What you should ask your doctor about OTC medications
May 01 '01
The Bottom Line Don't assume that it doesn't pose a danger just because it's available over-the-counter. Ask your doctor these key questions.
I am not a doctor. I don't even play one on TV. I'm just a well-educated and highly "epinionated" lay person, who also happens to be the mother of a soon-to-be one year old son. So why should you take my advice on "What you should know about over-the-counter medication for infants"?
The quick answer is: you shouldn't.
I say this not because there is any doubt at all in my mind about the accuracy and helpfulness of the advice I am about to dispense. I know that everything I am about to say is solid, useful information backed up by reliable medical authority. But you don't know that. Even if you are among that select group of epinionators who "trust" me, you don't really know me well enough to take my word on a matter that could mean life or death for your child. And that's no hyperbole. Overdoses and misuse of over-the-counter medication are serious matters that can have tragic consequences, especially where a young child is concerned.
So if you can take away only one piece of advice from this epinion, let it be this: Don't ever consider an epinion (even one written by me) to be a reliable source of medical information. Always check with your doctor before giving your infant any new medication.
Gee, this is going to be a really helpful epinion, isn't it? If I have to talk to the doctor first anyway, why should I even bother to read what she's got to say?
Glad you asked.
While I dearly hope you will not actually medicate your child solely on the basis of (alleged) facts you read in this or any other epinion, that doesn't mean that I think an epinion in this category can't be helpful. While you shouldn't expect to get definitive answers from it, what you can get are questions. Questions that you might not have thought to ask otherwise. Questions that your doctor might not think to answer unless you explicitly ask.
So without further ado, here are my nominations in the newly-renamed category of "Most Important Questions to Ask Your Doctor about Over-The-Counter Medication for Infants". Along with the questions, I will provide answers, which you should treat with all the respect due to a medical opinion offered to you by a complete stranger who doesn't even claim to be a doctor.
1. What medications can I use to bring down a fever?
Tylenol and Motrin, in special formulations for infants, both work well for reducing fever and are safe when used as directed.
Both medications are available in over-the-counter infant formulations, usually in the form of in highly sweetened, vaguely fruit-flavored drops taken orally. Generic versions of infant Tylenol are widely available: they are usually billed as "Non-Aspirin Pain Reliever for Infants" and contain the same active ingredient, acetaminophen. Generic versions are just as safe and effective as the name brand Tylenol. The active ingredient in Motrin is ibuprofen. I have not seen a generic version of Motrin for Infants, but your drugstore may well carry one.
The dosage for children under age two is based on weight as well as age. It is important to check with your doctor for the correct dosage if it has been a few months since the last time s/he recommended a dosage.
2. My drugstore carries both "Infants' Tylenol" and "Children's Tylenol". Does it matter which I use?
Yes! Many people fail to realize that "Infants' Tylenol" is more concentrated than the Children's version (the same applies to most other medications).
Read that sentence again; it's no typo. The infants' version is about three times more concentrated than the children's version. If you've already had the experience of trying to get an infant to swallow a dropperful of medicine without spitting it right out, then you'll understand the reasoning behind this seemingly odd fact. With a more concentrated formulation, you don't need to get as much liquid into baby's throat. Older kids, on the other hand, can take a larger volume of liquid from a spoon or medicine cup.
While there's a good, solid reason to make Infant's Tylenol more concentrated than the children's version, it can cause serious problems if a parent isn't aware and careful. When your baby becomes a toddler, at some point your doctor will begin to give you dosages for Children's Tylenol. If you carefully measure that amount of medication, but inadvertently use the infants' formulation instead of the children's version, you will be giving your child three times the recommended dosage!
3. Whoops! Well, it's just Tylenol after all. An overdose isn't really a big deal, right?
It's a very big deal. Tylenol may seem like an innocuous drug, but it doesn't take much to overdose. And overdosing on Tylenol can lead to serious liver damage and even death if not treated promptly. An overdose of Tylenol is an emergency; call your local Poison Control Center immediately if you suspect an overdose, even if the child appears to be unaffected. Which reminds me, you do have the Poison Control phone number posted on or near your telephone, right?
