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Flavored Spray May Help Pills Go Down A Little Easier!

1:45

When your child is sick, chances are you have a difficult time getting him or her to swallow their prescription pills. It’s a problem parents and caregivers have in common- getting a child’s medication into their body. Liquids typically come in several flavors, which can be helpful, but pills are another matter.

Some pills are tiny and smooth – making the job easier. But others can be large powdery and oddly shaped. To make things worse, they may need to be taken throughout the day. So, what’s a parent to do?

The results of a small study may be just what the doctor ordered. Researchers have found that a flavored spray, called Pill Glide, may make pill taking a lot more flavorful -- and maybe even enjoyable.

"There was a significant decrease in the difficulty of taking medicine with these sprays," said Dr. Catherine Tuleu, a pharmaceuticals researcher at University College London, who conducted the research with colleagues at Great Ormond Street Hospital in the UK. "The kids liked to be in charge and to change the flavor."

What is Pill Glide? It’s a spray that is squirted into the mouth to lubricate and add flavor to tablets and capsules to make them easier to swallow. It's available in five flavors: strawberry, peach, grape, bubble gum and orange, with strawberry coming through as the favorite in the trial. Its ingredients include artificial flavors and sweeteners. This spray was used in the trial study with results published in the journal Pediatrics.

Tuleu and her team tried it among 25 children ages 6 to 17 that were receiving long-term therapies for HIV or organ transplants and who were transitioning from liquid medication to solids or were known to struggle with swallowing pills.

Keeping diaries, the study participants used a six-point scale to note the levels of difficulty they experienced when taking their regular tablets for two weeks and then using the Pill Glide sprays for one week. The final analysis was conducted on 10 children who had kept complete diary entries.

The flavored sprays were found to decrease the level of difficulty by a score of 0.93, almost one full level on the scale used by the team.

"The swallowing of medicine in the form of pills often poses a real challenge for a good many children, making this study of definite interest," said Dr. Laura Jana, a pediatrician and director of innovation at the University of Nebraska Medical Center College of Public Health, who was not involved in the research. "Something as seemingly simple as improving the taste and ease of swallowing a pill can have a significant impact on the proper and effective use of medicines."

The trial was very small and limited especially when you look at the number of participants, their health issues and the age group. But it may still be a process worth considering.

Tuleu acknowledges these limitations, and in addition to trying Pill Glide among larger groups, she wants to test its benefits in children who are less familiar with taking pills and who start out on solid pills, rather than transitioning from liquids.

"It would be interesting to try it with more naïve patients," she said. "If swallowing is not the challenge anymore, giving medication could be a lot easier."

Will this product make it easier for all kids to take a pill? Probably not. But this new approach may help some kids get past their difficulty with swallowing larger, more uncomfortable pills. It’s worth a try!

Story source: Meera Senthilingam, http://www.cnn.com/2016/11/01/health/kids-swallowing-pills-spray/

Daily Dose

Giving Your Child Medicine

1:15 to read

Since I recently wrote an article about teaching young children to swallow pills, here is another reason to teach this to children sooner than later. The American Academy of Pediatrics has a new policy statement encouraging parents, physicians and pharmacists to use only metric measurements on prescriptions,medication labels and dosing cups to ensure that kids receive the correct dose of medication.

In other words, no measuring medications with teaspoons or tablespoons and especially not the ones in the cereal drawer.  Because spoons come in many sizes, they are not precise enough to measure a child’s medication.  For infants, toddlers and young children, a small error in dosing, especially if repeated for many doses, may be toxic.  

These recommendations also mean that doctors, like myself, need to prescribe medications in metric units like milliliters rather than teaspoons. We also need to instruct parents to use metric dosing devices, and not any measuring devices that have confusing markings with both teaspoons, tablespoons and milliliters. The medication should also come with an appropriate sized dosing device to avoid the possibility of two and three fold dosing errors.

The recommendations also call for manufacturers of over the counter medications to eliminate labeling, instructions and dosing devices that contain units other than metric units...no more 1 teaspoon, but rather 5 milliliters.

I am going to make a conscious effort to make sure that I am now writing my prescriptions with the correct units and help make dosing errors less of a problem and all medications safer for my “little” patients.

No more kitchen spoons!!!

Daily Dose

Colds & Suctioning Your Child's Nose

1:30 to read

I am beginning to sound like a broken record, but we are in the throes of cold and flu season and unfortunately there are a few more months of this.  As every parent knows, colds (aka upper respiratory infections) are “age neutral”. 

