Which OTC medications are safest for children?

Ask the Pediatrician

Q: My school-age children have been sick with colds lately, and because of conflicting information in the news, I’m still unsure about which over-the-counter medications are safe to use. Can you advise?
A: Good question, and I agree that the news has been conflicting lately. A few years ago, the advice was no over-the-counter cough or cold medicines for children younger than 2 years old, and then it was younger than 4. Now the American Academy of Pediatrics says to avoid giving these meds to children younger than 6.
For school-age children (6 and older), you should be safe with over-the-counter medications. What you have to look for in this case is combination products. Many cough and cold products combine two or three medications. Read labels, and make sure you are not doubling up on any of these medications. If you are giving acetaminophen (Tylenol) as a fever reducer, make sure it’s not also present in the cough and cold medicine. In addition, keep in mind that children often have multiple caregivers, so everyone should be aware of which medications are being used.
For ages 4 to 6, check with your pediatrician.
For kids younger than 4, simply avoid over-the-counter medications with a few exceptions. Some homeopathic medications can be used in this age group. Chestal, for example, is a honey-based product that you can give kids age 2 and older.
Now babies, especially younger than 3 months old, should be taken to the pediatrician for a cold.
If this is all too confusing, or you would rather try natural remedies, here are a few suggestions:
For congestion, clear the nasal passages with a saline flush. For babies younger than 6 months, you can also try to suction after the flush. If your child can breathe, eat and sleep normally, do not worry about congestion.
Often, the cough that comes with a cold is good because it helps clear the airways of mucus. If your child only has an intermittent cough, avoid suppressing the cough. However, if cough is your child’s main problem, honey is a good way to soothe both the cough and the irritated throat. Toddlers ages 1 to 2 can get a quarter to half teaspoon of honey, as needed. One teaspoon for children up to 12 years old; two teaspoons for those older than 12. Honey should be avoided in babies younger than age 1 because of the risk for botulism.
For coughing spasms, try a warm shower. For kids with asthma, their cough medicine is their asthma medicine, and it should be used when they first start coughing. Cough suppressants can cover up an asthma cough and mask asthma symptoms.
Most importantly, do not be afraid of fever. Fever is a tool to help the body fight off infection. If your child is still active and playful, a fever does not need to be treated. On the other hand, because fever is a sign that the body is fighting off infection, your child should not have contact with other kids until 24 hours after the last fever.
No matter which method you try, if your child is having difficulty breathing, becomes sluggish or dehydrated, you should see a pediatrician.

Q: My son’s 6-month-old boy is 30 pounds, and their pediatrician says he is in the 100th percentile. Their pediatrician also says they have nothing to worry about. However, I am indeed worried that this weight will be a lifelong curse. He is breast-fed exclusively, but they have been giving him baby food as well for the past month. Please advise.
A: While 30 pounds would be unusual for a 6-month-old baby — and could be too much — we are missing two important details: his height and rate of growth.
If he is an unusually tall baby, the weight should be greater than average. Babies who are short should weigh less than their peers. Your grandson’s height and weight percentiles should be similar.
In addition, his pediatrician will be looking at his rate of growth. The rate of growth for his weight should be around 1 pound per month. If he is gaining significantly more each month, it may be too much. But again, it depends on his height and rate of growth for height.
Another thing to consider is how much milk and food he is getting. If mom is pumping her breast milk, he should get no more than 32 to 36 ounces per day. If your grandson breast-feeds, do not worry as breast-fed babies tend not to overfeed. Bottle-fed babies can overfeed whether the bottle contains formula or breast milk. His pediatrician should ask how much baby food he is getting.

Diana Blythe is a board-certified pediatrician with Pediatric Associates in Plantation. Write to her at askthepediatrician@tribune.com.

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