4. Yikes! That's scary. What can I do to be sure I don't inadvertently overdose my child?
First, don't get too worried. As I mentioned above, Tylenol is perfectly safe when used as directed. So don't be so scared that you avoid using it at all.
There are some simple precautions that you can use to make accidents very unlikely. First of all, always use only the dropper, spoon or medicine cup that comes with the specific medication you are using. If you find yourself filling that Infant Tylenol dropper ten times over to get to the two teaspoons that your doctor said to use, alarm bells should go off in your head.
Secondly, be sure that you are aware of the active ingredients of every medication your infant is taking. Many cold remedies include acetaminophen among their ingredients; if you give your child the baby equivalent of Nyquil for nasal congestion and then add some Tylenol on top for the fever, you just exceeded the recommended dosage for Tylenol. Always check the labels. When in doubt, call your doctor.
Keep all medications stored safely out of baby's reach. The medicine s/he detests when forced to take it may inexplicably become a temptation when s/he manages to reach it when you're not looking.
Don't give your child an extra half-dose just because s/he spit out the first dropperful. That bright orange stream running down the baby's chin to a big orange splotch on the bib always looks like a lot more than it actually is. You don't really know how much went down and it's better to err on the side of not overdosing. But see below for what to do when the recommended dosage of Tylenol isn't bringing down the fever.
5. Neither Tylenol nor Motrin alone is enough to bring down the fever. Now what?
Give them both. Yes, it is perfectly safe to give your child (or yourself, for that matter) both Tylenol and Motrin simultaneously in their respective recommended dosages. They operate completely independently in the body and you need have no concern about combining their use.
This information can be a real life saver when your child is spiking a fever and (a) it's only been three hours since the last dosage of Tylenol and you don't want to wait another hour to give him/her some relief or (b) you just squirted a dropperful of Tylenol into your screaming baby's mouth and most of it came spraying right back at you. As long as you keep to the recommended dosages and frequencies for each medicine, you can give them both simultaneously or in staggered schedules.
6. My baby starts screaming as soon as s/he sees the medicine dropper. Is there any other way I can administer the medicine that will be less traumatic?
Infant acetaminophen is available over-the-counter in suppository form under the brand name FeverAll (actually, in my pharmacy it's more literally behind the counter -- if you don't see it on the shelf, ask the pharmacist if they carry it).
Now stop snickering. If your baby doesn't seem to mind having a temperature taken rectally, but throws fits when you try to administer oral medication, a suppository may be the answer. As a new parent, you'll just have to deal with the embarrassment; it comes with the territory. FeverAll is also available in both infants' and childrens' formulations; be sure to check with your doctor on the correct dosage.
You can also try a different brand of oral acetaminophen, which may have a flavor less offensive to your child. But don't hold your breath; if your child objects to oral medications, it's likely to be less the taste than the basic concept. Try working on your technique; it's usually best to try aiming the dropper off to the side, deep into the baby's cheek rather than straight down the throat. Some medications can be mixed with milk or applesauce, but this can make it difficult to get the dosage right. Check with your doctor whether a particular medication can be administered in this way.
7. Ok, you've talked a lot about fever medications. What about nasal congestion?
The number of products available for treating nasal decongestion has dropped significantly since the FDA's recent health advisory on phenylpropanolamine hydrochloride, also known as PPA:
http://www.fda.gov/cder/drug/infopage/ppa/advisory.htm
PPA had been very widely used in over-the-counter nasal decongestants, including those marketed for children; these have now been removed from the market. Any decongestant now on sale in the US should be PPA-free.
Among the remedies now available, my pediatrician now recommends PediaCare for nasal congestion; you should, of course, consult your doctor before using any such product.
8. Do I really have to call the doctor every time I give my baby some OTC medication?
No, actually, you don't. But you should check with the doctor the first time you give your child a new medication or if it has been a while since you checked the dosage. And you should ask your doctor for guidelines on what types of symptoms or circumstances warrant a call and which medications are ok to give routinely. In any event, if the symptoms persist longer than the doctor indicated would be expected or if your gut tells you that something is seriously wrong -- even if you can't articulate exactly what it is -- call your doctor.
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Location: New York, NY (it's a hell of a town!)
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About Me:
Company president, math geek, first time mom at 39, epinion addict. Sleep? Not lately.
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