In other words, there is not an age group that is immune to getting a cold and for every age child (and adult for that matter), the symptoms are the same. Congested nostrils, scratchy sore throat, cough, and just plain old feeling “yucky”. When an infant gets a stuffy nose, whether it is from “normal” newborn congestion, or from a cold, they often have a difficult time eating as an infant is a nose breather.  When they are nursing and their nose is “stopped  up”, they cannot breath or even eat, so it is sometimes necessary to clear their nasal passage to allow them to “suck” on the bottle or breast. 

Of course it is self evident that an infant cannot blow their nose, or rub or pick their nose so they must either be fortunate enough to sneeze those” boogers” out or have another means to clear the nose.  This is typically accomplished by using that wonderful “bulb syringe”. In our area they are called “blue bulb syringes” and every baby leaves the hospital with one tucked into their discharge pack.  As a new parent the blue bulb syringe looked daunting as the tip of the syringe appeared to be bigger than the baby’s nose.  But, if you have ever watched a seasoned nurse suck out a newborn’s nose, they can somehow manage to get the entire tip inside a baby’s nose. For the rest of us the tip just seemed to get inside the nostril and despite my best efforts at suctioning nothing came out. Once a nurse showed me the right “technique” I got to be a pretty good “suctioner”.  With the addition of a little nasal saline, which you can buy in pre made spray bottles, or which may be made at home with table salt and warm water, the suctioning gets a little easier as the nose drops helped to suction the mucous.

Now, I have become a firm believer that there is a place for suctioning a baby’s nose, but once a child is over about 6 months of age they KNOW  what you are getting ready to do. I am convinced that a 6 month baby with a cold sees the “blue bulb syringe” approaching their face and their eyes become dilated in fear of being suctioned!!  Then they begin to wail, and I know that when I cry I just make more mucous and the more I cry the more I make. So a baby with an already stuffy nose gets even more congested and “snotty” and the bulb syringe is only on an approach to their nose. It also takes at least two people to suction out a 6 – 12 month old baby’s nose as they can now purposely move away , and hit out to you to keep you away from their face and nose. It is like they are saying, “ I am not going to give in to the bulb syringe” without a fight! I swore I would not have a child with a “green runny nose” that was not suctioned.

As most parents know, don’t swear about anything, or you will be forever breaking unreasonable promises to yourself!  I think bulb suctioning is best for young infant’s and once they start to cry and put up a fight I would use other methods to help clear those congested noses.  Go back to the age old sitting in a bathroom which has been steamed up with hot water from a the shower. Or try a cool mist humidifier with some vapor rub in the mist (aroma therapy).  Those noses will ultimately run and the Kleenex will come out for perpetual wiping. Unfortunately, it takes most children many years before they learn to blow their nose, but what an accomplishment that is!!!  An important milestone for sure.

That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue!

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!

 

Daily Dose

Homeopathic Medicine

1:30 to read

I am sitting here writing this while “sucking” on a honey-lemon throat lozenge and drinking hot tea…as it is certainly cough and cold season and unfortunately I woke up with a scratchy throat. I am trying to “pray” it away and drink enough tea to drown it out. While I am not sure it will work, drinking hot tea all day will not hurt you!

 

At the same time (multi-tasking) I am also reading an email from a mother with a 4 month old baby, and they are out of town. Her baby now has a fever and runny nose and she sent me a picture of a homeopathic product for “mucus and cold relief” and wonders if it is safe to give to her infant.  The short answer is NO…even though the product says BABY on the label and has a picture of an infant.

 

Although homeopathic medicines were first used in the 18th century and are “probably safe” it is still unclear if they really work. Unfortunately,  there have been adverse events and deaths associated with some products ( see articles on teething tablets). The principle of homeopathy is that “ailments can be cured by taking small amounts of products that, in large amounts, would cause the very symptom you are treating. In other words, “like cures like” as these products contain “natural ingredients” that cause the symptoms that you are trying to treat, but that have been so diluted as to hopefully stimulate your body’s immune system to fight that very symptom. In this case, congestion and runny nose due to a cold.

 

So…I looked at all of the ingredients which included Byronia, Euphrasia, Hepar and Natrum…to name a few. Byronia is used as a laxative for constipation, Euphrasia is supposed to help with inflammation, Hepar is for people who tend to get “cold and therefore cranky and irritable” and Natrum is used for inflammation due to “too much lactic acid”.  This is the short version. The bottle also says contains less than 0.1% alcohol, but it has alcohol! 

