Here's what you should know about over-the-counter medicines for your baby
Easily accessible medicines may have harmful side effects, Paediatrician Dr Simon Stracham shares useful guidelines on what you should know before purchasing them for your baby.
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It is very easy to buy medication over the counter at your pharmacy. These medications are as potentially dangerous as any prescription medication so it is important to know what you are buying.

It cannot be said enough that over the counter (OTC) medications are for symptomatic relief, meaning that they treat the symptoms and not the cause of the illness.

Ingredients to watch out for:

- Dextromethorphan in cough suppressant syrups

  • Respiratory depression (breathing difficulties)

- Pseudoephedrine in decongestants

  • Heart rhythm changes
  • High blood pressure

- Antihistamines in both decongestants and cough suppressants

  • Drowsiness, loss of consciousness
  • Heart rhythm changes

These three ingredients are used most frequently to achieve relief from congestion and coughing and have significant side effects, especially when used in young children and when given in the incorrect dose.

It is important to note that the doses of these medications have not been accurately studied in children. The side effects of some medications have led to a global warning about the safety of products that contain these preparations.

All medications containing these ingredients must not be used in children under 2 years of age and their use in children from 2 to 6 years of age is discouraged.

While bearing this warning in mind, here are some symptoms and the medications that are commonly available for treating them.


Now that you've learned what to avoid, here are a few safety guidelines to follow. 

    Commonly used medicine for pain and fever in children

    * Paracetamol

    Commonly found in: 

    Panado, Calpol, Tylenol

    Use: 

    Fever control, mild to moderate pain.

    Dose:

    2mg per kilogram per dose and this can be given 6 hourly. The syrups are available in concentrations of 120mg per 5ml.

    Safe for: 

    All ages but must be avoided in children with liver or kidney disease.

    Available in:

    Syrup, drops, tablets and suppositories. Syrups allow more flexibility in dosing but suppositories are well tolerated and are better for vomiting children

    NB: Paracetamol does not sedate a child.

    * Paracetamol and combination medications for pain and fever

    Commonly found in: 

    Stopayne, Lentogesic, Stilpane, Painagon

    Use: 

    Combination medications are specifically designed for pain relief. They have no advantage over paracetamol for the relief of fever.

    Dose:

    2.5ml per 6kg of body weight.

    Safe for: 

    Only children over the age of 2 years.

    Common side effects:

    Sedation, constipation, dizziness and at very high doses, could cause difficulty in breathing.

    NB: These medications are a combination of paracetamol, codeine phosphate and promethazine. 

    Promethazine is an antihistamine that sedates the child and has an effect on relieving cramps. 

    Codeine phosphate is a cough suppressant as well as a pain reliever and is similar to dextromethorphan.

    * Paracetamol and ibuprofen combination

    Commonly found in: 

    Lotem

    Use:

    Anti-inflammatory agent, pain relief, fever.

    Dose:

    2.5ml per 10kg body weight – given 8 hourly.

    Safe for: 

    Only children over the age of 2 years.

    Common side effects: 

    Tummy ache, diarrhoea, prolonged use can cause bleeding in the stomach.

    NB: Not to be used in dehydrated children or children with vomiting and diarrhoea.

    Must be taken with food and must not be taken for more than 48 hours without speaking to your doctor.

    * Diclofenac

    Commonly found in: 

    Voltaren

    Use:

    Anti-inflammatory, excellent pain relieving properties, lowers fever.

    Dose: 

    1 to 3mg per kilogram per day divided into three doses- 12.5mg suppository given every 8 to 12 hours.

    Safe for:

    Only children over the age of 2 years without a doctor's authorisation.

    Common side effects:

    Tummy ache and possibly bleeding in the stomach if used for long periods.

    NB: Not for children with asthma, bleeding tendencies, dehydration, vomiting and diarrhoea. Must be taken with food.

    Medications for mucus (snotty nose or wet cough)

    Mucolytics

    These products are used to thin out or liquify mucus or phlegm in the chest and upper airway to allow easier coughing. They won't stop the cough, but will cause more coughing until the mucus is cleared. 

    Commonly found in: 

    Acetylcysteine (Solmucol), Bromhexine (Bisolvon, Bronkese), Carbocisteine (Mucosirop, Flemex, Mucospect)

    NB: The preparations are generally safe for children over two years of age and are typically used for coughs and colds.

    Follow the manufacturer's package insert for the correct dose.

    Medications for a wheezy chest

    Bronchodilators

    Bronchodilators relax the smooth muscle surrounding the airways and therefore relieve a tight chest. They are known as asthma pumps or inhalers but are also available in syrup form, which should only be prescribed if the child is unable to use the inhalers. The oral formulations are more concentrated than the pumps and cause more side effects, and their onset of action is slower, although the duration of action is longer.

    Commonly found in: 

    b2 Agonists (Ventolin, Berotec), Hexoprenaline (Ipradol)

    Dose:

    Dosage of the oral medication depends on the weight of the child. The inhalers are a standard dose and can safely be used 6 hourly during attacks of tight chest. The inhalers must be used with a spacer and mask in young children.

    Common side effects:

    Tremors, nervousness, rapid pulse, dizziness and nausea. Overdose will cause abnormal heartbeats.

