Dr. MJ Bazos MD, Patient Handout
A Guide to Children’s Medications:

Cold medicines, allergy medications, antibiotics, and other prescriptions, syrups, creams, drops.

Ever get confused over which medicines are made for children, when your child may need a prescription, or how much medicine to give your child? You are not alone. There are many medications that your child may need at one time or another. Some medications require a prescription from your pediatrician or other health care professional. Others, called over-the-counter medications, can be bought without a prescription. The following information will help you sort out the differences between prescription medications and over-the- counter medications, and when and how to use them.

Prescription medications
Prescription medications must be ordered by a doctor. If your child needs a prescription medication, it is very important that you understand the pediatrician’s and pharmacist’s instructions.

The following list of questions will help you find out all you need to know:

• What is the name of the medication?
• How will this medication help my child?
• Do I need to do anything before giving this medication to my child?
• How much of the medication do I give my child?
• At what times of the day should I give the medication to my child?
• How long does my child have to take the medication?
• Should my child avoid certain foods or activities while using this medication?
• Should my child avoid other medications while using this medication?
• Are there any side effects that I should know about?
• Is there anything unusual about how my child is taking this medication (for example, is it a larger than usual dose)?
• Does this medication come in other forms that may be easier for my child to take, such as chewable tablets or liquid?
• Can this prescription be refilled? How many times?
• Is there any written information you can give me?
• What do I do if my child misses a dose?
• What do I do if I give my child too much?
• What if my child spits out the medication?
• Can you show me how to use this medication?

Many medications come in less expensive forms. These are called generics. Often a generic can be used instead of a brand name. Other times it is more important to use the brand name. Talk to your pediatrician about the difference in using a generic instead of a brand name.

Ask as many questions as you need. If more questions come up after you leave your pediatrician’s office, call the office or ask the pharmacist for clarification. If your child is old enough, make sure he understands what he must do as well.

If your child goes to the hospital do the following:

• Bring your child’s health records.
• If your child is taking any medications, bring them to the hospital in their original containers. Bring a record of when your child last took the medications.
• Ask about any medications your child is given while in the hospital.

Read the label
Almost half of all parents do not correctly follow the directions on drug labels. However, labels have a lot of important information that you need to know. The illustration below shows the different parts of the label and what they mean.
a) Prescription number (you will need this number when calling the pharmacy for a refill or for insurance forms).
b) Doctor’s name and phone number.
c) Today’s date.
d) Your child’s name - this medicine is only for the child whose name is on the label. Do not give medications to another child even if the other child has similar symptoms.
e) Name of the medication or the main ingredient - make sure this matches what your pediatrician told you. There may also be information on the strength of the medication (ie, 10 mg tablets).
f) Pharmacy name and phone number
g) Refills - the label will show a number of how many refills are permitted. The label may also state "no refills – Dr. authorization required," which means you have to talk to your pediatrician if you need more.
h) QTY - "quantity" or how much is in the package
i) MFG -"manufacturer" or who makes it
j) Expiration date - do not use the medication past this date. Do not save unused prescriptions. If your child gets sick again, talk to your pediatrician.
k) Instructions - this is information about how often and when your child needs to take the medicine. Instructions on labels can be confusing. Talk to your pediatrician for specific instructions and make sure they match what is on the label.
The following are some common instructions you may find on a label:

• "Take full course" - means that your child should finish taking the entire contents of the prescription even if she is feeling better. This is especially true if your child is taking antibiotics. The infection can come back if you stop too soon.
• "Take with food"- means that you should give the medicine to your child after she has eaten a meal. Some medications work better when the stomach is full.
• "Take four times a day" - means to take the medicine four times throughout the day (for example, at breakfast, lunch, dinner, and before bed). This is different than "Take every four hours," which adds up to 6 times in a 24-hour period (for example, 6 AM, 10 AM, 2 PM, 6 PM, 10 PM, and 2 AM). If you are confused about when to give your child’s medications, talk to your pediatrician or pharmacist. Most medicines do not have to be precisely timed in order to be effective, but some do.
• "Take as needed as symptoms persist" - means the medicine can be taken when symptoms are present.

The package may also have brightly colored warning labels with additional information. The following are examples:

• Safe storage instructions, such as "keep refrigerated"
• Instructions for use, such as "shake well before using"
• Possible side effects, such as "may cause drowsiness"

Common prescription medications for children:

Antibiotics - used for bacterial infections like strep throat, some types of ear infections, sinus infections, urinary tract infections, and skin infections. Antibiotics are very safe but can have some side effects including skin rash, loose stools, stomach upset, staining of urine, or even mild to severe allergic reactions. Be sure to tell your pediatrician if your child has any side effects from antibiotics. Antibiotics (such as penicillin, amoxicillin, sulfas, and many others) can cure bacterial infections. Viral infections like colds and flu are not treated with antibiotics. New strains of bacteria have become resistant to some antibiotics because the antibiotics have been overused. When your child is sick, antibiotics are not always the answer. Your pediatrician will let you know if an antibiotic would help your child.

