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Daily Dose

Medicine Dosing Errors

1:30 to read

How do you give your baby/toddler/child their medications? In a recent article in Pediatrics it was found that up to 80 percent of parents have made a dosing error when administering liquid medicine to their children.  The study looked at children eight years old or younger. 

 

In the study both English and Spanish speaking parents were asked to measure different amounts of liquid medicines using different “tools”, including a dosing cup, and different sized syringes. They also were given different instructions with either text only or text with pictures. The different dosing tools were labeled with either milliliters/teaspoon or milliliters only.  Lots of variables! 

 

Not surprising to me, the parents who used the texts/picture combination instructions and who also used the milliliter only labeled dosing tools had the lowest incidence of dosing errors.  When parents had to use any math skills to calculate the correct dosage there were more dosing errors.  Most dosing errors were also overdosing rather than under-dosing the liquid medications.

 

This was an important article not only for parents to realize that it is not uncommon to make an error when giving their child medication, but also for doctors who write the prescriptions.  Before electronic medical records and “e-prescribing” I would typically write medication instructions in milliliters and teaspoons…in other words “take 5ml/1 tsp by mouth once daily”.  With electronic record you can only make one dosing choice which I now do in milliliters. But, with that being said, I still get phone calls from parents asking “how many teaspoons is 7.5 ml?”.

 

Previous studies have also shown numerous dosing errors when parents use kitchen teaspoons and tablespoons to try and measure their child’s medication. 

 

Some over the counter drug makers have tried to cut down on dosing errors with their liquid medications by making all of their products, whether for infants or children, the same strength. The only difference is the dosing tool that accompanies the medicine (syringe vs cup).  Interestingly, these medications may have a price difference when they are actually the same thing.  

 

This study may help to find strategies for comprehensive labeling/dosing for pediatric liquid medications, which will ultimately reduce errors.  Stay tuned for more!

 

 

 

 

 

Daily Dose

Alternative "Medicines" to Fight a Cold

What are some ways you can fight a cold using alternative medicines?I am still fighting (that is really a descriptive term) my latest cold and the office is engulfed in a cold virus epidemic. Children of every age have runny noses, are blowing noses, and there’s a cacophony of coughs.  So I thought I would finish discussing more alternatives for preventing the common cold and possible treatments.

A mother told me today about something called “boogie wipes” which are supposed to be far superior to a Kleenex.   Now you know that I am frugal but I do buy “fancy tissues with aloe vera etc. According to this Mom you can’t beat these new “boogie wipes” for keeping your nose clean as well as not chapped.  Best hint of the day!! Recently, I discussed the use of vitamins and minerals and their use to combat the common cold, but now want to look at some other interesting options.  Some herbs have been studied as well.  A. paniculata (king of berries) is a popular herb that is used to treat fever, sore throat and respiratory infections. In two different studies in children, one studying Russian children and another Chilean students, both found that those receiving this herb had a shorter duration of symptoms of their colds.  The Chilean study also showed that those who took A. paniculata had a 70% reduction in the number of upper respiratory infections than those given placebo. I found this very interesting!  I think I am going to head to store tomorrow to buy this herb which I had never heard of!  It certainly can’t hurt and I can just add it to all of the other stuff I am taking. What about probiotics (dietary supplements containing potentially beneficial bacteria or yeast)? Probiotics are being used in formulas and foods, to help prevent gastrointestinal issues as well as in the treatment of post viral gastroenteritis (vomiting and diarrhea).  How about to prevent or treat the common cold? A Finnish showed no difference in the symptoms of respiratory infection among those using probiotics as compared to placebo. Another study out of Israel also showed that those who consumed probitoics had no effect on the duration or frequency of respiratory illnesses. Honey has received a lot notoriety lately and is thought to have anti-inflammatory effects in general. Several years ago, a study with parent support reported honey was better for a nighttime cough than cough syrup containing dextromethorphan.  Buckwheat honey is considered safe for use to control cough in children who are over 1 year of age. The most interesting report I found was out of Australia.  This study  which looked at the effectiveness of mind-body therapies in combating cold symptoms. Children received stress management to deal with generalized anxiety and to promote positive self-esteem. Another group received guided imagery and relaxation therapy. The children who received either of these therapies had a shorter duration of upper respiratory symptoms than the control groups.  Many studies have looked at white cell function during times of stress and also So it looks to me like the use of elderberry and stress reduction may hold some value in combating common colds. I know there is much more data to come, but in the meantime it looks like another herb and a nap may help more than my current vitamin/herbal regimen. It certainly can’t hurt. I am also going to get my FLU SHOT tomorrow in hopes of keeping that virus at bay all winter long! That’s your daily dose for today.  We’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Get Rid Of Drugs Safely

1.15 to read

Got drugs???  Saturday, April 26 is National Take Back Day.  This day is set aside to help you clean out your medicine cabinet and dispose of your old, unused and expired prescription medications safely.  This is a “no questions asked” opportunity to dispose of your medication, without contaminating the environment or throwing away medication improperly.

