When Andrea Weinrick, of Lansing, Michigan, buys medicine for her kids, 3-year-old Elissa and 20-month-old Julian, she finds the array of choices for colds, coughs, fevers, allergies, and upset stomach confusing. "I'm never sure which brand I should get, or for what symptoms."
Andrea's predicament isn't unusual: Choosing a medication for your child can be confusing! What's the difference between a generic and a name brand? How do you calculate dosage? What's with all the different active ingredients? And how do you get your kids to actually take it?
Working with the Pharmacist
Like most parents, you're probably a quick Internet researcher, looking up every ailment that befalls your children. But the information you find might be difficult to sort out, and the credibility of the source might be questionable. Also, like most parents, you may not realize that pharmacists can do more than fill prescriptions -- they can offer advice. "Even if we look busy, we'll take the time to help you select the product that's appropriate for your child," says Winnie Landis, pharmacist and president of the American Pharmacists Association.
Moreover, it's a good idea to build a relationship with a specific pharmacist, rather than hopping around from pharmacy to pharmacy, says Ellen Guthrie, pediatric pharmacist at Children's Healthcare Pediatric Hospital, in Atlanta. "It helps to have somebody who knows, say, whether your child got hyper the last time he took Sudafed," she says. Plus, you can ask your pharmacist to call your doctor if you don't understand how to use a prescribed medicine.
But don't run to the store unprepared. First, recommends Landis, you need to have the following information on hand.
- Your child's age and weight. Don't guess! Pharmacists need this information to come up with a correct dosage. If your child isn't big enough to stand on a scale unsupported, then stand with him and subtract your weight from the number to get his weight. If you forget before heading to the pharmacy, be resourceful: when I wasn't sure of my son Isaac's current weight, we found the aisle that stocked scales and tried one out.
- Your child's temperature. The pharmacist will want to know what his last reading was and how long he's had the fever.
- The name and dosage of all medications your child is taking. If he's taking prescriptions, buy over-the-counter medicines in the same pharmacy -- the pharmacist has access to his records and can check for allergies or potential interactions.
Doing It Yourself
When your kid wakes up in a coughing fit or with an earache in the early morning and there are no 24-hour pharmacies nearby, what can you do? Here are guidelines to keep in mind before you reach quickly into your medicine cabinet.
- Think twice about using an all-in-one product. It's tempting to pick the bottle that claims to wipe out all symptoms -- after all, giving medicine is usually a struggle, and you want your kid to get some sleep. But what if the congestion clears up the next day while the fever continues? You don't want to risk an overdose; plus, you're suppressing symptoms and won't know if the illness is getting more serious. Also, your pediatrician might not recommend a cold medicine anyway.
- Make sure you have doctor-approved medications available at home. These include infant or children's acetaminophen (e.g., Tylenol) and ibuprofen (e.g., Motrin). Even so, no medicine should be overused. The FDA has recently proposed putting warning labels on ibuprofen and acetaminophen -- both common ingredients in multipurpose products -- because ibuprofen can cause bleeding in the stomach and intestines and acetaminophen can cause liver toxicity when taken for too long or in too high a dose.
In addition, doctors have long advised parents not to give aspirin (also known as acetylsalicylic acid, a salicylate) to kids and adolescents under age 19 because it's associated with Reye's Syndrome, a rare but potentially fatal disease. Salicylates are in some Alka-Seltzer products and anti-diarrheals, such as Kaopectate and Pepto-Bismol. Children's Pepto Chewable Tablets contain no salicylates and are labeled for kids ages 2 and up, but you should talk to your pediatrician before using it.
- Consider generic medications. Generic drugs have the same active ingredients as their brand-name counterparts. "The only difference between them can be the dyes, flavors, or inactive ingredients," says Landis. It's crucial to know this if your child has allergies or sensitivities to these substances.
- Use sense before you dispense. Again, you need to know your child's current weight to figure out the correct dosage as indicated on the drug's package. Then use a syringe, oral dropper, dosing spoon, or medication cup with the volume clearly marked, instead of a spoon from your silverware drawer. Various brands and types of medications might use different units of measurement -- e.g., teaspoon versus milliliters -- so make sure the correct units are on the syringe, dropper, dosing spoon, or cup.
- Dosing can be very different among formulas and within brands or medication types. For instance, Tylenol infant drops are more concentrated than its suspension formula. Read drug labels every time you use a medicine, so you don't give your child too much. If a label peels off, throw the bottle away.
- Don't combine any medications, including prescribed medicine and even herbal products. They may react with one another, so don't mix unless a doctor or pharmacist has told you otherwise.
- Pick dye-free formulas. You can get some medications, such as Tylenol, Motrin, and the antihistamine Benadryl, without dyes. Although this option is great for kids with allergies to artificial dyes, it also benefits parents who are tired of stain-treating the pink drool on their baby's clothes.
