Clearly, children react to drugs differently than adults.
There are fewer drugs available for children in the OTC arena. That’s a good thing. While I basically oppose the use of drugs for children, I am aware that there are times when it is necessary to use them. For example, when severe pain strikes it seems particularly cruel to allow a child to suffer when a relatively safe pain reliever is available. The same applies to situations where an allergic reaction is making life uncomfortable. Using small amounts of hydrocortisone antihistamine, or anti-infective cream for short periods of time seems appropriate. The effects of these same drugs could be negative, however, if taken by mouth.

Many cough and cold preparations for pediatric use are being removed from the market by order of the FDA. That’s a good thing. In years past, they contained alcohol. While the alcohol has been removed, the drugs have remained.

I remain torn on the topic of fever. While a fever is a sign that the body is working to rid itself of an attacking infection, they can also be excessively bothersome, especially when they don’t break in a reasonable amount of time.

Acetaminophen (Tylenol) is commonly used pain and fever relief for children. It is fairly effective as a pain reliever, but does little to relieve fever. The drug, though, can cause damage to the liver if used in high doses and/or for extended periods of time.

Ibuprofen (Motrin), and even aspirin, are better than acetaminophen for fever and they are often effective for pain. However, inappropriate dosing for extended periods of time can cause damage to the gastrointestinal tract.

On the topic of fever, I lean heavily on the use of cool baths and feeding of ice chips. Fevers are useful, and children can tolerate them at much higher levels than adults. While an older person can suffer severely with a fever of 102, a child can easily handle one, even up to 103 or 104.

Turn to a fever reducing drug only under the direct advice of a doctor.

One major area of concern over OTC drugs for children has long been the variety of ways the drug companies measure their products – and the strengths they make available. Recent action by the FDA and the drugs companies have been directed at standardizing children’s doses – within different products at the same manufacturer and between manufacturers. It has been easy to dose inappropriately because of the varieties of strengths available – and the way the companies suggested using them. While one product may have been recommended at a teaspoonful, a similar product might have been recommended in droppers full – or partial dropper. There could be serious side effects if a person gave a teaspoonful of a medicine that was supposed to be given in drops. As there are approximately 20 drops in 1 ml and 5ml in a teaspoon, giving a teaspoonful would deliver a dose of the drops ten to twenty times above the recommendation.

Standardizing the strengths is a good step. There should also be an effort to standardize the delivery devices. A “teaspoonful”, for example can run from 4ml to over 5ml – a variance of 20% or more. Different products provide differing delivery devices – spoon, droppers, cups, etc. While they might be similar from product to product, they could also be significantly different.

I prefer that OTC drugs be the absolute last resort when it comes to helping a child feel better. When the drug is necessary, it would be best if there were standard doses, droppers and spoons/cups. It would also be best to limit the size of the containers the drugs are sold in. A full container, for example, should not contain enough doses (drug) to be toxic.

These ideas can be fulfilled by the drug makers without government mandate.