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Use Of Medicines In Children

11 Feb 2008 8:26 PM - Dr Roger Morris

Because ‘Over-The-Counter’ (OTC) medications are readily available, it is often assumed by parents, and even by doctors, that they are safe, even in the situation of overdose. However, like prescription medications, OTC medicines can cause side effects, especially if the dose is incorrect or if the child has an underlying medical illness. The main type of OTC medicines used includes paracetamol, cough and cold formulations, antihistamines and vitamin preparations. Concerns have been raised in some quarters that the use of OTC medications may delay the diagnosis of serious illness such as bacterial meningitis and appendicitis. However, other than reduction in fever, OTC medications are unlikely to significantly affect the ability of a doctor to diagnose serious illnesses in children. It is important to remember that the dosage for most medicines in children – including OTC – is calculated using body weight. Therefore it is important to know the current body weight of the child being treated. It is also important to remember that dehydration from illness reduces the ability of the body to process and eliminate medications and can make over-dosage from accumulation of OTC medications in the system more likely. Many combination OTC medications may contain paracetamol or antihistamine and this should be taken into account when administering multiple different medications to avoid accidental overdose.

Paracetamol is the most commonly used OTC preparation in Australia and is safe if used in the recommended dose for relief of minor aches and pains. Fever reduction alone is not an appropriate indication for the use of paracetamol, as it is recognised that fever is a normal and beneficial physiological process the body uses to fight infection. A fever below 41 degC is not, in itself, dangerous and should be treated with extra fluids and rest. It is obviously important, though, to discover the cause of the fever and exclude immediately life-threatening infections. In overdose or with accumulation due to prolonged use, paracetamol can cause fatal liver failure. Regular use should not exceed 48 hours with a maximal dose of 60mg/lg/day. It should not be ‘double-dosed’, nor should it be combined with other antipyretics such as ibuprofen to suppress fever. Parents need to be aware that there are variable strengths of paracetamol mixture available and strengths should always be checked prior to administration. Aspirin should never be used as an OTC medication in children as there is a significant risk of Reye’s syndrome resulting in possibly fatal liver failure if used under the age of 15 years. Ibuprofen is similar in effectiveness and side effects to paracetamol, and can be used as an alternative for the relief of pain and discomfort associated with illness and fever. There is a slight increase risk of intestinal bleeding with ibuprofen, as well as kidney impairment in dehydrated children, and a small risk of asthma in susceptible individuals. Although widely promoted for treatment of colds and flu, there is little evidence that the use of decongestants and cough mixtures in the symptomatic relief of viral infections in children. Promethazine (‘Phenergan’) should not be used in children under two years of age due to extreme sedation and the theoretical risk of SIDS.

Complementary & Alternative Medicines (CAM) cover a range of medicinal products including herbal remedies, dietary supplements, homeopathic medicines, vitamins and minerals. CAM therapies are frequently used within the community, including in children. Many parents assume that CAM are natural and therefore safe. However, like other therapies, CAM carry the potential for both benefit and harm. CAM may interact with other prescribed and OTC medicines, and use of CAM should always be disclosed to your doctor. The diversity of CAM makes it very difficult to monitor and document beneficial effects and, more importantly, potential interactions and adverse effects.

Source: http://www.australiandoctor.com.au/htt/pdf/AD_HTT_025_032___JUL21_06.pdf