With teen prescription drug abuse on the rise and over 50% of teens reporting that they have obtained prescription drugs from a family medicine cabinet, what better time to check out your own family medicine cabinet.  It is surprising how many medications you might find that are either expired, or no longer being used. Rather than flush them down the toilet or throw them away, take them to a location (you can find a site on line at www.deadiversion.usdoj.gov) that will dispose of medications properly while protecting our environment and our water sources.

Accidental poisoning from medications in the medicine cabinet (or left on a kitchen shelf or table) is another problem for our children. It sometime seems that young children are better at opening “child proof caps” than many adults, and with many medicines being colorful children will eat a handful before deciding they may not taste so great. In some cases it only takes a few pills to cause toxicity. 

So, let’s all head to the medicine cabinet (or cabinets) and do a thorough spring cleaning.  Then, take that sack to your local drop off spot and feel a sense of accomplishment. We all should mark our calendars to do this every year.  

Daily Dose

Cough and Cold Medicine

1:30 to read

My husband has a cold (I have been fortunate not to have one) and he decided he needed some over the counter (OTC) “cold medicine”, despite the fact that I told him they don’t work!  At any rate, I stayed in the car while he went in to buy “some things.”  It wasn’t too long before he was back empty handed…..and asking for some help in deciding what to buy!  It seems that he was overwhelmed and confused by all of the different choices….so I thought this was a good time to review all of the “ingredients” in OTC cough/cold medications. But remember, OTC cough and cold products are not recommended AT ALL for children under the age of 4. 

Most of the products that are advertised and sold for treating coughs and colds contain either a decongestant, antihistamine, expectorant, or anti-jussive (for cough).  But many of the OTC medicines contain some combination of these ingredients and there are many similar products with different brand names. Just gazing at the row of choices is enough to confuse anyone….even a doctor.

The most common decongestant used in OTC products is phenylephrine but its effectiveness in reducing nasal congestion from the common cold has been inconclusive. Another decongestant, pseudo ephedrine (Sudafed) is available, but has become restricted (it is a precursor in the manufacturing of methapmphetamine) and is now found behind the counter. Both of these drugs are often found in combination with other ingredients.

Antihistamines are also in many products. First generation antihistamines include diphenhydramine (Benadryl) and chlorpheniramine and are known for their tendency to be sedating. Second generation non sedating antihistamines such as loratadine (Claritin), fexofenadine (Allegra) and cetirizine (Zyrtec) are also found in some preparations ( typically with wording “daytime”) and are not sedating. In either case antihistamines do not seem to help the common cold.  Antihistamines do help allergies which are histamine mediated while a cold is not.

Anti-tussives or cough suppressants are commonly found in OTC cold medications, as cough is one of the most irritating aspects of a cold.  Dextromethorphan acts on the cough center in the brain to suppress coughing. It is the main ingredient in many OTC cough syrups but may also be found in many cough and cold combos in either liquid or pill form.

Guaifenesin is an expectorant and is found in many products, but again has not been found to have a measurable effect on mucous production from a cold.

Lastly, there are many products that are advertised to help with the “aches and pains” of a cold including acetaminophen and ibuprofen which may be found in combination with some of the above ingredients.

So…you have to read labels and make sure you “know” what you are getting. Too many people do not realize that they may be taking the same medicine but with different brand names, and this could cause an overdose.  

But the take home message is that “we” spend billions of dollars on these OTC products with continued studies showing minimal if any effect on the common cold when compared to placebo!  

I would spend my money on some Vicks, honey, and chicken soup and forgo the confusion on the cough and cold aisle.

Daily Dose

Smart Moms

1.30 to read

Moms are so ingenious!  I learn new things from parents everyday and the saying “inventions are the mother of necessity” rings true again. 

As I have been discussing in earlier posts, RSV has really been rampant these last few weeks, causing many babies to wheeze and a few of my patients had severe enough symptoms to require hospitalization.  

A sweet 6 month old patient of mine was recently admitted to the hospital for a few days due to respiratory distress, and subsequently developed an ear infection (which is not uncommon) and was discharged on an oral antibiotic.  Oh, did I mention that while the baby was in the hospital, the 2 year old sibling started to cough and wheeze as well and he was at home getting breathing treatments. When it rains, it pours! 

Now that this family is on the mend, I had them return to the office for a post-hospitalization follow up and the mother said she had been a “bit overwhelmed” for the last few days. Poor thing! She said she was worried that she might “mix up” medication doses between the two children.  

