Friday, December 26, 2014

Tylenol vs Advil/ Dosage charts

  Please see the updated post May 2019

There are several  fever reducing/pain relief medication options currently on the market for infants and children.
Acetaminophen is most often found under the Brand Name Tylenol.
Ibuprofen is commonly found under the names Motrin or Advil.
Generic brands are perfectly acceptable.
Below you will find a dosage chart to refer to as your child grows.
The charts tell you how many milligrams of each medication your child needs. This is calculated by your child's weight.
The different concentrations can be confusing.
Let's go back to school for a moment for a quick review.

If you take a 500mg Tylenol tablet, crush it and then dissolve it in a teaspoon (5 ml) of water, you will have 500mg of Tylenol. If you take the same 500mg tablet and dissolve it in a cup of water (240 ml) you will still have 500mg...simply in a different concentration.

Once you know how many milligrams are appropriate for your child, your next step is figuring out what volume of fluid will deliver the proper dose. That will depend on the concentration of the medicine.

For the past several years, the Infant and Children's Tylenol have the same concentration of 160 mg/5ml. The infant bottle comes with a handy syringe for accurate dosing, but there is no other difference. The infant Tylenol used to be more concentrated but that formulation is no longer on the market. It is still important to read the label to make sure you know exactly what you are giving.
Acetaminophen also does come in suppository form. This is a terrific option for an uncooperative or vomiting child.

Acetaminophen is usually dosed every 4-6 hours. Too much Tylenol can be toxic to the liver, so it is important not to exceed the recommended dose.

Ibuprofen still has both infant drops and children's liquid that are NOT interchangeable. It is important to know which medication and dose you are giving. The infant formulation is about twice as concentrated. Ibuprofen is usually dosed every 6-8 hours and should be given with food when possible.

Both medications come in a variety of chewable tablets or swallow able capsules for older kids and adults.
I often suggest alternating the medications if you find yourself needing to use these for more than a few days in a row.
I recommend putting a piece of masking tape on the bottles and mark off times and dates of dosages. This can help sleep deprived parents keep track of when they gave what. It also alerts partners if a dose was recently given by another caregiver.

When it comes to medicine, some folks are under the assumption that less is better and try to give partial doses. This doesn't usually do the trick.
I like to use an analogy here. Imagine that you are trying to fix something on the roof. In order to get up there you need to climb a ladder. You must climb high enough to get on the roof. Climbing halfway gets you nothing. With medicine, you need to give enough to be efficacious. (enough to get you all the way up to the roof)
Some kids are certainly more sensitive and a smaller dose may help, If that is the case, by all means give the smallest amount that you can get away with, but understand that most folks will obtain the best results by following the guidelines for weight.

I don't have a strong preference between Acetaminophen or Ibuprofen. Ibuprofen does tend to last a little longer which makes it a good choice for a night dose, but on the other hand, if it is given repeatedly on an empty stomach it can cause irritation. This is challenging for sick kids with poor appetites.

Keep in mind that neither of these medications work instantly. It is common to have to wait at least 30 minutes or so before you notice any relief or decreased fever.
Both Acetaminophen and Ibuprofen are safe to give in conjunction with other medications like antibiotics and antihistamines. Do be careful if you are giving any of the multi-symptom cold remedies. Many of these already have the fever reducer as one of the ingredients, you don't want to double dose. 

*If your child is under 3 months of age, and you feel that they need any medication, check with your doctor's office. Any young infant with an elevated temperature needs to be evaluated.