 

While the FDA does monitor how homeopathic medications are made, they do not require these companies to show proof that these medications do what they say they do, as they are “natural”.   With that being said, natural does not always mean effective or safe.  Just as over the counter cold and cough medications are not recommended for children under the age of 2, I too would not recommend homeopathic products be given to an infant.

 

Best treatment for a cold and cough in young children?  Use a saline nasal spray followed by nasal suctioning to relieve the nasal congestion and mucus. I would also use a cool mist humidifier in the baby’s room to keep moisture in the air and help thin the mucus ( especially once the heat is on in the house). Make sure the baby is still taking fluids (breast or bottle) but you may also add some electrolyte solution to give your baby extra fluids if you feel as if they are not eating as well.  Lastly, always watch for any respiratory distress or prolonged fever and check in with your pediatrician!

Daily Dose

Confusion Over Cough & Cold Medicines

Why are so many parents confused about cough and cold medicines?The confusion over cough and cold medications continues and I must admit I am a little confused too.

The Consumer Healthcare Products Association announced changes to the labeling of over-the-counter (OTC) cold products to state “do not use in children under 4 years of age”. The FDA monograph still states “do not use in children under 2 years”. The American Academy of Pediatrics recommends not using OTC cough and cold preparations in children under six years. Looking at the little research on these products two things come to mind: 1.  There have been multiple studies done on these products (in adults) that do not show them to be efficacious for treating common cough and cold symptoms. 2.  The research among children using these products show that dosing errors and accidental ingestions are the leading cause of adverse events. This kind of leaves me thinking why use them at all in children? I really have never been much of a cold medicine giver in general, as I personally did not see my patients getting better any faster nor my own children. We continued to use the good old grandmother tested remedies of lots of rest, fresh squeezed orange juice (sometimes in pays to be sick), chicken noodle soup (canned or home made), and a vaporizer or humidifier in their rooms at night. I also know that younger children get more colds than anyone and no matter what you do you have to get through that too. But miraculously, as kids get older they get less colds and seem to tolerate them a little better. So… for this winter in our practice we are not recommending the use of any of these products for kids and trying the gold standards rest, fluids, cool mist humidifier and tincture of time. We’ll see how it goes. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

The Dangers of Homeopathic 'Medications'

The FDA announced that they are advising consumers not to use Zicam cold remedy nasal gel or swabs due to an association with the loss of the sense of smell.Even with cough and cold season behind us, over the counter cough and cold preparations continue to be in the news. The FDA announced yesterday that they are advising consumers not to use Zicam cold remedy nasal gel or swabs due to an association with the loss of the sense of smell, also termed anosmia.

The FDA reported that they had received over 130 reports of the loss of smell secondary to Zicam use, and the anosmia may be temporary or permanent and has been reported to occur even after a single dose. There were also reports of loss of taste. In a letter to Matrixx Initiatives, the maker of Zicam, the FDA also requested efficacy data showing that Zicam actually “shortens the duration of the common cold”, as well as the “severity of a cold” as stated on their label. Many parents assume that “homeopathic” medications and/or supplements are safe for use in their children, because they are “not” drugs. Homeopathic medications are often brought to market without FDA approval as they are not marketed as “drugs” and therefore may not be scrutinized by the FDA and get around new drug approval requirements, but they are often acting as drugs. In the case of Zicam, which contains zinc gluconate as its major ingredient, there may be deleterious and serious side effects from zinc absorbed intranasally. Other cold products, such as Airborne have been marketed in similar manners. Although hugely successful in the marketplace (including my Mother who bought some) there is no data on their true effectiveness or safety. To my knowledge there is still not data in the mainstream medical literature that shows any decrease in cold severity and duration with herbal concoctions (also known as hocus pocus in my vernacular). There continue to be ongoing randomized, placebo controlled, double blind studies (the gold standard in medicine) to look into drugs, herbs, supplements and such as cures to the common cold. Once found there will surely be a Nobel Prize awarded as there is not a man, woman or child who would not like to get over their cold as quickly as possible. Until such a time, it is important for parents to use “home remedies” such as fluids, rest, and good hand washing as the most important defense against the common cold and not over the counter products. We will discuss this again in the fall for as we all know, colds are just a season away. That’s your daily dose, we’ll chat again tomorrow.