She then pulled out the box that contained the medicine for the 6 month old and showed me how she had drawn a calendar on the side of the box, with a square for each dose of medicine to mark off as she gave the dose. That way she was sure that she had given the medicine.  It was like “cross-checking” medicines in the hospital to prevent dosing errors.  How clever is that!  No big chart, nothing fancy, but very practical. 

She had brought along the medicine for her visit so I could see how well the baby was taking the medicine (which was not one of the better tasting liquids) and she had the perfect technique for administering the medicine as well. 

So, this picture shows you how clever the bottle/box dosing calendar is. Of course she is a teacher, and I bet a good one!!

Daily Dose

Airborne & Your Kids

1.45 to read

It’s cold & flu season and I have already been receiving emails from parents asking what works/doesn’t work.  I reviewed a recent note from a well-meaning dad asking if he could give his 3 year old son Airborne to help “offset colds”. 

I myself have just recovered from my first cold of the “season” and have looked high and low for ANYTHING that might prevent or treat the common cold. As I tell my own patients on a daily basis, if I had the “magic pill” I would certainly not only manufacture it to distribute to everyone, but I would also be getting ready to accept Nobel Prize in medicine for solving the mystery of preventing the common cold!!  Airborne is NOT the magic potion and I see no reason to use it period.

I recently did an extensive review of complementary and alternative medicine for the common cold (selfishly trying to cure myself) and once again came up empty handed for any proven remedies. There are still a lot of ongoing studies (someone will win the Nobel Prize one day), but nothing so far has really proven to be the panacea.

Many people “swear” by Airborne.  I am just not sure what they are thinking it does. If you read their website it states, “there are scientific studies that the ingredients in Airborne have been shown to support the immune system”. I can’t find those studies anywhere. 

In 2008 a class action suit against Airborne resulted in a $23 million dollar fine for “misleading consumers and making false claims”, when Airborne claimed to “ward off colds”. They have now changed their advertising to the wording, “boosting the immune system” which also seems like deceptive advertising to me. Regardless, they continue to make millions (despite that huge fine).  My mother even called to say she thought she might take some before flying to visit at Thanksgiving asking, “did I think that would help her from getting sick?” OMG!

The ingredients in Airborne include Zinc, ginger, Echinacea, vitamins, minerals, and herbs.  This is what I commonly call “hocus pocus”.  Many of the ingredients in Airborne have been studied for use during a cold, without a lot of success.  Zinc is still being studied with varying outcomes, but there are still no definitive guidelines on using Zinc for a cold. Stay tuned for more as more studies are completed.

In the meantime, the answer to the email is NO; I would not give a 3 year old Airborne. What I would do is make sure that your child is getting nutritious meals, adequate sleep and that they learn to wash their hands and cover their mouths when they cough (hand hygiene). I would put the money you would spend on Airborne in their piggy bank for future college expenses.   I would also make sure to get your child their Flu vaccine. We do have data that vaccines work!

That’s’ your daily dose for today.  We’ll chat again tomorrow.

Parenting

Most Parents Give Their Child the Wrong Medicine Dose

1:30

According to a new study, most parents accidently give their child the wrong dose of liquid medication – sometimes, as much as twice the amount they should have.

The study, conducted at pediatric clinics in New York, Atlanta and Stanford, Calif., also found that most dosing errors occurred when parents used a measuring cup. There were fewer errors when parents measured the dose with an oral syringe.

Pediatric medicines generally rely on liquid formulations, and parents have to decipher a sometimes, bewildering assortment of instructions in different units with varying abbreviations — milliliters, mL, teaspoon, tsp., tablespoon. Some medicines come with a measuring tool, but often the units on the label are different from those on the tool. It can be very confusing, especially for a parent trying to treat a sick child.

The Food and Drug Administration (FDA) recommended in 2013 that over-the-counter products use a standard dosing tool with consistent labeling. The changes however, were not required.

The American Academy of Pediatrics (AAP) also recommended standard dosing tools for OTC products last year.

For this study, Dr. H. Shonna Yin and her colleagues ran an experiment to see what combination of tools and instructions would produce the fewest errors in dispensing liquid medication. They randomly assigned 2,110 parents to one of five pairings of the many possible combinations of tools and label instructions.

In nine trials, 84.4 percent of the parents made at least one dosing error, and more than 68 percent of the errors were overdoses. About 21 percent of parents at least once measured out more than twice the proper dose. Smaller doses produced more errors. When the dose was 2.5 milliliters, there were more than four times as many errors as when it was 5 milliliters.

The difference in errors was the tool used to give the medication. When a cup was used, there were four times as many errors as when an oral syringe was used.

“If the parents don’t have an oral syringe, the provider should give one to the parents to take home,” said Dr. Yin, who is an associate professor of pediatrics at New York University. “Especially for smaller doses, using the syringe made a big difference in accuracy.”

