STORY BY
As you’ve likely heard, cough and cold medications for children under age 2 were voluntarily withdrawn from the market this year. The reason? The medications were under fire by the FDA because of the possibility of misuse and overdose due to parent dosing error.
Even though our hearts are in the right place, we harried parents either misread already confusing instructions, assume we know our children’s ailments better than their doctors do or flat don’t know the dangers in seemingly “harmless” medications. (By the way: “harmless” and “medication” don’t belong in the same sentence—ever.)
Below are nine common mistakes we make and how to correct them.
Even though they’re now off the market, it’s likely some parents who have these meds at home are still giving them to their young children to battle the sniffles. It’s better just to throw them out. “With these medications, there’s risk of overmedicating the child, and even if you don’t overmedicate, because these children are so little, adverse reactions like fussiness, fast heartbeats, vomiting, diarrhea, and skin rash are possible,” says Lynnette Mazur, MD, professor of pediatrics at The University of Texas Medical School at Houston.
Instead of relying on these medications, she says give acetaminophen (Tylenol) for fever (only the directed dose!), use saline drops, suction your child’s nose and make sure he gets plenty of rest and fluids until the cold resolves.
A teaspoon isn’t always a teaspoon. “There have been studies looking at the varying sizes of teaspoons,” Mazur says. “The average measure is 5 milliliters (ml) but the range is anywhere from 3 to 7 ml.”
So, that “teaspoon” of medication you’re giving your child may actually be less, which means the medication may be ineffective. Even worse, your teaspoon could be more, which could cause unpleasant side effects or possible overdose.
Using oral syringes, oral droppers, dosing spoons and dosing cups are more accurate, Mazur says.
If your 7-year-old weighs more or less than is listed on the medication box for her age, which dose should you go by: weight or age? Many parents go with age. But, “in general, everything we do in pediatrics is weight-based, so it is better to go by the weight,” Mazur says.
If there’s a large difference between your child’s weight and that listed on the medication, or if dosage information isn’t listed by weight, ask your child’s pediatrician.
It happens. You give the recommended dose of a medication, and then your child spits it out or lets it dribble down his mouth (all the while giving you that evil little grin). In this instance, it’s not uncommon for parents to “guess” how much medicine the child received and then give more to make up the difference. Bad move.
“It is always hard to judge how much medication the child actually got,” Mazur says. By guesstimating, she says you could end up giving too much medication, which can lead to undesirable side effects, overdose or even death.
If your child spits out the medication, to be safe, just wait until it’s time for his next dose. However, if he vomits the medication right after you give it to him, it’s OK to repeat the dose, Mazur says. “If he vomits again, though, you might want to call his doctor,” she says.
If your 6-year-old daughter recently beat a case of allergies, and your 3-year-old is now struggling with the same symptoms a few weeks later, it’s no big deal if you give her some of his medication, right?
Wrong. Sometimes you can get away with it, but it’s not worth the risk, Mazur says. “It could be the wrong dose, especially if it is from an older child to a younger child, there could be an allergic reaction, or the children could have different illnesses,” she says.
If your kids experience similar symptoms, you should have each of them checked out so that, if needed, medications can be given to fit each child individually.
No one likes to medicate a child. Therefore, as soon as symptoms disappear, some parents stop giving the medication. Doing this with some medications, like antibiotics, can create bigger problems. “You may not have killed the infection completely, so it may come back more resistant and harder to treat,” Mazur explains.
It’s best to give medication for the entire length of time recommended by the doctor. If you feel your child no longer needs a med, check with her pediatrician before discontinuing.
Unfinished prescriptions of antibiotics have been blamed in part for the recent rise in drug-resistant strains of certain pathogens such as strep or staph.
If your child gets sick in the middle of the night, the closest 24-hour pharmacy is more than five miles away, and there’s medicine at home that’s “only” a month or two past its expiration date, what do you do?