    Watch out for:

    Theophylline (Nuelin, Alcophyllin, Solphyllin)

    • These medications exert their action by causing bronchodilation. 
    • The side effects of rapid heart rate and feeling jittery and tremulous are greater than for the above group. 
    • They should not be given with antibiotics belonging to the macrolide group (Erythromycin, Klacid, Zithromax). This group of medications should only be used under instruction of a doctor.

      Decongestants (wet, runny nose and wet, mucusy cough)

      Pseudoephedrine

      Commonly found in: 

      Sudafed, Actifed, Sinumed, Sinumax, Demazin, Coryx

      These medications are used on their own or in combination with antihistamines. They dry up secretions and allow clearer nasal passages during infections like a common cold.

      Dose: 

      The dose is age and weight dependent, so check the package insert for the correct dose. Pseudoephderine must not be used as an agent on its own. In combination with other medications in a syrup it must not be used in children under 2.

      Common side effects:

      These medications interact with anaethetic gases (halothane) and heart medication (digoxin, beta-blockers). If used in the correct dose they are safe but overuse can result in high blood pressure, rapid heart rate, restlessness and tremors. 

      Nasal decongestants

      Oxymetazoline (Iliadin, Drixine), Phenylephrine (Vibrocil)

      These preparations are used for the short-term symptomatic relief of nasal congestion and for treatment of the common cold. 

      Common side effects:

      The side effects are potentially the same as for pseudoephedrine if used in patients potentially the same as for pseudoephedrine if used in patients with heart disease, but they are generally extremely safe. 

      NB: During use, the lining of the nose dries out and this gives relief from nasal blockage. If used for longer than one week, they can potentially cause a rebound blockage of the nose when the therapy is stopped. 

      Cough suppressants (dry cough)

      It is hardly ever necessary to suppress a cough. Coughing is the body's protective reflex that protects the lungs be expelling mucus. A persistent dry cough, such as the coughing from whooping cough, may respond to cough suppressants.

      Commonly found in: 

      Dextromethorphan (Benylin Dry cough), Noscapine (Nitepax), Pholcodine (Pholtex)

      NB: These medications are safe for children and registered for use in children older than 6 years of age. Not to be taken more than 8 hourly. They may cause drowsiness and tummy upsets.

      Earache

      If this is associated with a fever it is probably an ear infection. Oral medications for pain and fever must be used. ear drops can be used but won't treat the infection. They are for pain and must contain local anaesthetic such as Convocaine or Auralgen.

      Ear pain caused by irritation or infection of the ear canal (otitis externa) should be treated with anti-inflammatory drops like Spfradex, Betnesol and Covomycin.

      Allergic reactions (itchy skin rashes, stings, hives)

      Antihistamines

      Commonly found in: 

      Clarityne, Deselex, Zyrtec

      These new generation antihistamines don't generally cause sedation and are safe for long-term use and use in children from 1 year.

      Dose:

      2.5ml daily for children under 6 and 5ml daily for children over 6. 

      Common side effects:

      Side effects are minimal but may cause irritability, sedation, constipation or difficulty passing urine.

      NB: Allergex is the most common antihistamine dispensed. It causes drowsiness and has potentially serious side effects in young children. It should not be used in children under 2 years of age.

      Medication for vomiting

      Cyclizine 

      Commonly found in: 

      Valoid, Covamet, Emitex

      These are used to stop vomiting and to treat motion sickness and dizziness.

      Common side effects:

      The medication causes drowsiness, lethargy, dry mouth, blurred vision and nervous system reactions. 

      NB: It must not be used in children under 2 years of age and children under 6 years must be under direction of a doctor. The paediatric suppositories (50mg) must only be used in children over 6 years of age. 

      Prochloperazine

      Commonly found in: 

      Stemetil

      It is very effective in stopping vomiting but can cause serious reactions in the nervous system. 

      NB: This medication must only be used on prescription. Children who have viral gastroenteritis should not be given medication to stop vomiting.

      Antispasmodics (tummy cramps)

      Commonly found in: 

      Hyoscine butylbromide (Buscopan)

      Buscopan is derived from belladonna and causes relaxation of the gut, the bile ducts and the urinary system. It is poorly absorbed from the gut and it has very few side effects at recommended doses. 

      Safe for:

      It is safe for children from one month of age. 

      Common side effects:

      It can cause drowsiness and should not be used in conditions causing obstruction of the gut. 

      Available in:

      It's available in syrup (5mg per 5ml) and the dose depends on the age. See the package insert.

      Antidiarrhoeals

      The most common cause of diarrhoea is gastroenteritis and the diarrhoea in this condition can persist for up to ten days

      Commonly found in:

      Loperamide (Imodium)

      This medication slows down the movement of the gut and therefore stool is passed less frequently. 

      NB: This medication will not decrease the length of the illness and probably will not decrease the quantity of diarrhoea, but may reduce the number of stools per day. Generally, antidiarrhoeals are not used to treat the diarrhoea in viral gastroenteritis.

      Constipation

      Osmotic laxatives (Lactulose)

      Commonly found in:

      Duphalac, Senokot syrup, Lacson, Laxette

      These medications are very safe for long term use. No effect on the lining or muscles of the intestine. 

      Dose: 

      Starting dose is 1ml per kilogram per day. 

      Safe for: 

      Safe for any age.

      Suppositories

      Commonly found in:

      Glycerine, Dulcolax

      Safe for: 

      Safe for any age. 

      NB: Use for short periods of three days.

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