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CHILDREN’S MEDICATIONS: MUFFING THE HEALING PROCESS

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A sick child is a parent's trauma. No parent wants to see a child suffer through an illness - but some parents may be hindering as much as helping the healing process.

Consider:- The Food and Drug Administration estimates that of the 13 million children who are given medicines in any two-week period, only about half take the medicine correctly. This includes both prescription and over-the-counter (OTC) drugs.

- A panel of pediatric experts reviewed 3,900 OTC-medication decisions made by 500 mothers over a nine-month period in a study conducted at the universities of Michigan and Rochester. The panel found "only minimal approval" for the way the mothers treated their ailing children. In fact, the panel felt the mothers did only slightly more good than harm for their children. And in a few cases, the mothers' decisions were considered dangerous.

Common errors made by parents in treating their children include:

Stopping the medication too soon. One of the most common misuses of medication is not giving it as long as necessary. This is particularly critical with antibiotics. Often, when a child begins to feel well, the parent thinks the infection is cured and stops giving the child the antibiotic. This may mean the child will become sick again with the same bacterial infection.

Parents should use any prescribed medications for as long as the doctor recommends. This usually means using up all the pills or liquid.

Giving too much medicine. This kind of misuse is one of the most dangerous. It sometimes is the result of guesswork in measuring doses or not paying attention to the dosing schedule. Parents sometimes rely on the "more is better" logic, thinking that if a little is good a lot will help the child get better quicker. But this can lead to severe reactions in many children.

Selecting the wrong medication. This is another dangerous practice. Some parents have been reported to use OTC products for prevention - giving children regular doses of aspirin to prevent headaches, for example, or laxatives to prevent constipation. Some medications shouldn't be given to children at all - such as extra-strength cough/cold products, some time-release remedies and sleeping pills.

Simply reducing the adult dose. When children's medicines aren't handy, some parents - figuring that children are just like grown-ups, only smaller - give children adult medications and just reduce the dose size. They may cut a tablet in half, for example, or measure out half as much liquid.

For some medications, this system is OK, but for others, it doesn't work at all. A time-release tablet, for example, can't be divided without disrupting its timing mechanism. Check the label; if a children's dosage is not given, the medication should not be used until a physician is consulted.

Not taking enough medicine per dose. Even with partial medication, the child may begin to feel better, leading the parent to believe the medicine is working as it should. However, the full dose may have worked better or faster.

Not taking the medicine at all. Children may refuse to take medicine for a number of reasons: pills are hard to swallow, medicines taste awful, a general fear of medicines. Or, parents may skip giving medicine because they don't like the side effects or don't want to interrupt the child's sleep or play. Sometimes children miss doses because parents simply forget about it. (Parents should be aware that this is a problem and ask their doctor in advance what to do about a missed dose.)

With some OTC drugs, misdosing may not entirely be the fault of the parent. Many medications are not clearly labeled with children's dosages. While parents realize there is a big difference between infants and children of 6 and 12, many medicines don't make any distinction in the dosage.

Recent research has also shown that where recommended doses were given for children, in some cases they were too low for maximum effectiveness of the medication. Part of the problem is that drugs are usually tested on healthy adult volunteers; experiments on children are out of the question. So some dosing recommendations have evolved only through experience.

The FDA has initiated an effort to address the labeling of medications for use by children. After years of research by its staff and advisory panels, the agency also asked for recommendations from the pharmaceutical industry and for public comment.

But standardizing the use of medication is not as easy as it might seem. The goal is a labeling system that is both reliable and simple to follow.

One central issue is determining the best criteria for measuring the effects of drugs on the body - particularly as those bodies are rapidly growing. Age may be the most obvious determinant, yet it may be much less precise than weight or body surface area. Body length is also a useful dosing guideline, since many medications are distributed through body water rather than body fat.

The big argument for using age is that it is almost always known, more so than weight and length, and definitely more so than body surface.

Until these questions are resolved and final regulations put in place - and even after that, in fact - the responsibility for properly medicating children still rests with parents.

While modern pediatric OTC medicines are very safe, any drug can have bad effects if taken in excess or without regard to instructions. And any product that may be beneficial in itself can be harmful if used inappropriately.

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(ADDITIONAL INFORMATION)

ASPIRIN AND ACETAMINOPHEN

Pediatric dosages

Based on a standard adult dosage unit of 325 milligrams (mg) - the familiar size of an aspirin tablet - and on the smaller 80-mg unit of children's analgesic products, FDA is proposing to recommend the following dosage every four hours, up to five times a day, until fever or other symptons subside.

AGE DOSAGE

(CHILDREN'S PRODUCT (80 mg) ADULT PRODUCT (325 MG)

UNDER 2 ASK DOCTOR ASK DOCTOR

2 TO UNDER 4 2 UNITS 1/2 UNIT

4 TO UNDER 6 3 UNITS 3/4 UNIT

6 TO UNDER 9 4 UNITS 1 UNIT

9 TO UNDER 11 4-5 UNITS 1 TO 1 1/4 UNITS

11 TO UNDER 12 4-6 UNITS 1 TO 1 1/2 UNITS

Aspirin - even children's aspirin - should not be given to children or teenagers suffering from or recovering from flu, chicken pox or other viral illness. Use of aspirin in such cases has been associated with Reye syndrome, a rare but serious - even fatal - condition.

TIPS FOR PARENTS

Talk with your doctor or pharmacist. Be sure you understand directions completely. Ask about what will happen if directions are not followed. (If you miss a dose for example, should you give a double dose later, or will that be too much medicine?)

Read and follow all label directions

Before you give any medicine to children, you should know:

- What the medicine is for.

- How much to give.

- When to give it.

- How long to continue giving it.

Set a good example for your children in taking medication. (Many adults don't take medications properly; and this habit is continued when the parent gives medicine to children.)