Medications and drugs
Antibiotic medicines
Instructions to parents I may prescribe an antibiotic medication for your child’s infection. Treatment requires special care to help avoid unwanted after effects. The antibiotic will help cure the infection when taken regularly for the time stated on the prescription. It may not seem necessary to continue giving antibiotics when your child feels well after just a few days. I urge you to give the full dose each day for as long as is stated on the prescription. Report to me if severe diarrhea develops or a skin rash appears. These signs may be due to the effects of the medication. Mild diarrhea can occur with some antibiotics and no special attention is required if your child tolerates it well. Use extra Vaseline™ or Desitin™ creams on his or her bottom to shield the skin from harsh stools. Avoid extra dairy products and fruit juices if there is much diarrhea (see Diarrhea…).
Give the antibiotic medicine the number of times per day prescribed during the hours your child is awake. Space the doses out evenly. Use a medication spoon for liquid medications to ensure an accurate dose is given. Kitchen spoons are sometimes inaccurate. The medication may be given at the same time as other medications. If the antibiotic is a liquid, store it at the back of the refrigerator, out of reach. Shake the bottle well before giving the dose to make sure it is mixed well. This can be very important because the favoring can settle and your child won’t receive the medication in even doses, causing side effects or worse, no effect on the infection.
If there is fever, aspirin free medications can be used along with the antibiotic. It may take 1 or 2 days to see definite results so Tylenol™ may need to be continued even after starting treatment with other medications. Report back to the office if you have seen no improvement in about two days or you believe your child has gotten worse.
If a return appointment is recommended, please keep the appointment.
I may need to make sure no further treatment is necessary. Unfortunately, some infections don’t clear up completely but your child may seem well for days before symptoms become apparent. Do not give antibiotic medicines away to family, friends or relatives to give to their children. Partial treatment may initially hide but not cure a serious infection that could damage or kill another child. After giving the antibiotic for the full time prescribed, you should throw away the remaining amount, unless I instruct you differently.
Medication dosing
When I was updating my pediatric office manual Notes and Tips, I realized that I was missing one important topic for my patient’s parents medication dosing. I wrote about the subject a long time ago, and I wanted to go over it again for new parents.
Many OTC or over-the-counter medications are available now that were prescription only a few years ago. Some examples would be hydrocortisone creams, Triaminic, Benadryl, Claratin, and the list grows. The problem for parents is that the labeling tells the parent to call the doctor for children 2 and under. That is a major problem when most of the sick kid calls we get are for the very young child.
To help save you time and confusion, these are guidelines for you.
You can always give Tylenol™ or acetaminophen products with cough and cold medications, asthma medications, or antibiotics. In fact, you can give any of these medications together. Old package inserts still might counsel against giving cold medications for asthma patient, but my experience and modern theory indicates it is very safe to combine all the ingredients.
A safe rule of thumb for average size children is you can give over the counter medication in these amounts: 3 months = ¼ tsp., 6 months = ½ tsp., 9 months = ¾ tsp., and 12 months = 1 tsp. I usually follow 1 tsp. Per 20 lbs. Of body weight (do not exceed 3 tsp.).
Common side effects of these cough-and-cold medications are either sleepiness, or hyperactivity or irritability. You can adjust the dosing up or down according to the side effects. For example, if your child is too sleepy decrease the amount by ¼ to ½ tsp.
Most cough-and-cold medications work more effectively for allergic illnesses like hayfever. Colds don’t respond dependably to any prescription or nonprescription cold medication.
Antibiotics, asthma medications, or any other prescription medication will have the dose written on the bottle label. You are to follow the dose exactly as written on the label. If you ever believe the dose is too great or too little, you must notify the pharmacist or me as soon as possible.
For Tylenol™ or Motrin dosing refer to my Table in this manual.
Aspirin, Tylenol™, or Advil™
There are so many products in the stores, and so many claims by the manufacturers. Which product should you use? What is the difference?
Aspirin, Tylenol™, and Advil™ are actually three different drugs. Aspirin is the generic name for a drug that has been used for many years.
It is so well recognized, parents often say aspirin when they mean a different drug like Tylenol™.
Aspirin use in children has declined in recent years. Pediatricians were concerned about the many poisonings from aspirin each year and began recommending the safer drug, Tylenol™ or acetaminophen when it became available. Poisonings from aspirin are rare, because of safety caps and reduced use.
Aspirin is still an important drug that effectively lowers fever and controls pain. Because it works no better than Tylenol™ for these two conditions, I recommend you use Tylenol™ as your first choice. One advantage of aspirin over Tylenol™ is its anti-inflammatory drug properties. Aspirin works better for injuries or for arthritis, reducing swelling and inflammation. It is a very safe drug and reactions beyond mild stomach upset are unusual. Do not use aspirin if your child has a cold or “FLU.” A rare condition called Reye’s Syndrome is associated with aspirin use and can cause serious disability or death.
Tylenol™ or acetaminophen is an excellent pain reliever and is good at lowering a fever. Even though Tylenol™ must come with a child-proof cap, accidental poisonings from an overdose are rare because the drug is tolerated in larger amounts without side effects.
Recently, Ibuprofen, or Advil became available without prescription. In large doses, it has some of the same undesirable side effects as aspirin. It is safe enough to take without the danger of undesirable side effects. Ibuprofen also has good pain relieving properties. Unlike Tylenol™, it does have the anti-inflammatory effects of aspirin and can be used instead of aspirin. Recently, some studies showed the safety and effectiveness of using Tylenol™ and Ibuprofen together to lower the temperature in children who were very uncomfortable and not helped by Tylenol™ alone. Currently, Ibuprofen liquid is available only by prescription. I use it sparingly for two reasons. Tylenol™ is safer and just as effective for minor fever or pain. I don’t believe fever is a serious problem for most infants and children. By encouraging parents to use fever lowering medications, I pass on a wrong message — worry about fever. When a children or infants is very uncomfortable, these medications can be safely used. Medications are not necessary for happy, content children with fever. Instead, dress them lightly and encourage fluids. (See section on fever)