Monday 23 April 2018

Easing the pain - medication types and doses

Pharmacist Kathy Maher talks to Grainne Rothery about the medication types and dosages you should give your child when they are in pain, plus what to do when your child has a temperature

Grainne Rothery

Seeing your child going through physical pain is obviously distress¬ing for any parent. The good news is that pain related to most common ailments and minor accidents can be treated quite effectively with over-the-counter medication.

Pharmacist Kathy Maher, a member of the Irish Pharmacy Union executive and owner of Donore Pharmacy, stresses that it’s vital, however, to be vigilant around both the dosage and the age recommendations for all medications aimed at children.

Maher says both paracetamol-based pain relief, such as Calpol or Paralink, and ibuprofen-based formulations, which include Nurofen for Children and Provin, are suitable for young children and for babies from a certain age.

Age appropriate

“Paracetamol can be taken by babies above the age of two months,” she says. “It’s recommended from three months, but it can be given at two months, just after their vaccinations.”

Ibuprofen, meanwhile, is suitable from three months and upwards.

For teething babies, Bonjela is only appropriate from four months up. One alternative for younger babies is Nelsons Teetha, a natural homeo-pathic product that comes as a sachet of powder and can be sprinkled onto the gums. It can be used from birth.

“We’d always recommend that people stick to the age that’s on the packaging,” says Maher. “Always ask the pharmacist about the age limit. The age limits are there for a reason.”

This applies right the way up, she says. “Often parents will say: ‘He’s a big five, can I give him the six plus?’ That’s a ‘no’. It goes on the developmental age of the child, not just the body weight.

Maher also points out that aspirin-based medicines should never be given to children. “It can cause various conditions in children so the minimum age to give aspirin is 16,” she explains.

The right dose

Parents should also always stick to the correct dosage according to the instructions on the box. Maher notes that mistakes are often made around how often medicines are given.

“It is really important that parents stick rigidly to the schedule that’s on the box according to the child’s age. Paracetamol can only be given every four to six hours and ibuprofen is given just three times a day, usually every eight hours. Sometimes parents make the mistake of giving ibuprofen every four to six hours.”

Ibuprofen and paracetamol can be given at the same time and work well together to reduce temperature and kill pain.

“From a practical point of view, you’re better giving one a chance to work and then try the other. But they don’t interact at all and one can be used as a back-up for the other. If one doesn’t work, try the second one. If the second doesn’t work, contact the doctor.”

Maher also says it is important to measure out the dose that’s appropriate and to use a proper medicine spoon and not a teaspoon, which will not necessarily be the set 5ml in volume.

Pain reliefs are generally in syrup form as it’s not recommended to give tablets to children because of the risk of choking. For children who are vomiting and are unable to hold down any liquid, meanwhile, Maher says suppository forms of both paracetamol and ibuprofen are available.

Dealing with temperature

“If a child has a temperature, we’d always recommend that you give them paracetamol or ibuprofen, but also to check other things,” she says.

“Make sure you’ve checked the temperature, because it’s a good way to check that the medicine is working. Usually we say if the temperature has dropped a degree within an hour, then the medicine is starting to work. If the child’s temperature is 38.5 and it comes down to 38 or 37.5 within an hour, that’s fine. People sometimes expect it to work within 15 or 20 minutes but you do need to give it an hour or so.”

Maher also recommends ensuring that a child with a temperature is dressed loosely.

“The old fashioned thing to do was to put the child into a cold bath. That’s not recommended any more. That tricks the body into thinking it’s cold and the internal mechanism sends the temperature up higher. Have the child in layers of clothing so you can remove them as necessary and put them back on as needs be.

“If the temperature’s not being reduced by either of the medications, or if they’re becoming very listless or have other symptoms like drowsiness or intolerance to light, that could be a sign of possible meningitis. With anything like that, you would need to contact a GP straight away. If they don’t have those symptoms but the temperature stays high, there could be a risk of a child having convulsions. The most important thing is to reduce the temperature. If the temperature won’t come down, you should go straight to the doctor or hospital.”

For pain related to sprains and strains, meanwhile, Maher recommends bringing your child to the pharmacist, who will always know if your child needs to go to casualty or if they need a simple strapping. Ibuprofen may also be effective because it has anti-inflammatory properties.

In the case of a burn, she says it’s important to run cold water on it and not to put the affected area into a basin of water as this will heat up the water around it.

“Give pain relief and then check with the pharmacy, just to see how bad it is and if it needs to be dressed.”

Maher says it’s always a good idea to have pain relief on standby as children tend to get worse in the middle of the night.

“But make sure from a safety point of view it’s out of children’s reach and locked away. These things are flavoured and they’re very pleasant for children to take so you need to have them well out of the way.”

Finally, when in doubt, Maher recommends going to the pharmacist and bringing the child along.

“When a mum comes in with a child I’d nearly know when they’re at the door if they need to go to the doctor,” she says. “A lot of the time, the parents know themselves, but they just want someone to reassure them.”

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