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Daily Dose

Treating Late Season Colds

Even though the temperatures are really warming up and we are approaching the end of the "sick'" seasons, there are still a few children with lingering colds. The most frequently asked question is "how long does a cold last?" and everyone is disheartened to hear that a typical cold lasts anywhere from 7 - 14 days. (UGH, in unison).

Despite all of the medical science we have, a common cold due to a virus, still causes symptoms of congestion and or runny nose, sore throat, and cough. A cold usually begins two to four days after exposure to the offending virus. It often starts with a scratchy or sore throat and then is followed by the runny nose, congestion and cough. The nasal mucous usually begins as a clear discharge that is then followed by color change to green or yellow mucous, which then thins out and becomes less cloudy as the cold improves over the requisite 7 -10 day period. In children it is not necessary for them to see their pediatrician for a common cold if they are fairly comfortable, do not show any signs of respiratory distress and do not have persistent fever of more than 48 - 72 hours. I am often more concerned about a child who has had a cold for a week and then develops a fever, which may signal a secondary infection, like an ear infection later into the course of a cold. Coughs often linger the longest but again should not be getting worse after a week, instead of improving, and your child should not have any respiratory distress or wheezing. Children can manage horrible sounding coughs, but look totally well and have no breathing problems, as they are quite comfortable in coughing very productively which is actually beneficial in keeping their chests clear. For children whose cold seems more persistent or who seem to be getting worse instead of a little better each day (after the first 5 - 7 days), my rule of thumb is that they are seen in the office. Only by looking at their nose, throat, and ears and listening to their chest am I able to see if they are developing any secondary infections. That's your daily dose, we'll chat again tomorrow.

Daily Dose

Over The Counter Products

1:30 to read

So, if you have read my daily doses you are aware that my “news watching” comes from morning TV while I am getting ready for work!!  I often find myself talking to the TV, especially when it is a medical segment which includes pediatrics.  While I am excited that morning TV is covering health topics, some of the information may be a bit “misguided” when a pediatrician is not the one discussing a pediatric topic.

I “heard” another example of this the other morning when the morning shows were discussing the “top pharmacist picks for over the counter products”.  It seems they surveyed pharmacists  and then compiled a list of “favorite” name brand OTC products in numerous categories - I don’t  think there was much science behind this. At any rate, we all have our “favorite” go to “OTC” products which for one reason or another we prefer. Does that actually mean they are better?

So, here are a few that I had issue with:

Allergy medications: They picked Claritin, but why not Zyrtec or Allegra?  They are all second generation anti-histamines and there is not a great deal of data that one is better than another. If push came to shove and I could only pick one antihistamine it would be Benadryl (diphenhydramine) - despite its sedating properties it is still a great drug.

Topical antibacterial medication: They picked neosporin and I would pick polysporin. Neosporin contains neomycin which may cause an allergic contact reaction. Other than neomycin they are quite similar and both contain topical lidocaine for pain relief.  Guess what -  they are made by the same company!!  

Pain relief:  They picked Advil, but why not Motrin or generic ibuprofen.  I am frugal and buy whatever is on sale, same drug.  I always remind parents of this as sometimes they get confused and say, “Advil didn’t work so I gave them Motrin” double dosing them with same drug. Be careful.

GI complaints:  Pharmacists picked Pepto-Bismol. I do not recommend Pepto-Bismol to  children as it contains  bismuth subsalicylate which is related to aspirin and has been associated with Reye’s Syndrome.  The bottle is labelled “do not use under the age of 12 years” due to this concern, but parents may not read the fine print. There is a Children’s Pepto that contains only calcium carbonate and may be given to children as young as 2 years….really important to read the labels as there are many choices with similar names.

Lip balm: Their choice was Carmex. I do not recommend lip balm/gloss that contains menthol or camphor as it may actually damage the lips and cause more drying…so you apply more then it is a vicious cycle.  You want to use lip balm with bees wax or petrolatum and no fragrance. I like Aquaphor, Burt’s Bees and Vaseline.  

Formula: Their choice was Enfamil.  I recommend any of the formula brands including Simliac and Gerber as well as some Organic Formulas if my patients desire.  I don’t know why they would pick only one brand…no data on that either.

Sunscreen:  Their choice Neutrogena, which I also love. They make good products that are hypoallergenic and PABA free, and they have many different vehicles (spray, lotion, stick) to choose from. I am also a fan of Cerave products and they now have sunscreen for babies.  But the most important fact is to use a sunscreen of any brand with an SPF of at least 30 and one that contains zinc or titanium dioxide and no PABA or oxybenzone. 

Those are just a few of my comments and favorites.

 

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