Medication Safety

Giving kids medicine safely can be complicated. It may be frightening to give a young child certain medications knowing that too much or too little can cause serious side effects.

But with a little knowledge and a lot of double-checking, you can give your kids medicine safely and prevent dangerous reactions.

Using medications safely means knowing when they're necessary — and when they're not. Always check with the doctor if you're unsure whether symptoms require treatment with medication.

In many cases, non-medicinal treatments may be the best bet for a quick recovery, especially with cases of the flu or the common cold. Getting enough rest will allow the body to rejuvenate, and plenty of clear fluids (such as water, juice, and broth) will help kids avoid dehydration from body fluids lost through vomiting, diarrhea, perspiration, and nasal secretions.

If your child suffers from congestion and a stuffy nose, saline drops can thin nasal secretions. A cool-mist humidifier or a warm-air vaporizer keeps moisture in the air, helping to loosen congestion. If you use a humidifier or vaporizer, though, be sure to clean it thoroughly every day because bacteria and mold can develop if it isn't kept clean and dry.

Administering Medication

To ensure the safe use of prescription or over-the-counter (OTC) medicines, discuss your child's symptoms with your doctor and pharmacist.

When giving your child medicines, you'll need to know:

• the name and purpose of the medication
• how much, how often, and for how long the medicine should be taken
• how the medicine should be administered (whether it should be taken by mouth; breathed into the lungs; inserted into the ears, eyes, or rectum; or applied to the skin)
• any special instructions, like whether the medicine should be taken with or without food
• how the medicine should be stored
• how long the medicine can safely be stored before it needs to be discarded (asthma inhalers, for example)
• common side effects or reactions
• interactions with other medications your child may be taking
• what happens if your child misses a dose

Because the dosages of prescription and OTC medicines depend on a patient's weight, make sure the doctor and pharmacist have updated information about your child's size. Too little medication can be ineffective and too much medication could be harmful. Also, make sure the doctor and pharmacist know if your child has allergies or takes other medications regularly.

Sometimes medicines should be given on an as-needed basis (given only when a child needs them for certain symptoms, such as pain or discomfort). OTC drugs that relieve symptoms like aches, pains, or fever (such as acetaminophen and ibuprofen) should only be taken as your doctor recommends.

Many medications, though, should be taken until finished as prescribed by the doctor — even if your child begins to feel better before that.  For example, antibiotics help to kill bacteria in the body, so it's important to finish all doses even after symptoms disappear because the infection can return if the antibiotic is stopped too early.

Aspirin Alert!

Never give aspirin to kids, especially during viral illnesses. Using aspirin during an illness caused by a virus (such as the flu, chickenpox, or an upper respiratory infection) can cause Reye syndrome, a potentially life-threatening disease with symptoms such as nausea, vomiting, and extreme fatigue that progresses to a coma.

Because some OTC medicines (including some that treat headache and nausea) contain aspirin, you should always read labels and check with your doctor before using them. Be aware that some aspirin-containing medications use words other than aspirin (such as salicylate or acetylsalicylate), so avoid those, too.

Other tips for safe medication use:

• Don't try to diagnose your child's problem yourself. Always check with your doctor if you're unsure whether symptoms require medical treatment.
• Never use leftover medications. For example, pharmacists will sometimes dispense more liquid medication than is needed in case some is spilled or measured incorrectly. If you have liquid left over after your child has completed the course of treatment, throw it out. For medicines taken as needed, keep an eye on the expiration date to make sure you're not giving an outdated medication.
• Never give your child medications that have been prescribed to someone else, whether it's an adult or child. Even if two people have the same illness, they may require different drugs with different doses and directions.
• If you're purchasing OTC medications, check the medicine's packaging for possible tampering, and don't use medications in cut, torn, or sliced packages. Be sure to check the expiration date, too.
• Develop a relationship with a local pharmacist so that your family's medication history is in a central location. Consult your pharmacist if you have questions about any medication, including information about possible side effects or reactions.

Giving Medicines to Kids

After leaving the pharmacy, you'll still need to take a few precautions. First, check to make sure you have the correct prescription. Many prescription and medicine bottles look the same, so make sure your child's name is on the label and it's the medicine that the doctor recommended or prescribed.

Be especially careful when reaching into the medicine cabinet in the middle of the night — it's easy to grab the wrong bottle when you're sleepy.

Read all instructions. Both prescription and OTC medications usually come with printed inserts about common side effects and further instructions on how to take the medicine. Be sure to read all information carefully before beginning the medication, and call the doctor or pharmacist if you have any questions.

With or without food? All prescription medications contain labels or instructions about how to take them. For example, "take with food or milk" means the medicine may upset an empty stomach or that food may improve its absorption. In this case, your child should eat a snack or meal right before or after taking the medication.

Another common instruction on prescription medicines is "take on an empty stomach," in which case your child should take the medicine 1 hour before or 2 hours after a meal because food may prevent the medicine from working properly or may delay or reduce its absorption. Some medications interact only with certain foods or nutrients, such as dairy products, so be sure to check the label for any additional instructions.

The label may instruct you to shake a liquid medicine before using so that the active ingredients are evenly distributed throughout it.

