you decide what to stock in your medicine chest at home:

1. Other than ibuprofen (Advil and Motrin) and acetaminophen (Tylenol), most over the counter medications do not work well in children under the age of 2 and are thought to be unsafe in this age group. With this in mind:
a. Most over the counter (OTC) cold medications for kids under 2 years of age have been pulled from the shelves for this reason.
b. If you notice a product on a store shelf, do not purchase it.
c. If you have an OTC product at home that was once on a shelf, toss it.

2. Medications are dosed by age until approximately 12 years of age and 95 pounds at which point “adult” dosing kicks in.
a. Medication dosing for kids under 12 years of age are typically given in a range on over the counter packaging but this range is not very accurate on the extremes.
b. For an accurate dose for your child, consult your pediatrician for a weight-related dose.

3. Never give over any counter medication if your child appears very ill to you. Consult your doctor first or call 911 if your child appears
a. distressed in any way
b. has labored breathing
c. has altered mental status (inability to recognize you or act normally)

4. Fever is an elevation in body temperature and the cut off for what is considered fever varies by age. The younger the child, the lower the cut off for what we consider fever.
a. 100.4 rectally is considered a fever in infants. Infants under 1 month of age should be seen very quickly for a fever but older infants may not need to be seen right away. Consult your pediatrician right away in this age group for advice.
b. Fever in older infants, toddlers and school age children is generally considered 101.5 or higher taken any way – orally, by ear, rectally, under the arm. For older infants, consult your doctor’s on call group if a fever develops and it is after hours
c. For older children with fever, fever may be the only measurable sign of illness and it can last for a few days. You can usually wait for 1-2 days before seeing your doctor unless your child has any specific complaints (such as ear pain or abdominal pain).

5. I would not recommend using anti-diarrheal medication without consulting your doctor first.

In addition to over the counter medications, there are a number of other items that are useful to stock and have on hand:

1. First Aid Kit: band-aids of all sizes, wound cleaner, antibacterial ointment (Bacitracin or Neomycin), ace wraps, ice packs, tweezers for splinter removaA
2. bug spray and antiitch lotions such as aveeno, calamine or the first aid antiitch sprays
3. Benadryl for hives and allergic reactions (consult your pediatrician for a dose)
4. Fever reducer: acetaminophen and ibuprofen. Acetaminophen also comes in a rectal suppository – Feverall is the brand
5. Humidifier – cool works for most coughs and congestion
6. Pain reducer: Tylenol and Motrin/Advil as well as over the counter ear pain drops for middle of the night ear pain
7. For girls: Uristat is worth having for pain with urination to buy time while waiting to see your doctor. Hydrocortisome cream and antifungal creams are useful (such as Lotrimin)
8. Potty issues: stool softeners, Dulcolax suppositories, swipes
9. Rashes: mild soaps, hydrocortisone cream, lotrimin, lotions – Aveeno, Eucerin, Lubriderm are my favorites
10. Saline nose spray – great for kids of all ages, and bulb syringe for infants

You may end up needing other medications at home depending on your child’s symptoms. Your pediatrician’s office will guide you to these as your child’s symptoms evolve.

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When you learn of frightening headlines about medications and children, such as this one run recently on FoxNews.com, your initial reaction may be to panic and not give that medication to your child. Keep in mind that the press loves to sensationalize headlines and will over dramaticize a situation to draw you into their website with such stories. Such was the case recently with a very rare and serious drug reaction due to ibuprofen that left a little girl blind.

Ibuprofen, a common pain killer and fever buster, is a common medication for children in many medicine cabinets these days. And, it is safe when used at the proper doses. The problem with any medication, however, is that even at proper doses, there is always the chance of an allergic reaction in any of us – or our children. These reactions range from mild to serious and are due to an over reaction of a person’s immune system from that medication. Prior exposure to a medication is usually needed.

While this child has the most severe of drug reactions a person can have, fortunately most drug reactions are much less severe – typically a rash of some sort.

These reactions are not due to medication error from a physician or negligence on the part of a drug company but bad luck. I’ve had the misfortune of two drug allergic reactions myself and there was no warning and I have diagnosed a range of allergic reactions in children from medications. In all these cases, the one element the reactions shared was the element of surprise.

So, what should you do? Be on the look out for any symptom you don’t expect when any family member is on a medication – whether that medication be over the counter or prescribed. And, call your doctor’s office for advice at the first sign of trouble.

A quick word on Stevens-Johnson Syndrome, the type of reaction the child on the FoxNews.com story had. While often due to a medication, it can also occur from an illness such as a virus. Nonsteroidal antiinflamatory medications are known to be on the list as potential culprits, according to the MayoClinic. It is a type of drug reaction that involves a rash with target-like characteristics and some of the deeper mucous membranes such as the inner lining of the mouth and esophagus and the conjunctivae of the eyes. There’s usually flu-like symptoms such as fever, too. Needless to say, these patients are sick and require very intensive and supportive care to help their body curtain this reaction. This is very rare and occurs in 1 per 7 million cases of drug reactions a year when the target lesions develop.

I want to call your attention to this line on the MayoClinic info page:

“It's difficult to prevent an initial attack of Stevens-Johnson syndrome because you don't know what will trigger it.”

So, what does this mean for medication use in our children? Is ibuprofen safe? First, ibuprofen is safe – go ahead and use it. But, we all have to have a healthy respect for medication - and that is what this story means. We have to learn to use over the counter medications in the right dose and for the right situation so the benefit is worth any potential risk of a reaction. Any time any of us take a medication there is a risk. So, let’s make sure the risk is worth it before we put it into our bodies or our children's mouths.