A spoonful of sugar not needed, just a straw

Having and caring for your own children really has put things into perspective for me. Although I have shared many tricks with parents on how to give medicine to your children, I've had to be really creative with my own. Fortunately, the only medicines my daughter took as an infant were famotidine suspension for her reflux, which resolved before she turned 1, and one course of amoxicillin for sinusitis. The famotidine was quite the challenge because even at 8 weeks, she was already clamping down her lips when she saw me coming with the dropper. I ended up using an oral syringe instead and "shot" the medicine into the side of her mouth a little at a time. Now she only takes fluoride tablets, which are chewable and flavored, but after 3 months, she started resisting. Thankfully, the tablets we got with our refill were grape-flavored, and she is willing to take it again.

With my son, we've had a few pink messes when I tried to give him the amoxicillin for his ear infection. The first couple of times, he tolerated the oral syringe. Then he realized he could spit it out. I knew it was time for an old trick: the straw. Sometimes I use a straw like a pipette to get him to drink fluids. So, I measure the dose he needs with a medicinal spoon, then I use the straw to give him small aliquots until the entire dose is given. Yes, he knows what's going on, but he'll drink the medicine. I add water to the spoon to get what is left on the side. Yes, I do have to hold his hands down and we still get a little messy, but the dose is successfully given. We do this twice a day - only 6 more days to go!

What are some of the tricks up your sleeve?

Mom vs. RPh: the Inner Struggle

My son had a fever Sunday night that lasted until yesterday afternoon. He was cranky, lethargic, and woke up every hour. His rectal temperature was 99.8 degrees F at 10 pm, 101.8 at 3 am on Monday, 101.9 at 9 am, and 98.9 at 3 pm. He had a lot of mucus coming out of his nose and mouth, but other than that no other symptoms. His appetite was decreased, but was still willing to drink.

The mom in me wanted to medicate and make a doctor's appointment ASAP, while the RPh in me wanted to just wait it out; it's probably just a virus. Well, the mom won and gave him 2 doses of acetaminophen. The RPh helped figure out the dose since the label only offered contacting the doctor for children under 2. I used his weight in kg, calculated his dose, and adjusted slightly (he's 30 pounds and only 13 months=old). At 9 am, the mom panicked because the fever was high and a rash was seen. An appointment was made for later that evening. Until then, the pharmacist recommended giving a dose of ibuprofen and giving him a tepid bath.

The mom and RPh came to common ground at 4 pm when the fever broke. Both agreed that the appointment could be given to someone who needed it more. Unfortunately, the engagement could not be broken without a penalty, so I brought him anyway. It turns out he has a left otitis media. What I didn't tell you is that my son had fevers two weeks ago, so he probably had it then, too. In any case, amoxicillin was prescribed. The RPh was ambivalent about starting it, but the mom remembered the colored mucus and misery during the last several weeks. I just have to make sure he doesn't miss any doses and that he completes his 10-day course.

As a mom, I want what is best for my children, and I find that having a background in the health profession helps me make better decisions for them. You, too, can be an informed parent. The information is out there. In fact, many hospitals and general practices have their own web sites to provide you with important information about your child(ren)'s health. Your pediatrician might even have print resources in his office. Some centers have family-oriented libraries. Take a minute to get better acquainted with common illnesses in children and their management. Most of the time, you can treat them at home, but worsening symptoms or changes in behavior warrant a call to the pediatrician.

Safe contact lens use: advice from the FDA

I just switched to daily disposable contacts last week, but this is good information from the FDA for all contact lens wearers. A video is also available on their site.

Intranasal Zicam linked to loss of smell - throw out!

I have never used or recommended this product. This just in from the FDA:

Loss of Sense of Smell with Intranasal Cold Remedies Containing Zinc

June 16, 2009

FDA is alerting consumers that Zicam Cold Remedy Nasal Gel, Zicam Cold Remedy Nasal Swabs, and Zicam Cold Remedy Swabs, Kids Size, a discontinued product that consumers may still have in their homes, have all been associated with long lasting or permanent loss of smell (referred to as anosmia). These products, marketed by Matrixx Initiatives, are zinc-containing, nasal cold remedies used to reduce the duration and severity of cold symptoms. However, these products have not been shown to be effective in the reduction of the duration and severity of cold symptoms.

This advisory does not concern oral zinc tablets and lozenges taken by mouth.

FDA recommends that consumers stop using these products and throw them away. See the FDA website for How to Dispose of Unused Medicines.

For treating symptoms of the common cold, consumers can take a number of other over-the-counter drugs. However, the common cold goes away without treatment, usually within seven to ten days.

Since the introduction of Zicam Cold Remedy Nasal Gel to the market in 1999, FDA has received more than 130 reports of anosmia associated with the use of Zicam zinc-containing intranasal products. The reports vary. Many people state that the loss of sense of smell occurred with the first dose of the Zicam product, although some people report it happened after later doses. The loss of sense of smell may be long-lasting or even permanent in some people.

Loss of the sense of smell may cause serious problems, such as failing to smell smoke, a gas leak, or spoiled food. Also, loss of the sense of smell is often linked with a loss of the sense of taste. People who cannot taste could unintentionally eat spoiled food and not appreciate flavors, and lose much of the pleasure of eating.

