How to Avoid Overmedicating your Child

Sneezing, sniffling, coughing, the past three days are a blur. Tissues piled on every surface, a chorus of coughing echoes through the house, and you’d give a million dollars for two consecutive hours of sleep. As you swig a shot of Nyquil right from the bottle, you wonder, maybe we could cut the adult dose in half for junior here and all get some sleep tonight.

Not so fast! As tempting as that sounds, medicating our children is just a bit more complicated than that. These munchkins are not just little adults, they’re built a little differently. They have their own little metabolisms and are not just pint sized replicas of us despite their gigantic ability to spread whatever illness they contract. In fact, even the medications that are made and marketed specifically for them should be used with caution as the risks of side effects are great and damage to their liver and kidneys can occur if used incorrectly or too often.

So how do we manage our little one’s symptoms so we can all get some rest?
Before we medicate, we need to educate, it can be done. So here is what you need to know before medicating your tyke:

Your child’s weight: All pediatric dosages should be based on weight, not age. The average weight of a two year old can be 20-30 pounds. That can be a huge difference in the amount of fever medication received over several days time, the bigger kid would be OK, the smaller one would be overdosed and could face problems later on. Do you know your child’s weight?
So your toddler won’t stand on the scale and it’s been three months since the baby was weighed, whatever you do, don’t guess. Here’s the next best thing: grab that screaming infant or toddler and stand on the scale together, then put them down and just weigh yourself. The difference between the two weights is the child’s weight. It’s not rocket-science accurate, but close enough.

Medication and strength: The active ingredients, the mg / mL of each drug listed.
In case you’ve never noticed, you can have a medication that comes in several forms (infant drops, elixir, chewables, tablets, capsules, suppositories) and each has it’s own mg/mL or mg/pill strength. You have to know what you’re working with. If you need to call the doctor or a pharmacist for a dose, they will require the name of the active ingredient and it’s strength.

How / what you’re going to measure with:
Some medicines come with their own measuring device, either a cup or dropper. If you have lost the measuring device, don’t be tempted to use a household spoon. Although technically a teaspoon is equal to 5 mL, household ‘teaspoons’ vary in size, so unless you are using a true measuring spoon, it won’t be accurate. Giving even 1 mL too much to a baby can be serious. Tip: next time you’re at the pharmacy, ask for some oral medication syringes, and keep them on hand.

How often you’re going to medicate: Read the fine print.
What does the label say? Some medicines say they can be given every 4 hours, but when you look at the fine print, it says not to exceed @#$ mg in 24 hours. If you do the math, it works out that you can only give 5 doses in a 24 hour period, that’s not every 4 hours, and if you give it every 4 hours, you would overdose your child.

The symptoms you want to treat:
What are you wanting to accomplish? Are you trying to help with one symptom or three? For kids, especially younger ones, it is best to use medications that are for one specific symptom. It is easier to figure out and control the actual dosing of the medicine. For older kids, a multi-symptom cold reliever is OK if the child is suffering from all the symptoms listed, but figuring out the correct dosages for each ingredient can be tricky, especially if it is an adult medicine. It can be done, but is not recommended, try and use pediatric multi-symptom cold medicines for kids between 6 – 12. Kids under 6 should not take multi-symptom medicines.

So you’ve decided to medicate, here are some tips and alternatives to try, and things to watch out for with each symptom reliever:

Nasal Congestion:
For children under 2: antihistamines and decongestants have not been found to be effective and are not routinely recommended due to the risk of side effects which include rapid heart beat, irregular heart beat, flushed skin, drowsiness, lethargy, irritability and hyperactivity. However, there are several non-medication alternatives that help with these symptoms.

Humidifier (cool mist) or vaporizer (warm mist) help to keep secretions loose so they can drain better. For nasal congestion, suctioning the nose with a bulb syringe will help clear the nasal passages. If the secretions seem thick, a few drops of saline can be placed in the nostril just prior to suction to loosen it for easier removal. You should occlude the other nostril during suction for best results. If the nasal secretions are constantly running, you can suction first, then use the saline drops and suction again. The salt in the saline will help to dry up some of the mucous.

Tip: suction infants prior to each feeding, they will eat better. Let infants sleep sitting in their car seat, having their heads elevated helps with drainage of nasal secretions.

For children over 2: use decongestants and antihistamines sparingly.
Humidifiers /vaporizers help as listed above. Prop kids on pillows so their heads are elevated to help with nasal drainage during sleep. Encourage them to blow their nose, or use the bulb syringe to help clear their nose if they are not able to. Saline drops can be helpful in drying up secretions, but stay away from decongestant nasal sprays, they usually aren’t tolerated well and tend to make congestion worse if used more than one or two days.

Cough
Coughing is good, it helps remove secretions that have migrated down toward the lungs. We usually don’t want to interrupt the body’s way of keeping the chest clear, so most pediatricians don’t recommend cough suppressants in children younger than 6. Most often a cough in younger children is related to draining nasal secretions. Keeping the head elevated helps prevent the mucous from pooling in the back of the throat, young infants especially have difficulties with coughing and gagging when they lay flat.
This is not to say that we never give cough medicine to kids. If you have a child (who is not an asthmatic) and has a persistent dry cough that is keeping him (and you) awake at night, it may be appropriate to give a cough suppressant prior to bedtime. A humidifier will help moisten the air and lessen the irritation and dryness of the airways as well.
Tip: If your child is wheezing, breathing faster or harder, or is a known asthmatic, do not give cough medicine, and have them seen by the doctor right away.

Fever
A plethora of fever reducers for kids are on the store shelves. With so many different forms and strengths, it can be very confusing to know which one to choose. This is where it is helpful to keep the measuring device with the medicine it came with to avoid potential confusion and mis-dosing. Every child will eventually have a fever, and this is probably the most overused and often abused class of medication in children. What seems like innocent medicine, antipyretics like Tylenol and Motrin can cause lifelong damage to liver and kidneys if used for prolonged periods of time, or in excessive doses.
Tip: Ibuprofen (Motrin/Advil) should not be used in infants under 6 months of age, unless prescribed by physician. No medication should be given to a febrile infant under 3 months of age. Fever in small infants may indicate a severe bacterial infection, they should be seen by a physician right away.
In addition to giving antipyretics, comfort measures to help reduce fever are to dress the child in lightweight clothing, sponge head and neck with warm water and let it evaporate off skin, and to encourage them to drink cool liquids. Avoid over-exposure or chilling which may cause the child to shiver. Shivering is the body’s way of generating heat, it will drive the temperature higher.

So as you lay in bed with your head propped up on pillows, listening to the hum of the humidifier, and waiting for the decongestant to kick in, breathe easy knowing that this too shall pass.