Welcome again to another pediatric blog. The holiday season has quickly descended upon us and is in full swing. I hope everyone had a great Thanksgiving filled with good food and family. I know most of us are now busy with decorating, shopping, planning and attending holiday parties, while trying to enjoy our families and any visitors so I will keep this blog short.
This week’s topic was touched on briefly in the last blog but being that it was towards the end it may have been skimmed right over. I think it deserves its own dedicated blog because it is very important and I have been getting a lot of questions at sick visits about this topic as well. The topic is: Which over the counter medications can I give my child (infant, toddler, child, and adolescent)?
I want to start with the most important piece of information in this blog and if you read nothing else in this blog please at least read this:
Over the Counter Combination Cough, Cold, and Flu Medications:
**These medications are not recommended for children less than 4 years of age**– They are not recommended because they contain several different medications within the dose and many children have overdosed accidentally. For example Tylenol Cold contains Acetaminophen, Phenylephrine HCL, and Dexamethorphan; so many parents do not know what these drugs are and would potentially give a dose of Tylenol or something else on top of this leading to overdose and harm. As a result, the FDA required manufacturers to pull all combination medications marketed for children under four from store shelves. Another reason they are not recommended for children younger than four is that they have not been adequately studied, meaning at this time we are unsure if they cause harm or damage to organs such as the liver at that young of an age.
I typically do not recommend these combination medications to children of any age because many of them contain two or three medications and most of the time are not warranted or needed. For example, why take Tylenol Cold that has Acetaminophen, Phenylephrine HCL, and Dexamethorphan for just a cough; the Dexamethorphan will help a cough but then you are giving the child two other medications that they do not need. This is why I generally recommend that parents treat specific symptoms, for example fever with Tylenol or Motrin or a cough with Dexamethorphan. So you may be asking what if my child has two symptoms I need to treat, for example, fever and cough. In this case you could give a dose of Tylenol and a dose of the cough medicine. With the typical progression of the illness, fever should resolve in 2-3 days so then you could stop giving the Tylenol and just continue the cough medication for a cough.
Alright with that out of the way let’s get back on track now with other available over the counter medications:
Tylenol (Acetaminophen): this medication is used to reduce fever and for minor aches and pains (headache, muscle ache). This is widely available and comes in different formulations such as liquid, chewable and tablet/capsules. It is also available in dosing specific for infants and children so pay attention to the bottle when purchasing. This medication can be given every 4 to 6 hours as needed.
Motrin (Ibuprofen): this medication is also used to reduce fever and for minor aches and pains. It also is the drug of choice for inflammation or swelling due to injuries, such as a sprain. It too comes in different formulations such as liquid, chewable and tablet/capsules. It also is available in dosing specific for infants and children so pay attention to the bottle when purchasing. NOTE: This medication should not be given to infants less than 6 months of age. It is typically given every 6 hours.
Note: It is not recommended to give these two medications (Tylenol and Motrin) at the same time or in alternating schedules/dosing. When given in alternating schedules it is easy to forget which medication was given last and/or timing of the last dose there is a potential to overdose.
Benadryl (Diphenhydramine): this medication is used for rash, sneezing, itching caused by allergies or allergic reactions. This is widely available and comes in different formulations such as liquid, chewable and tablet/capsules. It is typically given every 6 hours.
Phenylephrine HCL: this is a nasal decongestant, which means it reduces the inflammation in the nasal passages caused by allergies and colds. It does not last as long as the medication below. It is typically given every 4-6 hours. This medication is usually found in certain forms of Sudafed or Suphedrine (Wal-Mart Brand).
Pseudoephedrine: like the above medication, this is a nasal decongestant. Since pseudoephedrine can be made into methamphetamine, the U.S. Senate passed a bill restricting its sale, so most manufacturers are steering away from using this drug. Pseudoephedrine containing products can still be purchased in limited quantities, but identification and signatures are required. It is typically given every 6 hours. Sudafed and Advil cold and sinus are common medications that this drug is found in.
Dexamethorphan: is a cough suppressant used to treat a cough. It is found in Children’s Delsym, Robitussin, Tussinex, Dayquil, and Nyquil to name a few. Usually dosed every 6-8 hours but pay attention to the bottle as some extended release dosing available and is typically dosed every 12 hours.
Guaifenesin: this is an expectorant and works by thinning mucus so it can be coughed up or blown out via the nasal passages. Usual dosing is every 4-6 hours but again paying attention to the package as max strength might be every 12 hours. Products that typically contain this medication are Mucinex and Tussin.
As you can see there are many available products containing similar sounding medications in them which makes it very confusing. On top of that, there are different strength of the medications which changed how frequent they can be given. It makes it even more confusing when there are multiple of these in one packaging ( the combination medications) which is why they are not recommended for children less than four and why I typically don’t recommend them to any of my patients. The last four (Phenylephrine HCL, Pseudoephedrine, Dexamethorphan, Guaifenesin) are okay to use, when given by themselves, in children over 6 years of age but I typically don’t recommend them until pre-teen and adolescent age (11 and up). I find that these medications, especially the cough medications, do not usually help and that they sometimes cause side effects. I tend to recommend more natural products such as drinking tea with honey for a cough and saline drops or spray for congestion. Other products such as Vicks vapor rub and using a humidifier in the room also help with a cough and congestion.
If you have any other questions or concerns you could always call and schedule an appointment with your child’s provider. That wraps up this blog and I hope everyone enjoys the holiday season and stay safe.
Written By: Christopher Elkins, CPNP
Practitioner Elkins was born and raised in Chapel Hill, North Carolina. He is a board certified Pediatric Nurse Practitioner by the PNCB (Pediatric Nursing Certification Board). He sees patients from birth to 21 years of age. Christopher and his wife Erin have an 8-year-old son, Everett and are expecting another baby boy in October 2017. Christopher and his family enjoy traveling to the mountains of North Carolina in the fall; enjoy the beaches during the summer, and concert-going all year round.