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"Open wide ... here comes the choo-choo."
When it comes to giving children medicine, a little imagination never hurts.
But what's more important is vigilance: giving the medicine at the right time at the right dose, avoiding interactions between drugs, watching out for tampering, and asking your child's doctor or the pharmacist about any concerns you may have.
Whether it's a prescription or over-the-counter (OTC) drug, dispensing medicine properly to children is important. Given incorrectly, drugs may be ineffective or harmful.
Be careful when giving children prescription drug doses, because such drugs are often addictive, and might eventually lead to teen drug abuse when they grow up.
READ THE LABEL
"The most important thing for parents is to know what the drug is, how to use it, and what reactions to look for," says Paula Botstein, M.D., pediatrician and acting director of the Food and Drug Administration's Office of Drug Evaluation III. She recommends that a parent should ask the doctor or pharmacist a number of questions before accepting any prescription:
CHECK FOR SIGNS OF TAMPERING IN ANY (OTC) PRODUCT.
The safety seal should be intact before opening. Also, parents should be extra careful to read the label of over-the-counter medicines.
"Read the label, and read it thoroughly," says Debra Bowen, M.D., an internist and director of FDA's medical review staff in the Office of OTC Drugs. "There are many warnings on there, and they were written for a reason. Don't use the product until you understand what's on the label."
Make sure the drug is safe for children. This information will be on the label. If the label doesn't contain a pediatric dose, don't assume it's safe for anyone under 12 years old. If you still have questions, ask the doctor or pharmacist.
Children are more sensitive than adults to many drugs. Antihistamines and alcohol, for example, two common ingredients in cold medications, can have adverse effects on young patients, causing excitability or excessive drowsiness. Some drugs, like aspirin, can cause serious illness or even death in children with chickenpox or flu symptoms. Both alcohol and aspirin are present in some children's medications and are listed on the labels. (SEE Aspirin and Children)
YOUNGER AND TRICKIER
The younger the child, the trickier using medicine is. Children under 2 years shouldn't be given any over-the-counter drug without a doctor's OK. Your pediatrician can tell you how much of a common drug, like acetaminophen (Tylenol), is safe for babies.
Prescription drugs, also, can work differently in children than adults. Some barbiturates, for example, which make adults feel sluggish, will make a child hyperactive. Amphetamines, which stimulate adults, can calm children.
WHEN GIVING ANY DRUG TO A CHILD, WATCH CLOSELY FOR SIDE EFFECTS.
"If you're not happy with what's happening with your child, don't assume that everything's OK," says Botstein. "Always be suspicious. It's better to make the extra calls to the doctor or nurse practitioner than to have a bad reaction to a drug."
And before parents dole out OTC drugs, they should consider whether they're truly necessary, Botstein says.
Americans love to medicate--perhaps too much. A study published in the October 1994 issue of the Journal of the American Medical Association found that more than half of all mothers surveyed had given their 3-year-olds an OTC medication in the previous month.
Not every cold needs medicine. Common viruses run their course in seven to 10 days with or without medication. While some OTC medications can sometimes make children more comfortable and help them eat and rest better, others may trigger allergic reactions or changes for the worse in sleeping, eating and behavior. Antibiotics, available by prescription, don't work at all on cold viruses.
"There's not a medicine to cure everything or to make every symptom go away," says Botstein. "Just because your child is miserable and your heart aches to see her that way, doesn't mean she needs drugs."
The first rule of safety for any medicine is to give the right dose at the right time interval.
Prescription drugs come with precise instructions from the doctor, and parents should follow them carefully.
OTC drugs also have dosing instruction on their labels. Getting the dosage right for an OTC drug is just as important as it is for a prescription drug.
Reactions and overdosing can happen with OTC products, especially if parents don't understand the label or fail to measure the medicine correctly.
Similar problems can also occur when parents give children several different kinds of medicine with duplicate ingredients.
Children can easily overdose on acetaminophen! Check for dosing on OTC medicines with your pediatrician. Most of the time, the labels err on the side of caution. Dosing is determined by the child's weight, NOT age.
Pediatric liquid medicines can be given with a variety of dosing instruments:
Whether they measure teaspoons, tablespoons, ounces, or milliliters, these devices are preferable to using regular tableware to give medicines because one type of teaspoon may be twice the size of another. If a product comes with a particular measuring device, it's best to use it instead of a device from another product.
It's also important to read measuring instruments carefully. The numbers on the sides of the dosing instruments are sometimes small and difficult to read. In at least one case, they were inaccurate. The FDA received a report of a child who had been given two tablespoons of acetaminophen rather than two teaspoons because the cup had confusing measurements printed on it. The incident prompted a nationwide recall of medicines with dosage cups.
The following are some tips for using common dosing instruments:
Syringes: Syringes are convenient for infants who can't drink from a cup. A parent can squirt the medicine in the back of the child's mouth where it's less likely to spill out. Syringes are also convenient for storing a dose. The parent can measure it out for a babysitter to use later. Some syringes come with caps to prevent medicine from leaking out. These caps are usually small and are choking hazards. Parents who provide a syringe with a cap to a babysitter for later use should caution the sitter to remove the cap before giving the medicine to the child. The cap should be discarded or placed where the child can't get at it. There are two kinds of syringes: oral syringes made specifically for administering medicine by mouth, and hypodermic syringes (for injections), which can be used for oral medication if the needles are removed. For safety, parents should remove the needle from a hypodermic syringe. Always remove the cap before administering the medication into the child's mouth. Otherwise, the cap could pop off in the child's mouth and could choke the child. FDA is working with manufacturers to eliminate the safety hazards posed by the caps. Until then, parents must be extra cautious when using capped syringes.
Droppers: These are safe and easy to use with infants and children too young to drink from a cup. Be sure to measure at eye level and administer quickly, because droppers tend to drip.
Cylindrical Dosing Spoons: These are convenient for children who can drink from a cup but are likely to spill. The spoon looks like a test tube with a spoon formed at the top end. Small children can hold the long handle easily, and the small spoon fits easily in their mouths.
Dosage cups: These are convenient for children who can drink from a cup without spilling. Be sure to check the numbers carefully on the side, and measure out liquid medicine with the cup at eye level on a flat surface.
If your child's prescription medication does not supply a dosing device, ask the pharmacist which type you can purchase separately. NEVER USE A DOSAGE DEVICE FROM ANOTHER MEDICATION and NEVER ESTIMATE.
Portions have been reproduced from information contained in Publication No. (FDA) 96-3223 of the U.S. Food and Drug Administration
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Important Information on Giving Medicines to Kids