Doses are every 6-8 hours

Milligram Dosage
Advil/Motrin Drops
Children's liquid
9-10 lbs >3 months
1/3 dropper(0.625ml)
11-16 lbs
2/3 dropper(1.25ml)
1/2 tsp (2.5ml)
17-21 lbs
1 dropper(1.875ml)
3/4 tsp (3.75ml)
22-26 lbs
1 1/3 dropper(1.875ml + 0.625ml)
1 tsp (5ml)
27-32 lbs
1 2/3 dropper (1.875ml + 01.25ml)
1 1/4 tsp (6.25ml)
33-37 lbs
2 syringes (2 x 1.875ml)
1 1/2tsp (7.5ml)
38-42 lbs
2 1/3 dropper (2 x 1.875ml + 0.625ml)
1 3/4 tsp (8.75ml)
43-53 lbs
2 2/3 dropper (2 x 1.875ml + 1.25ml)
2 tsp (10ml)
54-64 lbs
Use liquid or tablets
2 1/2tsp (12.5ml)
65-75 lbs
3 tsp (15ml)
76-86 lbs
3 1/2 tsp (17.5ml)
87-95 lbs
4 tsp (20ml)
> 95 lbs


Milligram Dosage
Children's liquid 160mg/5ml
5-8 lbs
1/4 tsp
9-10 lbs
1/3 tsp (1.8ml)
11-16 lbs
1/2 tsp (2.5ml)
17-21 lbs
3/4 tsp
22-26 lbs
1 tsp (5ml)
27-32 lbs
1   1/4 tsp
33-37 lbs
1 1/2 tsp (7.5ml)
38-42 lbs
1 3/4tsp (8.75ml)
43-53 lbs
2 tsp (10ml)
54-64 lbs
2 1/2
65-75 lbs
3 tsp (15ml)
76-86 lbs
3 1/2 tsp (17.5ml)
87-95 lbs
4 tsp (20ml)
>95 lbs
Give Adult Dosage

Friday, December 19, 2014

Taking your infant out into this Non sterile world

When is it okay to take a newborn baby out into the germy world?

This is one of those questions that gets a lot of strong and differing opinions from anyone you ask. The only opinion that counts in the end is that of you and your partner. All the well meaning friends, family and healthcare professionals can only advise. It is up to you to pick a path that feels right for you.

The discussion with new parents about when it is safe to take the baby out and about and risk exposure to crowds comes up quite a bit. It is an especially popular question this time of year with holiday celebrations and gatherings.  I don't always have the same answer each time.

It is often not a black and white case and we end up trying to identify all the considerations specific to your situation. There is a vast difference between a single parent taking the baby with them to get some food, and the choice to take a newborn out to a crowded concert. Sadly, I recently had to tell the parents of a 3 day old that I thought taking them to one of the World Series games was a VERY bad idea (they heeded my advice, and no I didn't get the tickets.)

Travel questions come up a lot. I would rather avoid having a super young baby on a full airplane flight but some travel is worth the risk. I would likely say "go for it"  to a baby going to see aging great-grandparents, or to a once in a lifetime family event like a wedding. I would say "are you absolutely nuts???" to a family taking an infant to a beach vacation in Mexico.

These of course are my opinions. Parents get to make their own choices.
What time of year is it? Are there any active viruses circulating? We are just coming into the winter cold and flu season. I am going to be stricter in my recommendations this month. RSV is actively going around. I want my newborns safe.

Here are some factors to consider.

Babies are the most vulnerable the first 6-8 weeks of life. If one of these young babies gets a fever, it is going to be taken very seriously by any doctor that they encounter. In an emergency room, a fever in a young baby will most likely trigger diagnostic testing such as blood work, urine catheter, x-ray and even a spinal tap.
If in fact that baby has a serious infection, early intervention can be life saving, so the doctors aren't kidding around. No one wants to put their baby through that.
I have a very different standard when dispensing advice about the under two month crowd. Any fever gets my attention. That two month old check up and first set of vaccines is a significant milestone.

I know that many new parents get cabin fever, but whenever possible, keep your newborn away from any circumstance that may expose them to anyone who is sick. In general crowds should be avoided. If someone is coming to the house to visit make sure they are healthy before they come in. If they feel like they may be coming down with something, they are not doing you any favors. If you have family staying with you, ideally they have gotten the TDaP and Flu vaccines already. Unfortunately the Flu vaccine this year may have missed the mark and an early look at the Flu cases so far indicates that even if you have had the shot you may not be as protected as we would hope.
In any case, it does take a week or so for immunity to take effect. Better late than never. I prefer that anyone who is planning on spending time with your baby to be vaccinated. Send them over to Walgreen's for the shots as soon as possible if they haven't gotten around to it. As long as visitors appear healthy and are more help than hindrance, don't hesitate to take advantage of your support network even if they haven't gotten the shots yet. Good hand washing is essential.