Going Down Smoothly
Let's face it: No matter how much you beg and plead with your kids, asking them to take medicine is easier said than done. Here are tips to help you win the battle.
- Mask the bitter taste. When Kathy Mayers's son was 4 years old and had to take a bad-tasting medicine for his reflux, the pharmacist suggested mixing it into a few ounces of caffeine-free Dr. Pepper: "It covers up the taste of almost any liquid," says the mom of two, in Milwaukie, Oregon. If you're going to mix medicine into another drink, such as juice, don't add too much liquid because your child will have to drink the whole thing to get the full dose of the medicine. And talk to your pharmacist before mixing medicine with dairy, such as a drinkable yogurt -- milk can sometimes affect absorption.
- Mix medicine with soft food. I've put it in applesauce for my boys. Just make sure your child eats all of it.
- "Chase" medication with a sweet beverage. If your child gets to drink something afterward that she usually isn't allowed to have, she might be willing to take her medicine.
- Ask your pharmacist to flavor medicine. Choosing the flavor -- such as apple, watermelon, or bubble gum -- helps kids feel in control, leading to less of a fuss.
- Just cool it. "Medicine tastes much better chilled than at room temperature, so put it in your fridge before giving it to your child," says Guthrie. When Laurene Tennant, of South Huntington, New York, couldn't get her toddler Will to take a bad-tasting medicine, she made small popsicles by mixing it with grape juice in ice-cube trays. The trick worked.
- Think about what's age-appropriate. For toddlers and babies, syringes and oral droppers usually work better than spoons or cups. If your toddler is under age 2 and under 35 pounds, your pharmacist can calculate the appropriate dosage of children's acetaminophen or ibuprofen in concentrated infant drops, so your kid can take less medicine.
- Create a relaxing environment. Tennant has also learned that the best way to give medicine to her son is to make sure he's calm beforehand. "I sit him in front of the TV with his favorite video," she says.
- Consider alternative routes. If you can't get your baby or toddler to swallow her medicine, you may be able to use a suppository. I'm not brave enough to try this, but I've been told it's not as bad as it sounds. On the flip side, if your doctor wants you to use a suppository and you're squeamish too, your pharmacist might be able to mix the ingredients into a gel to rub on the child's body, says Guthrie.
- Take it slow. Some kids might swallow medicine quickly, but others need time. "I tell Will that he can take a sip of medicine, then a sip of water until he finishes the dose," says Tennant.
- Use the element of surprise. "I don't make a big deal out of giving medicine," says Jessica Isaacs, of Brooklyn, New York, who has a 23-month-old toddler. "I don't say, 'It's time to take your medicine.' I give it to him when he's not expecting it, like during a diaper change."
When it comes to medicating my kids, I've learned that less is more. Make your child comfortable, relieving pain if she has any, and let her body fight off the infection. And when you're considering using something else, call the doctor first.
Cough and Cold Formulas?
Recently, the Centers for Disease Control and Prevention released a report that linked the deaths of three infants to cough and cold medications. According to the American Academy of Pediatrics (AAP), you should always ask your doctor before you give your child decongestants, cough medicines, or expectorants. These medicines may temporarily cause a little relief, "but they could be covering up something more serious or make symptoms last longer," says Daniel Levy, MD, spokesperson for the AAP. Dr. Levy points out that the symptoms these drugs can suppress -- like coughing and mucus production -- are your child's first line of defense in fighting infections; he almost never recommends these medicines for children.
Paula Gardiner, MD, a family medicine physician and research fellow at the Division for Research and Education in Complementary and Integrative Medical Therapies at Harvard Medical School, in Boston, offers these suggestions for natural and safe remedies to relieve cough and congestion.
Make a baby-safe version of a steam tent: Put some eucalyptus oil on a washcloth and toss it into the bottom of a hot shower (don't put undiluted essential oils directly onto baby's skin). Take your baby into the bathroom and shut the door. The steam from the shower will loosen mucus, making it easier for her to cough or blow her nose; the menthol from the eucalyptus will soothe her nasal passages and chest.
You can also put a few drops of an essential oil containing menthol, such as eucalyptus or rosemary, in your cool-mist humidifier or vaporizer. Or apply a few drops to a light bulb: the heat will make the vapors diffuse into the air. Vapor rubs can soothe airways, but the active ingredient can be camphor (e.g., Vick's VapoRub), which at certain levels can be toxic for babies. Look for vapor rubs that are labeled as safe for your child's age.
Last, a squirt of saline nose spray is a safe, effective way to shrink nasal passages and help break up mucus so it comes out more easily.
Meagan Francis, mom to four boys, has learned from the trenches the ins and outs of giving medicine.
Originally published in American Baby magazine, March 2007.
All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.