FDA recommends that consumers contact their healthcare provider if they experience loss of the sense of smell or taste, or experience other problems after using any zinc-containing nasal products.

Adverse reactions or quality problems experienced with the use of this Product may be reported to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail or by fax, using the contact information at the bottom of this sheet.

Following the label, the label, the label

Just because a medicine is over-the-counter does not mean it is safe from overdosing! In fact, it is important to read the label for the active ingredient(s), strength of the ingredient(s), age recommendations, directions for use, and inactive ingredients (especially if you have known allergies to make sure cross-allergies do not occur). Other important information include warnings for use when your child has underlying conditions, like asthma (may result in an asthma attack), or having an increased risk of a heart attack or stroke when overusing (more or longer than directed) medications, like ibuprofen (brand names are Motrin and Advil). This addition to the label have been recently approved by the FDA for pediatric ibuprofen suspensions. Knowledge is helpful for safe medication use. We will be seeing more approvals for revisions to labels in upcoming months.

Speaking of ibuprofen, it is exciting that the FDA also recently approved an injectable formulation of the pain and fever reliever. The brand name is Caldolor. Although its use will be limited to hospital use only, it will be an important addition for pain treatment algorithms, especially for children with acute painful crises, such as those with sickle cell disease, and can't tolerate medication by mouth and need the combination of an opioid and a nonsteroidal antiinflammatory drug (ibuprofen). For postpartum pain, I preferred moderate doses of ibuprofen over opioids; the former was effective to control my pain after vaginal delivery and, surprisingly, after the c-section years later.

“Injectable ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) are promising pain management options,” said Bob Rappaport, M.D., director, Division of Anesthesia, Analgesia and Rheumatology Drug Products in the FDA’s Center for Drug Evaluation and Research. “But until now there were only oral forms of most NSAIDs. An injectable ibuprofen product can provide patients with relief from pain and fever when they cannot take oral products.”

Caldolor will be available for hospital use only. It is approved to be administered in 400 mg to 800 mg doses, over 30 minutes, every 6 hours for acute pain. To treat fever, the drug is approved in a 400 mg dose administered over 30 minutes, followed by 400 mg every 4 to 6 hours, or 100-200 mg every 4 hours, as necessary.

In a clinical trial of 319 women who had undergone an elective abdominal hysterectomy, patients were less likely to request morphine for pain on an as-needed basis when administered Caldolor.

Caldolor should be used with caution in patients with congestive heart failure, kidney impairment, at risk of blood clots and those who have a prior history of ulcers or gastrointestinal bleeding. When used in such patients, attention to using the lowest effective dose for the shortest time period is important to reduce the risk of serious adverse events. The drug has also been associated with high blood pressure, serious skin reactions, and serious allergic reactions.

The most common adverse reactions reported in the controlled clinical trials were nausea, flatulence, vomiting, and headache.

Caldolor is manufactured by Cumberland Pharmaceuticals Inc., Nashville, Tenn."

Although pain is subjective, no one, not even a young child, should suffer from it.

Go generic; it can save you lots

There are some products that just aren't the same when they are the store brand, such as toilet paper, aluminum foil, and markers, so I try not to buy them. Generic, or store brand, medications, however, I trust. The FDA vouches that they are as safe and effective as the brand name versions. I buy generic whenever it is available. Many practitioners and patients may find that biological products (hormone injections) and some drugs (medicines for seizure control) that require specific blood levels of the drug may not be interchangeable. Work with the doctor and pharmacist; switching from a brand to a generic medicine may require more careful (frequent) monitoring of the blood level of the drug. If the medicine produces the same outcome, it will be a huge cost savings in the long run if you need this medicine long-term. For instance, yesterday I refilled my daughter's fluoride tablets. The last time I got the prescription, I paid $9.99 for 120 tablets. Of course, my insurance does not cover vitamins or supplements. This time it was a different generic company, but I got an even better deal: $3.99 for 120 tablets. They are purple and taste better, according to my daughter. That's great, because she was starting to try to refuse her medicine. Of note, generic products may look and taste different, but as long as the main ingredients (for example, acetaminophen or loratadine) and strength (mg or %) are the same, you're getting the same medicine. Hey, I just saved $6!

When I was still at the Children's Hospital at Montefiore, I wrote this piece about generic medicines for them. Please feel free to leave me comments if you have any questions!

Random information

I came across some interesting posts from the US Department of Health and Human Services, and the CDC this past week and wanted to share some links:

- Breastfeeding benefits babies AND moms, but you already knew that. What you may not have known is that it can help reduce the risk of heart disease, a heart attack, or stroke by 10% in postmenopausal women. Learn more at hhs.gov.

- From the CDC are tips for parents on how to protect your kids from skin cancer and playing it safe in the sun.

- Don't forget about protecting yourself, too. My diuretic makes me more prone to sunburns, so I am taking this seriously.

- Going nuts trying to fill up the summer schedule? Don't forget water safety, whether your kids are heading to the pool or to the beach!

- Tick tick tick tick...prevention.

Please let me know if there are other links to share.

-