Further Instruction

The right dose. Giving the correct dose is important because most medicines need to be taken in a certain amount and at certain times to be effective. The dose will be written on the prescription label or, on OTC medications, should be printed on the package insert, product box, or product label.

In general, use caution when giving OTC medications to young kids. Cough and cold medicines are discouraged in children younger than 2 years old due to potential side effects. Consult your doctor if you have any questions.

You can dispense medicine in a variety of ways, and the best choice depends on your child's age and willingness to take medicine. For babies who aren't yet able to drink from a cup, try a calibrated dosing syringe, which lets you dispense the medication into your baby's mouth, making it less likely to be spit out. Be careful when using a syringe, though — many come with a small cap on the end that can be a choking hazard to young children. Store a medication syringe in a safe place out of the reach of kids.

Other options for young kids are plastic droppers; cylindrical dosing spoons (these have a long handle that's easier for children to grab); and, if your child can drink easily from a cup without spilling, the small dosage cups that come with many medications. 

Some medicine dispensers are fashioned like pacifiers and proved effective with infants and toddlers. With these, you put the medicine in a small measuring cup attached to a pacifier, and then give the pacifier to the baby to suck — most of the medicine slips past the taste buds, making the medication go down easily.

Whatever method you use, it's important that your child takes all of the medicine each time it is given.

Never use tableware or a kitchen spoon to measure medication because these don't provide standard measurements. Instead, visit your local pharmacy or drugstore to find a measuring device designed to deliver accurate medication doses.

"But It Tastes Yucky"

Try these tips to get kids to take "yucky" medications willingly:

• Some kids may prefer it if medications are chilled, but refrigeration may alter the effectiveness of some drugs. Check with your pharmacist to see if chilling the medicine is safe.
• Mixing the medicine with a small amount of liquid or soft food (such as applesauce or yogurt) may make it more palatable. Use only a small amount of food and make sure your child eats the entire portion to receive the complete dose of medication. Avoid mixing medication in a baby's bottle — a baby who doesn't finish the bottle might not receive the full dosage. Check with your pharmacist to make sure that the medication's effectiveness will not be altered by mixing it with food or liquid.
• If you're using a syringe, try squirting the medicine (a little bit at a time) on the inside of the child's cheek, where there are no taste buds.
• If your child has difficulty swallowing a tablet or capsule medication, you may be able to crush it and mix it with soft food (such as pudding). However, always check with your pharmacist before crushing a tablet or opening a capsule because the effectiveness of some drugs may be compromised by crushing.
• Some pharmacies offer flavorings such as chocolate, cherry, grape, and bubblegum to make drugs like antibiotics and cough syrup more appealing to children. Only a small amount of flavoring is needed to disguise the taste. Although supporters say the better-tasting flavor may be an incentive for a child who has to take medication regularly, other experts say the chemicals in the flavoring may diminish the effectiveness of the drug. Ask your doctor or pharmacist for more information about the safety of flavoring in medicine, especially if your child has an allergy to certain dyes or sweeteners.

Caution

Never try to entice a child who balks at taking medicine by saying that it's candy. This tactic can backfire, and a child could accidentally overdose by ingesting dangerous medicine mistaken for a tasty treat. Instead, explain that medicine can make your child feel better, but it should never be taken without a parent's supervision.

If your child spits out or vomits medication, don't give another dose — call your doctor for instructions.

Side Effects

After giving your child a dose of medicine, be on the lookout for side effects or allergic reactions. The pharmacist or product packaging may warn you about specific side effects, such as drowsiness or hyperactivity.

If your child has side effects such as a rash, hives, vomiting, or diarrhea, contact your doctor or pharmacist. Penicillin and other antibiotics are among the most common prescription drugs to cause an allergic reaction.

If your child develops wheezing, has trouble breathing, or difficulty swallowing after taking a medication, seek emergency help by calling 911 or going to the emergency department immediately. These could be symptoms of a serious allergic reaction that requires emergency care.

Safe Storage

You'll need to be as vigilant about storing medications as you are about giving the correct dose. Read the medication's instructions — some drugs need to remain refrigerated, but most should be stored in a cool, dry location away from direct sunlight.

Despite the convenience of your bathroom's medicine cabinet, it's a poor choice for storing most medicines because of the humidity and moisture from the tub or shower. Instead, store medicines in their original containers in a dry, locked location that kids can't reach.

Child-resistant caps can be difficult even for adults to open, but make sure to protect your kids by re-locking and recapping child-resistant bottles properly.

Safe Disposal

When disposing of medications, make sure they stay out of the reach of children and don't contaminate the environment. Keep these suggestions in mind:

• Break down tablets or capsules and return them to their bottle. Remember to put the child-resistant top back on. Then secure the bottle further — for instance, with tape or enclosing it in a bag — before finally tossing it into a garbage can that is well out of the reach of kids.
• Return the medication to a local pharmacy. Many pharmacies take back expired pharmaceuticals. However, each pharmacy has a different policy regarding old or unused medications, so contact yours beforehand to see if it will accept them.
• Local household hazardous-waste collection facilities often take expired medicines. These are the places where antifreeze, oil, and used batteries are taken for proper disposal. Similar to pharmacies, each facility has a different policy regarding unused medication, so call first.

Reviewed by: Kate M. Cronan, MD
Date reviewed: May 2008

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