Toss it out and head to the drugstore. Once medications are past their expiration dates, they may become less effective, and in some cases, the medications can deteriorate and have a toxic effect, Mazur says.
Medicated ointments can be powerful stuff, especially certain steroid preparations. Parents sometimes assume that if a little is a good thing, then a lot should be a great thing. Overuse or misuse of steroidal preparations can cause damage to the skin or accelerate an infection.
Overuse of topical steroids can thin the skin, creating changes in the connective tissue of the dermis. They also can depress the skin’s ability to ward off a bacterial or fungal infection. Parents often assume they know the type of rash children have and grab the steroid cream prescribed for a prior malady, “only to find out that this time, it is not an allergic reaction to something, but is in fact a fungal infection,” Mazur says. Suddenly, the rash has proliferated to a much larger area.
Use any topical medication only as directed. Once the skin lesion has healed, do not assume that the next bump or red patch will require the same medication or regimen. "Steroid creams and ointments which include over-the-counter cortisone creams can also take the swelling down just enough to mask the underlying cause of the lesion, making it difficult for the doctor to diagnose the real problem," Mazur adds.
If your child has been prescribed a steroid ointment, do not cover the affected area with a bandage unless doctor-directed. This increases its absorption many times over. And, most important, do not assume that the percentage of your steroid’s active ingredient is safe for your child.
Finally, different strengths are formulated for different parts of the body. What belongs on the thicker skin of the arms and legs can cause serious damage if used on the delicate skin of the face. Cases of glaucoma have even been reported from improper use of steroid creams on the eyelids.
Three youngsters with three different medications and suddenly, you’re taking your SAT all over again. It can be so confusing. Certain medications shouldn’t be taken together. Some are taken with food, others without. Some can’t be taken with milk products; others require it. Some medications must be refrigerated; others only after opening and then some must be stored away from sunlight. (And, some medicines require that your child be kept from sunlight!) Who can keep track?
The only way to be certain is to read the instructions, reread them and read them again. Then, use a highlighter pen to underscore specific instructions. If you are still unsure, read the accompanying pamphlet, Mazur says, or swallow your pride and make the call to the doctor or pharmacist. It only takes a few minutes and can help keep your child safe.
UPDATED: 12-12-2007
Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
©2000-2006 Office of Institutional Advancement, UT-Houston
Dr. Lynnette Mazur is a professor of pediatrics at the UT Medical School.
See Dr. Mazur also at:
Summer Carbon Monoxide Dangers
Generators used to cool off homes in hot summer months can cause death through carbon monoxide (CO) poisoning.
CO is an odorless, colorless gas that can kill or seriously and permanently injure people who inadvertently breathe in the noxious fumes emitted from generators in an enclosed space.
During hurricane season, emergency rooms see a rise in cases of CO poisoning from people bringing generators into their homes to provide power, often for cooling fans as well as cooking.
“During Hurricane Rita, we had a family of five die here in Houston for CO poisoning,” reminds UT Medical School Hyperbaric Medicine expert, Dr.Caroline Fife. “The Center for Disease Control and Prevention tracked deaths from CO poisoning due to combustion engines after Katrina and Rita and there was a dramatic increase.”
“Teak surfing”—holding on to the back of a power boat’s swim platform and being towed—is another danger. The boat’s exhaust pipe is in the face of the swimmer.
People riding in the back of pick-up trucks are at risk, too. Numerous cases have been cited of children poisoned by riding beneath tarpaulins or enclosed “cabs” in the back of the truck. In these cases, the trucks had a leak in the exhaust system or a rear-exiting tail pipe, not a side exit.
Fife also has seen this in boats with malfunctioning exhaust systems. She urges doctors and bystanders to pay special attention when groups of people begin to feel ill at the same time, particularly severe headache and nausea. Children often become symptomatic before adults.
“People associate CO poisoning with cold weather and northern states, but in the South, we see it a lot in summer with people just trying to stay cool,” Fife says.