If you don’t have an oral syringe at your home, you can check with your pediatrician or pharmacist and they should be able to help you choose the right one for your child.

The study was published online in the journal, Pediatrics.

Story source: Nicholas Bakalar, http://www.nytimes.com/2016/09/13/well/family/most-parents-give-the-wrong-dose-of-liquid-medication.html?WT.mc_id=SmartBriefs-Newsletter&WT.mc_ev=click&ad-keywords=smartbriefsnl&_r=0

Daily Dose

Gassy Baby? No Problem!

1:30 to read

So you are home from the hospital with your newborn baby and suddenly you realize that the babies you see on TV never cry -  but your newborn is not reading the same script.  All babies have some fussy times, and this is especially true of a newborn in the first few months of life.  While a “typical” baby cries for a total of  3-4 hours a day, there are other babies that seem to be more difficult.  

 

Besides praying for an easy baby it seems to be luck of the draw and you don’t get to pick your baby’s temperament. In many of the cases of an “irritable” infant parents point to the fact that their baby acts uncomfortable and will frequently pass gas or draw up their legs or arch their backs as if something “hurts”.   

 

Your newborn’s tummy and intestines are just as “new” as they are and early on it may be more difficult for some babies to digest breast milk or formula.  In this case pediatricians often try to make changes in a breast feeding mother’s diet (taking out dairy), or changing a formula to a lactose free formula to see if that helps a baby to be more comfortable and less fussy. There are also “elemental formulas” that may be tried for extremely fussy babies. Discuss this with your own pediatrician.

 

Little tummies do make a lot of gas (you hear those toots all of the time) and I often recommend a trial of Little Remedies Gas Relief Drops® which contain simethicone (to help break up gas bubbles). These drops are especially made for infants and do not contain any alcohol, preservatives or dyes.  You can try using the gas drops after your baby has been fed as well as at bed time. 

 

Colic is defined as crying that occurs in an infant for at least 3 hours a day, for 3 days a week, for at least 3 weeks.  Colic typically “rears its angry head” after a baby is 3 -4 weeks of age.  For those irritable, colicky babies (I had one and you will know) I also like to try Little Remedies Gripe Water which is made with ginger and fennel, herbs that have been shown to help relax the  smooth muscle of the intestine.  Again, these drops do not contain any alcohol….which is very important. 

 

I also recommend swaddling and a pacifier for “non- nutritive” sucking to help calm a crying baby.  Many babies also like being on their tummies (tummy time is important developmentally as well) when they are fussy, and you can even massage their backs as well. Remember, even if tempted,  NEVER let your baby sleep on their tummy, even if you are in the room!! Backs to sleep only.

 

Babies also seem to like motion to calm them so holding your baby and rocking or swaying may help decrease crying. A walk in the stroller is sometimes another great way to get a fussy baby to settle down. Fresh air is good for both parent and child!

 

Your Teen

Acetaminophen, No Threat To Child's Liver

2.00 to read

With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. Concerns about liver injuries in children who take the common painkiller acetaminophen, sold as Tylenol in the U.S. are unfounded, researchers said on Monday. "None of the 32,000 children in this study were reported to have symptoms of obvious liver disease," said Dr. Eric Lavonas of the Rocky Mountain Poison and Drug Center in Denver. "The only hint of harm we found was some lab abnormalities." With more than eight million American kids taking the drug every week, acetaminophen is the nation's most popular drug in children. It's toxic to the liver in high doses, and can be fatal if taken in excess. Very rarely, adults may also get liver damage at normal doses, so doctors had worried if the same was true for kids. "This drug is used so commonly that even a very rare safety concern is a big concern," said Lavonas, whose findings appear in the journal Pediatrics. Some researchers suspect there is a link between long-term use of acetaminophen and the global rise in asthma and allergies, but the evidence is far from clear at this point. For the new report, researchers pooled earlier studies that followed kids who had been given acetaminophen for at least 24 hours. There were no reports of liver injuries leading to symptoms such as stomachache, nausea or vomiting, in the 62 reports they found. Ten kids, or about three in 10,000, had high levels of liver enzymes in their blood, which usually means their livers have been damaged. In most cases, however, those elevations were unrelated to acetaminophen. And even if they were caused by the drug, they don't indicate lasting damage, according to Lavonas. "Acetaminophen is extremely safe for children when given correctly," he said. "Parents should not be afraid to give acetaminophen to their children when they need it, but they should be very careful about giving the right dose." "If you suspect that you have given a child an overdose, call your state's poison center," he added. The Rocky Mountain Poison and Drug Center receives funding from McNeil Consumer Healthcare, the Johnson & Johnson subsidiary that sells Tylenol, but the researchers said the company did not support this study.

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