You’ve probably heard that babies and children must be treated with special care when it comes to giving them medicines. But as a concerned parent, you want to do everything you can to soothe your child when he or she is sick. What can you do? These are some of the most common questions that parents often ask us as physicians about over-the-counter (OTC) medicines:

Q: What can I do to make sure I am safely administering medicine to my child?

A: Medicines can be safely used in your child as long as you read labels carefully to select an age-appropriate medicine and follow some simple guidelines.

• Always look at the minimum age recommended for taking the medicine and don’t give it to your child if he is younger than the recommended age until you discuss it with a physician.
• Look at the dose and strength of each medicine each time you use it, as many active ingredients in medicines, such as acetaminophen in liquid products, come in different strengths and formulations. Pediatric liquid acetaminophen in particular has undergone recent dosing changes and has transitioned to single-strength. Learn more about the recent changes at KnowYourDose.org.
• Check the minimum amount of time you can re-administer a medicine and the total dose you can give each day. Giving a medicine too frequently, even if it is the right dose, can lead to an overdose and side effects.
• If you are giving more than one medicine, look at the active ingredients listed on the Drug Facts label in each medicine to make sure you are not giving the same medicine twice (and thus, overdosing) or giving a medicine that interacts with another one your child is taking.  For example, many cold medicines contain acetaminophen. So, your child would receive twice the recommended dose if he or she is given a cold medicine along with a fever reducer and both contain the active ingredient acetaminophen.
• Only use a medicine that treats the symptoms your child is experiencing at that time.

Q: What are the most common OTCs used in children? Are there any concerns that I should be aware of?

A: The most common OTC medications for use in children are:

1. Multivitamins. Although multivitamins are not medications, they are one of the most popular supplements given to children. They can be used beginning in infancy, but the type of vitamin varies by age. In infants, vitamins come as a liquid and parents use a dropper to administer it into the mouth. Beginning at age 2 years, vitamins begin to come in various forms, such as a chewable tablet, gummy, and gumball.  Some formulations recommend ½ tablet for toddlers while others recommend 1 tablet. Different formulations recommend different doses. Check the label each time you buy a different brand or shape of vitamin, as the dose may change.
   
   ‍ALERT: Many of these vitamins taste and look like candy, so make sure they are locked away from your child and never refer to medicines as candy.
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2. Fever and pain medicines. These include the active ingredients ibuprofen and acetaminophen.
   
   ‍ALERT: Never give aspirin to a child under age 18 for cold or flu symptoms. If your child is under 2 years of age, pay special attention to the label on when to check with your doctor before giving a medicine to reduce the fever. Some pain and fever reducers have label directions down to 6 months of age. Others have directions for ages 2 and up, but may have extra information on dosing for your doctor. Pediatric liquid acetaminophen in particular has undergone recent dosing changes and has transitioned to single-strength. Learn more about the recent changes.
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3. Cough and cold medicines. They are used most frequently in the winter, and often contain a combination of active ingredients. Common ingredients are guaifenesin, acetaminophen, ibuprofen, phenylephrine, pseudoephedrine, and dextromethorphan, among others.
   
   ‍ALERT: Do not use oral cough cold medicines for children under 4. Be careful not to exceed the recommended daily dose of these active ingredients by giving your child medicines that contain additional doses of the same ingredients. Only give your child the active ingredients that treat your child’s specific symptoms.
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4. Allergy medicines. These are used not only for seasonal allergies but also for allergic reactions. The most common active ingredients in these medicines are diphenhydramine, chlorpheniramine, brompheniramine, doxylamine, cetirizine, and loratadine.
   
   ‍ALERT: Diphenhydramine should not be used in newborns and only in infants after consultation with a physician. Seasonal allergy medicines have been approved for ages 2 years and older. Never use an antihistamine to try to sedate your child.
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5. Constipation treatments. These medicines have differing amounts of time you should give the medicine to your child, so do not use for a longer period of time than the label says unless your doctor tells you to. Common ingredients include polyethylene glycol 3350, mineral oil, and others.
   
   ‍ALERT: Some of these medicines may be used in young children, but be sure to talk to your doctor before use unless the label tells you the medicine is age-appropriate for your child.

Q: I have heard that it may not be safe to alternate ibuprofen and acetaminophen in my child if he has a fever.  Is that true?

A: First of all, not every fever needs to be treated.  So, if your child is feeling fine and his/her temperature is less than 101 degrees, don’t rush for the medicine.  If your child does need a fever reducer, it is better to choose one type, either acetaminophen or ibuprofen.  If the fever reducer you choose doesn’t seem to work, consult your doctor.

Q: Why do we need to use more caution in giving medicine to children than adults?

A: While there is usually just one dose of medicine to give adults, the amount to give a child may be based on age or weight. Plus, medicines can have different side effects or may not be safe in children below a certain age, while they are fine for older children and teens.  In addition, most medicines have been tested extensively in adults but many have not been tested in a younger child, so we don’t know if they cause problems in this age group.

Q:  What are the most common types of medicines involved in accidental overdoses?

A: Some of the most common childhood overdoses occur with OTC medicines containing acetaminophen, as well as vitamin supplements with iron. Young children are curious and explore, and will swallow pills or drink a liquid when they don’t understand what it is. Just like prescription medicines, OTC medicines must be kept out of a child’s reach at all times – always store every medicine and vitamin up and away and out of children’s sight. Overdosing of OTC medicines can lead to serious illness and even death.  Remember that when your child’s pediatrician asks you what medicines your child is taking, you must include OTC medicines because some may interact with prescription medicines.

Fun Fact

Did you know that your body produces about a quart (or a liter) of mucus every day? Mucus serves many purposes, including preventing the lung tubes and nasal cavity from drying out, cracking, and letting bacteria and viruses into the body.