Ear preparations - commonly used for infections of the ear canal, like swimmer’s ear. They may cause minor side effects.

Eye preparations - for conjunctivitis (pink eye) or allergies. Some children may get puffy eyes from using these medications.

Skin preparations - for skin infections, burns, lice, rashes, and acne. When used correctly, these medicines usually have no side effects. Certain lice medications can be toxic. Talk to your pediatrician if using a medication for lice.

Analgesics - used to relieve pain. Analgesics can have many side effects including stomach upset, ringing in the ears, dizziness, irritability, and nervousness. Since young children cannot always tell you if they are feeling these symptoms, talk to your pediatrician if your child acts unusual after taking these medications.

Inhalers - used to treat asthma. Include bronchodilators, inhaled steroids, and a drug called cromolyn sodium.

Over-the-counter medications:

Over-the-counter medications (OTCs) can be bought at your local drug store or grocery store without a doctor’s order. This does not mean that OTCs are harmless. Like prescription medications, OTCs can be very dangerous to a child if given incorrectly. You need to read and understand the instructions before giving OTCs to your child.

Common OTCs for children

The following list describes some common OTCs for children. Talk to your pediatrician before giving any medications to your child.

Fever reducer or pain reliever (ie, acetaminophen, ibuprofen)
If your child has a mild fever but is playing, drinking fluids, and generally acting well, there is no reason to treat the fever. However, if your child complains of headaches, body aches, or seems irritable, there are fever reducers such as acetaminophen and ibuprofen that may help him feel better. They can also help relieve minor pain from bangs and bumps, or tenderness from an immunization.

Given in the correct dosage, acetaminophen and ibuprofen have few side effects and are quite safe. They come in drops for infants, liquid ("elixir") for toddlers, and chewable tablets for older children.

Acetaminophen also comes in suppositories for the child who is vomiting and cannot keep down medicine taken by mouth. Remember, the infant drops are stronger than the liquid elixir for toddlers. Too many parents make the mistake of giving higher doses of the infant drops to a toddler thinking the drops are not as strong. Be sure the type you give your child is appropriate for her weight and age.

Ibuprofen tends to be more effective than acetaminophen in treating high fevers (103F or higher). However, never give it to a child who is dehydrated or vomiting continuously. Also, children who are sensitive to aspirin, have a kidney disease, asthma, or an ulcer should not take ibuprofen. Ibuprofen should not be used with any other pain reliever or fever reducer, unless directed by a doctor. Read the instructions and talk to your pediatrician about dosage to avoid giving your child too much for too long.



A warning about aspirin

Never give aspirin to your child unless your pediatrician specifically instructs you to use it. Aspirin has been linked to Reye’s syndrome, a serious and sometimes fatal liver disorder, especially when given to children with the flu or chicken pox.

Antihistamines
Antihistamines can relieve runny noses, itchy eyes, and sneezing due to allergies (but not colds). They also relieve itching from chickenpox or insect bites and may even control hives or other allergic reactions. They can make some children sleepy. In other children they may cause irritability and nervousness. For that reason, avoid giving an antihistamine for the first time at bedtime. If you do, your child may have difficulty sleeping. If your child has asthma, check with your pediatrician before using antihistamines.

Mild cortisone cream
Insect bites, mild skin rashes, poison ivy, or small patches of eczema usually respond to cortisone cream. Never use it for chickenpox, burns, infections, open wounds, or broken skin. Check with your pediatrician before using it repeatedly or using it on your child’s face.

Cough syrups
Coughing helps the lungs clear out germs. A cough is "productive" if it sounds like mucus is being brought up. You can best relieve it by humidifying the air in your child’s bedroom to loosen mucus. Be sure to clean the humidifier frequently to prevent mold and bacteria buildup. Some cough medicines, called expectorants, may also help loosen mucus. Sometimes, a cough may be dry and annoying, and may keep your child awake. However, avoid using cough suppressants, as coughing is necessary to clear the lungs. Check with your pediatrician before giving your child cough medicines or expectorants, especially for use in infants. Cough syrups may not relieve cough caused by asthma.

Cold remedies
Combinations of antihistamines and decongestants can have side effects such as hyperactivity, sleeplessness, and irritability. Giving your child more than one cold medicine to treat different symptoms can be dangerous. Some of the same ingredients may be in each product. Also, many cold medicines contain acetaminophen. If you are already giving your child acetaminophen in addition to the cold medicine, this can lead to overdose. Read labels carefully. Check with your pediatrician before giving your child any cold medicines.

