Who’s Medication?

This 16 year-old boy hurt his knee playing basketball, banging it into another player’s knee. He was brought in limping by his mom. “Did you give him anything for pain?” I asked. “I gave him one of my prescription ibuprofens,” mom replied. I gave a little jerk inside: you did WHAT?  But I checked myself from berating her, because mom actually did right- ibuprofen is safe, good for her son’s injury pain, and he was big enough to tolerate that dose. She chose right, but I had instinctual alarm because some parents don’t.

Parents give their kids all kinds of medications- old prescriptions, over-the-counter (OTC) meds, herbal supplements. Using someone else’s prescription is fraught with danger. Those medications are available only by prescription for a reason; their misuse can harm. OTC medicines are typically safer; thus the FDA allows people to buy them without a doctor’s okay. But sometimes they can be dangerous if used improperly.

Among the safest, most effective, and most under-used medications are OTC fever and pain relievers. It’s hard to hurt kids with Ibuprofen and acetaminophen (Tylenol), and they work great. However, some parents are afraid to use them, or give enough. I’ll ask “how much Tylenol did you give?” Mom will indicate a tiny portion of the dropper, and I’ll say “no wonder her fever didn’t break, she didn’t get near enough!” Mom’ll look sheepish and say she was afraid to overdose her child. We laugh, and then have a conversation about effective dosing.

Sometimes parents worry these’ll make their child too sleepy, as if they’re narcotics. However, no one’s ever seen drug dealers pushing ibuprofen or Tylenol: “Psst, over here! This’ll get you high!”  Some kids do sleep after these medications, but not because of narcosis. It’s because their pain or fever’s relieved, and they can finally rest!

Other safe OTC medications include Peptobismol and Imodium for diarrhea, and laxatives for constipation. Except when parents give laxatives when they think their kid’s cramps are from constipation. If they’re actually from a stomach virus, the ensuing diarrhea from the virus plus the laxative is really bad!

Even doctors make mistakes with medications and their kids. During my residency, one of the pediatric oncologists rushed his toddler into the Emergency Department. He’d  been brushing his teeth at the bathroom sink, and looked down to see his boy sucking on a bottle of Visine eye drops. The doctor’s eyes bugged out, and he scooped up the toddler and zipped in. After several days in the Pediatric Intensive Care Unit, the boy’s heart rhythm quit hiccuping in scary ways, and he went home. I remember thinking: why did he buy Visine in the first place?  It’s not even good for eyes, much less exploring children.

Above we discussed safe and helpful over-the-counter (OTC) medications. Conversely, most OTC cold medicines are bad for children: they don’t work, and they’re not safe. They’re not deathly harmful, or the FDA wouldn’t allow their sale. They also get a pass from the FDA because they’ve been around for decades. But they’re not good: they can  make kids jittery and irritable. One time I gave a kid a prescription version of a cold medicine, the mom was so desperate for relief. The next time I saw her in the Emergency Department, she had dagger-eyes for me. I asked, what’s wrong?  She told me after giving her child that medicine, he screamed all night. That’s why we don’t  prescribe cold medicines. And they don’t relieve coughs and runny noses either.

Asprin is another OTC medicine kids shouldn’t get. In the 1970s they found that children who got Influenza or Chicken Pox viruses, and aspirin for their fevers, had liver damage. Thus for your child’s fever and pain, Tylenol and ibuprofen only. Beware, aspirin comes in forms you may not recognize as aspirin, like BC Powder or Goody”s.

Above we also mentioned not using old prescriptions. They’re available only by prescription for a reason- their potential harm. Certainly don’t give your kids old narcotics. If you get the dose wrong, they could stop breathing. Never give children old antibiotics either, since each antibiotic has a specific use and probably won’t work for this new illness.  Also, they have side effects like allergic reactions or yeast infections. Leave the prescribing to us!

Cold Medicines- Still in the cowboy days

When I was in medical school, one of my professors told a story of when he was snowed in in a cabin in the woods, and one of his kids got a cough and runny nose.  He had no cold medicine with him, so he mixed his own like they did in the cowboy days- whisky, honey, and lemon.  “And by God,” he told us, “it worked!”

The science of treating coughs and colds has not come very far since those days.  There is still no medicine that science has shown helps much for coughs and runny noses from cold viruses.  When the drug companies come out with a “new” cold medicine, like they did most recently with Mucinex, it is just the same ineffective ingredients in a new package. 

Now, some people swear by their favorite cough medicine.  “Works every time!” they crow about their Robitussin or Dimetapp.  However, what is working is the Placebo effect, a psychological trick where if you believe in the medicine, it seems to work.  When you test the medicine in a blinded study, where you can’t tell the medicine from a dummy fluid, patients report no difference between the medicine and the dummy.  In 2007 scientists tested honey against dextromethorphan (the “best” of the cold remedy ingredients).  Guess who won- honey! 

Most prescription cough and cold medicines are no better.  Most of these are anti-allergy medicines, and if your cold is from a virus instead of an allergy, good luck.  The only prescription that has been shown to really help for coughs is codeine, and that really only for dry, hacky coughs.  And you can’t give codeine to a kid under 3 years-old.

So next time your child gets a cold, try the things I talk about in the “Cold in Babies” category.  Don’t ever smoke in the house.  And feel free to try your favorite grandma remedy- chicken soup, honey, lemon.  Just please leave out the whisky!