First time parents have the luxury of protecting and isolating the baby and should take advantage. That being said, in my opinion, a walk outside on a lovely day is usually perfectly fine for even the most conservative family

Second kids are a different story by necessity.  They are often born into the situation where they have a loving, snotty nosed older sibling that wants to kiss and handle them from the start. These babies generally get exposed to things much earlier. Anyone who has multiple kids can tell you that it is really sad watching the young babies struggling with their first illness.

When making these types of decisions what are your actual options? Sometimes they are limited, in which case you simply do the best you can.
Use your best judgement!

Friday, December 12, 2014

Holiday Safety Tips

Next week the winter holidays begin. For most people, holidays are a time for celebration. That means more cooking, home decorating, entertaining, and an increased risk of fire and accidents.

Call me a Debbie Downer if you must, but the mind of an advice nurse is a skewed one. For every aspect of holiday celebrations, I can tell you the story of a patient who called with a related accident. It is not my intent to scare folks with my tales. As I tell parents who attend my safety class, if you know ahead of time what accidents can happen, you have a way better chance of avoiding them.

Baking cookies is just one example. A patient's mom called to tell me that her 10 month old had sustained a burn on his hand. She was holding him in the crook of one arm as she removed the cookie sheets  from the oven. As she recounted, he turned into a cartoon character with a telescoping reach and he was able to stretch across her body and grab a hold of the piping hot tray. Simple solution: don't hold your child when you are working with hot stuff in the kitchen. Their arms are longer than you think. If even one accident has been prevented, this post was worth it.

Candles are another biggie. It was a winter evening several years ago in a cabin at Lake Tahoe. Dr Jessica and family lit some holiday candles and went to sleep. Somehow one of the candles ended up burning a hole through a plastic mat that was on the table. Luckily the smell of burning plastic woke them up before any real damage was done, but it was a frightening lesson. This was a vacation rental. In this instance there seemed to be no working smoke detector. She had no idea if and where there was a fire extinguisher. There are several obvious lessons here. Never to go to sleep leaving candles or a fireplace still burning. Get acquainted with the safety features of any place your family is staying.
Below are some safety checklists for dealing with the holiday season ahead. Some of these may seem like common sense but there might be a few tidbits in here that you haven't thought about.

For instance...button batteries. They are everywhere nowadays in all sorts of small electronics (and musical cards) and can be quite hazardous if swallowed. Take time in advance to do a mental inventory of items that you have around that may be powered by these. Put a piece of duct tape over the battery compartments to make sure they can't fall out.

Certain holiday plants like poinsettias can be mildly toxic (especially to someone with a latex allergy). You may not have them in your own house, but if you are  visiting a friend or even a supermarket make sure little hands don't grab the pretty red leaves and put them in their mouths.

Be very careful transporting hot food to a holiday potluck. I have patients who have been burned from hot food spilling on them in a car.

Since Chanukah comes first this year:
   *Make sure that all candles are safely out of harms way
   *Make sure candles are not close to wrapping paper
   *Don't go to sleep with candles still burning
   *Don't leave the matches or lighters hanging around
   *If you are frying latkes make sure that no one gets spattered by oil