Nose drops (saltwater/saline)
Infants and toddlers cannot sniffle or blow their nose. If your child is sleeping well and eating happily, there is no need to treat her stuffy nose. But if your child is unable to sleep or eat because of thick mucus, saltwater nose drops can help clear the nose. Put a drop or two into a nostril at a time. Using a bulb syringe, squeeze the bulb, put the tip gently into your child’s nostril, then let go. This will suction out the drops, along with the mucus. Be careful, overuse of a bulb syringe can be irritating to a child’s nose.

Nose drops (decongestant)
Decongestant nose drops can shrink the membranes in the nose and make breathing easier. However, they should never be given to an infant because too much of the medication can be absorbed through the membranes of the nose. Also, the more they are used, the less effective they become and symptoms can return. If your older child can’t eat or sleep because of nasal stuffiness, use decongestant nose drops only for a brief time. Talk to your pediatrician if your child’s symptoms do not improve.

Medications used for common GI problems
There are many OTC medications for heartburn, gas, constipation, and diarrhea. Most of these conditions usually go away by themselves or by a temporary change in diet. Before using any medicine for constipation or diarrhea, talk to your pediatrician. Repeated bouts of diarrhea or chronic constipation can be due to serious underlying problems.

Liquid medicines

Many children’s medicines come in liquid form because they are easier to swallow than pills. But they must be used correctly. Too often parents misread the directions, giving children several times the recommended dosage. This can be very dangerous, especially if given over a period of several days. Read the instructions carefully. Call your pediatrician if you are not sure how much, how often, or for how long to give medicines to your child. When giving your child a liquid medication, do not use standard tableware tablespoons and teaspoons because they usually are not accurate. Instead, use one of the measuring devices listed below (many children’s medications come with one). These can help you give the right amount of medicine to your child.

Syringes and oral droppers - These can be very helpful when giving medicine to an infant. Simply squirt the medicine between your child’s tongue and the side of his mouth. This makes it easier for him to swallow. Avoid squirting the medicine into the back of your child’s throat - he is more likely to gag and spit the medicine out. If you have a syringe that has a plastic cap, throw the cap into the trash so that it does not fall off in your child’s mouth causing a choking hazard. You do not need to re-cap the syringe.

Dosing spoons - These can be useful for older children who will open their mouths and "drink" from the spoon.

Medication cups - These often come as caps on liquid cold and flu medicines.

Taking medicines safely

You can help prevent overdose or poisoning by following these tips:

• Always use good light. Giving medicine in the dark increases the risk that you will give the wrong medicine or the wrong dose.
• Read the label before you open the bottle, after you remove a dose, and again before you give it. This routine can ensure your child’s safety.
• Always use child-resistant caps and lock all medications away from your child.
• Give the correct dose. Children are not just small adults. Never guess how much to give your child based on her size.
• Never play doctor. Do not increase the dose just because your child seems sicker than last time.
• Always follow the weight and age recommendations on the label. If it says not to give it to children younger than age 2, don’t. Check with your pediatrician.
• Do not confuse the abbreviations for tablespoon (TBSP or T) and teaspoon (tsp or t).
• Avoid making conversions. If the label calls for 2 teaspoons and you have a dosing cup labeled only with ounces, do not use it. Use an appropriate measuring device.
• Be sure your pediatrician knows if your child is taking more than one medication at a time.
• Supervise your children if they are old enough to take medicine by themselves. Never let young children take medicine by themselves.
• Before using any medication, always check for signs of tampering. Do not use any medicine from a package that shows cuts, tears, or other imperfections.

Syrup of Ipecac
Keep a small bottle of syrup of ipecac on hand in case of poisoning. Store it with your other medicines, out of the reach of children. This is available without a prescription at most drug stores.

Syrup of ipecac is used to induce vomiting and empty the stomach. However, sometimes vomiting causes more harm than good. Do not make your child vomit unless your pediatrician or the poison center tells you to do so.

If you suspect your child has swallowed any substance that might be harmful, call your pediatrician or a local poison control center (post this number on your phone) first to find out whether and how to use syrup of ipecac.

It is not always easy to give medicine to a child. You may find your infant or toddler hates the taste and spits out the medicine or refuses to swallow it. Try adding a little sugar or juice to the dosing device to make it taste better. However, do not mix medications into a bottle of milk or a bowl of cereal. Your child may only eat part of it, or it may settle to the bottom and never get into his mouth. Older children may be more willing to take chewable tablets over liquid medicines. Although most children’s medicines are flavored to make them taste better, avoid calling them candy. It might make your toddler decide to take them on his own.

Talk to your pediatrician if you have any questions or concerns about giving your child medications. Keep your pediatrician informed about any changes in how your child is feeling or if your child has any reactions to the medications.