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Articles on Child Matters:

To Self-Medicate Your Child or Not? - Consult A Doctor When In Doubt (Part 1)

You don't always have to run in a panic to the doctor when your child has a little sniffle. If symptoms are mild and does not persist, some parents do turn to over-the-counter medicines as the first line of action. But before you self-medicate, always ask the doctor or pharmacist for advice first. Let them know if you child has any allergies or is suffering from other illnesses.

Pharmacist at National Healthcare Group Pharmacy and KK Women;s & Children's Hospital Pharmacy walk us through over-the-counter remedies for children over two years of age.

Cough
Coughs are either productive (with phlegm) or non-productive (without phlegm). Most laymen describe it as wet or dry coughs respectively. Idebtify which one your child has first.

A wet cough (with phlegm) needs to be treated with expectorants and mucolytics. Expectorants stimulate coughing to help loosen the phlegm and to expel it. Warm water can be used as an expectorant as well as a vapouriser. The active ingredients to look out for are: ammonium chloride, diphenhydramine (e.g. Benadryl), and guaifenesin (e.g. Cofen 50/100, Breacol). When the phlegm is too thick, mucolytics can be taken to thin and dissolve it. The active ingredients to look out for are: acetylcysteine (e.g. Fluimucil), and bromhexine (e.g. Mucosol, Bisolvon).

A dry cough (without phlegm) can be treated with cough suppressants or antihistamines. The suppressants reduce the urge to cough. The active ingredients to look out for are: dextromethorphan (e.g. Dexcophan, Metophan), and clobutinol (e.g. Silomat). An Antihistamine like promethazine partially munbs the back of the throat and relieves the tickle that brings the cough.

What else you can do?
- Give the child plenty of liquids.
- Increase humidification to soothe irritated airways.

When to consult a doctor?
- The cough is severe or unusual (like a barking cough or if the child loses his/her voice)
- The cough persists for more than a week, or mainly at night.
- The cough worsens in intensity or frequency.
- The cough is accompanied by high fever, chest pain, greenish-yellow or blood-stained phlegm, or breathing difficulties.

Fever
High fever above 38 degrees celcius are often accompanied by chills and body aches.

Paracetamol, alsoknown as acetaminophen, is the most common fever medicine. It lowers fevers and help relieves pain. It comes in the form of chewable tablets, syrup (e.g. Panadol Syrup for Children, Paximol, Calpol) and suppositories (e.g. Remedol)

Note that there are various concentrations (ranging from 120mg to 500mg) of paracetamol, and these will affect the dosage. High fevers are treated with Ibuprofen (e.g. Nurofen). Ibuprofen should be given after food to prevent gastric upset. Aspirin should not be used for children under 16 years old unless under doctor's supervision.

What else you can do?
- Give the child extra fluids, even popsicles and iced drinks.
- Keep clothing to a minimum and the room ventilated and cool.
- Sponge with tepid (not cold) water. Do not sponge for more than 30 minutes at a stretch.

When to consult a doctor?
- The fever lasts more than three days, or remains at 38.5 degrees celcius or higher despite efforts to lower it.
- The child is feeding poorly, is lethargic, and urinates less.
- The child shows other symptoms, e.g. cough with yellowish or greenish phlegm, earache (could be ear infection), severe headache*, marked irritability or confusion*, high-pitched crying*, stiff neck*, rash*, vomiting*, fits*, abdominal pain, severe back pain, extreme thirst, severe throat pain (could be throat infection), painful urination (could be urinary tract infection).

* Symptoms for Meningitis. Go see a doctor immediately.

Young Families
Singapore
25 Jan 2007

To Self-Medicate Your Child or Not? - Consult A Doctor When In Doubt (Part 2)

Runny Nose
There are no curative remedies for colds. Adequate fluid intake, a well-balanced diet, and keeping away from air-conditioned areas provide equal or better relief than the use of drugs.

Oral anitihistamines that contain the active ingredients chlorpheniramine (e.g. Piriton), promethazine, loratidine (e.g. Clarityne) or cetirizine (e.g. Zyrtec) and fexofendine (e.g. Telfast) can help to relieve symptoms such as sneezing, itching and a runny nose. They also dry up a runny nose, but do not always clear up stuffiness. Some medicines like Actified and Clarinese contain a nasal decongestant as well for this purpose.

Nasal decongestants can also be in the form of nasal sprays or drops. However, the congestion often returns once the medication wears off, and may be more severe than before. To prevent this, do not use for more than five days continuously. The decongestants usually contain oxymetazoline (e.g. Afrin, Iliadin, Kotrin). Different strengths are used for different age groups.

What else you can do?
- Give plenty of liquids to thin the mucus.
- Ensure a balanced diet.
- Get the child to sleep with her head elevated.
- Blowing the nose too hard can make the condition worse by forcing mucus into the sinuses. Make sure the child blows the nose gently, clearing one nostril at a time.

When to consult a doctor?
- Symptoms do not improve, or worsens while taking non-prescription medicine.
- Child has thick opaque mucus, high fever, shortness of breath, chest congestion, wheezing, significant ear pain (could be middle ear infection) or rash.

Diarrhoea & Vomiting
For most cases, no medication is rquired, just an adequate intake of fluids to prevent dehydration.

Most actue vomiting is caused by viral infection of the stomach lining, or by food poisoning. It may be accompanied by diarrhoea. Adsorbents such as cahrcoal (e.g. Ultracarbon), kaolin mixture abd dioctahedral smectite (e.g. Smecta) help to adsorb the toxins.

Vomiting usually stops within six to twenty-four hours. If your child also has diarrhoea, it will often continue for several days.

What else you can do?
- Give a paediatric oral rehydration solution to replenish lost water and electrolytes.
- For children on formula milk, stop the feed for 24 hours. Give him the same amount of rice water, diluted formula or soy formula instead.
- For vomiting in older children, stop solid food and give small amounts of clear liquid for eight hours. Then offer bland food if there has been no vomiting for eight hours.
- For diarrhoea, avoid fatty, high-fibre or highly seasoned food for a few days.

When to consult a doctor?
- The child shows sign of dehydration: more than eight sessions of diarrhoea in 24 hours; going for 10 hours or more without passing urine; crankiness or sleepiness; sunken eyes or shadows under the eyes; cold and clammy skin; very dry mouth, tongue and lips, or no tears.
- Diarrhoea worsens in 48 hours.
- Diarrhoea is bloody or accompanied by vomiting.
- The child has severe headache, or a painful swollen abdomen, appears pale or lethargic, has a fever of 40 degrees celcius or more, or vomits often for more than 12 hours.
- The child starts vomiting after a head injury.
- There is blood/mucous in the vomit or it resembles coffee grounds.

Things to note when giving medicine to your child:
Over-the-counter medication refers to those found in retail store shelves or from the pharmacist's. Always follow these guidelines when giving medication to children.:
- Read the label and insert and follow the instructions.
- Know your child's weight, and follow the age/weight limit recommendations. Never guess the amount or give half an adult dosage to a child.
- Don't exceed the duration of treatment recommended.
- Use a calibrated spoon, medicine dropper or syringe for exact measurement.
- Medicine, vitamins, supplements, food and beverages don't always mix well with each other so tell the pahrmacist what your child is taking.
- Consult your doctor or pharmacist when in doubt or if your child has any pre0existing conditions or allergies.

Young Families
Singapore
25 Jan 2007