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!

Taking Care of Fever and Pain in the Middle of the Night

When the sun goes down, people worry more.  They stay awake at night worrying about their job, their relationships, their finances.  There are few other people awake with whom to talk the worries out.  And when kids get sick with fever or pain at night, the worriers bring their kids to the Emergency Department.  When I ask “Did you give any medicine?” for the ear pain or fever, often they say no, or they did give some but not nearly enough.  And why didn’t you give more?  “I was afraid to.”

Fear is the enemy of the parent and the pediatrician at night, and knowledge is the weapon we give to parents to fight that fear.  The first knowledge point, that I repeat again and again in this blog and at work: fever will not hurt your child.  Fever does not cook brains.  Fever and seizure are very rare, and the seizures do not hurt your child either.  Fever is not the enemy, fear of fever is. 

The second point then is this: give a medicine for the pain and the fever, and give enough.  Most of the time enough medicine will help reduce the fever, take away the pain ,and get you easily through the night where you can see your doctor the next day.  Medicine is not the enemy, fear of the medicine is.

Our two pain and fever medicines are acetaminophen (Tylenol) and ibuprofen (Motrin, Advil).  If you give as much as it says to on the bottle (not less!), and give it at the recommended times, you will be perfectly safe.  If you are not sure of your measurements, call your doctor or the pharmacy.  Your doctor should have someone to talk to at night, and there are 24 hour pharmacies in the area as well.  It is much better to call first and give enough of the right medicine than to come into the Emergency Department and wait for hours for something you could have taken care of at home. 

When you measure medicines, you need to be sure you are measuring with the right spoon.  “Infant’s” pain and fever medicines come with their own measuring droppers- use only the dropper that came with the bottle- don’t use any other thing to measure those with.  For ”Children’s” medicines that call for teaspoons, use a measuring teaspoon like you would use for cooking.  Don’t use your regular teaspoons-those are often smaller than the measuring spoons and you won’t give enough medicine.  If you are not sure of your spoons, get a measuring syringe from your pharmacy or doctor, and ask about which are the right marks to measure with. 

Fear is the enemy.  Don’t be afraid of fever and pain.  Don’t be afraid of the medicines, they are designed to be very safe.  And don’t be afraid to call for medicine advice.  We are much happier to answer phone questions about medicine at night than we are about seeing kids who could have been taken care of at home.