Christmas tree checklist:
*When purchasing a live tree, check for freshness. A fresh tree is less of a fire hazard
*Cut 1-2 inches from the base of the trunk immediately before placing the tree in the stand and filling with water to ensure absorption
*check the water level daily to avoid the tree drying out
*When purchasing an artificial tree, look for the label "Fire Resistant"
*Never use electric lights on a metallic tree. The tree can become charged with electricity from faulty lights and a person touching a branch could be electrocuted
*Place your tree at least 3 feet away from all heat sources, including fireplaces, radiators and space heaters
*Make sure the tree is steady enough that it can't be pulled over by a toddler
*Trim your tree with non-combustible or flame resistant materials
*Before using lights outdoors, check labels to make sure they have been certified for outdoor use
*Make sure all bulbs work and that there are no frayed wires, broken sockets or loose connections
*Plug all outdoor electric decorations into circuits with ground-fault circuit interrupters to avoid potential shocks.
*Strings of lights and garlands are a staple of holiday decorating, but they can also pose a strangulation hazard.
*Avoid trimming the tree with things that look like candy which may pose a temptation to the kids.
*Keep sharp, glass or breakable ornaments out of reach of small children
*Holly berries and other small decorations can be choking hazards
*Don't overload extension cords

Kwanzaa may be the safest of the holidays, (no hot oil or stressing the electrical outlets)  but there are still candles involved, so make sure they are placed in a safe place and toddlers don't have access.

This is a great time to test your smoke alarms!!!

Stay safe and Have Happy Holidays!
Check out this post from last year: The best present is your presence

Friday, December 5, 2014

Alternative Approach to Allergy treatment

A year or so ago a patient came in to our office for a visit. This little girl had a strong history of asthma and had a regular regimen of medications to manage it. At this visit, the doctor took note that our little patient was no longer taking her meds. Her asthma seemed to have mostly cleared up. The mom explained that they had done some treatments at a local place called Advanced Allergy Solutions and that the medications were no longer needed nearly as much. 
Dr S asked me to find out more. The patient's mom was happy to tell me all about it. She herself had done some treatments and that as someone who used to be allergic to dairy, she was now able to enjoy ice cream. For both her and her child the treatments had been life changing.
She got the report about the treatments sent over, but they didn't make a lot of sense to us. There was simply not a clear translation from this mode of treatment over to "Western Medicine".
I was intrigued though. Both of my daughters have had trouble with gluten since they became adults.
Lauren was the first to discover that her frequent migraines went away when she went on a gluten free diet. Alana, my youngest would have severe episodes that made her feel like her throat was closing. This was frightening and upsetting to say the least. Myriads of Western MD's had tried unsuccessfully to figure things out before we  had ascertained  out the gluten  seemed to be the culprit for her as well.  Anything that could ease these symptoms was worth a shot. Even though Alana was on a gluten free diet, gluten is sneaky and she had accidental exposures every so often.

She set up an appointment at Advanced Allergy solutions and I went along to watch.
They put a cuff on her arm and sent frequencies of different allergens.  If she was sensitive to something her arm would lift. It seemed like absolute voodoo, but then......
We looked at the list of things allergies that they had identified and to my surprise I saw that it was very consistent with the results from testing done at UCSF years ago. I had watched the process with the cynical eye of a scientist and was impressed with the results.

They told us from the get-go that they don't always have success treating gluten intolerance, but they did treat Alana for some food sensitivities, including wheat. Her symptoms noticeably shifted.  When she gets an accidental gluten exposure she still bloats up and feels gross, but she no longer has the same throat tightness. That is an important improvement.
My brother-in-law was also interested in hearing about our experience. He was super allergic to cats. He couldn't go into a house that had a cat without having significant wheezing and distress. He did a couple of treatments with great success. He now can do a cat house visit with the aid of a Zyrtec and have only mild symptoms.
There is something to this.
Over the years I have certainly told quite a few people about this treatment option and some of my patients have seen significant success, but it is just so strange. I found myself being cautious about bringing up to just anybody.

Recently we had a meeting with the Advanced Allergy folks and talked about all sorts of ways that their treatments could benefit people with stomach issues, respiratory issues, attention issues, get the idea.
It of course doesn't fix everything, but for some lucky people it is an absolute magic wand.
It still feels a bit like voodoo but it is completely non invasive and reasonably priced so I decided to spread the word and ask them to  do a better job explaining what they offer.  
******** **********************************************************

We're so happy Nurse Judy came in for an appointment at Advanced Allergy Solutions! It's true; the treatment is a little outside of the box from conventional medicine. However, this therapeutic approach has evolved from over 16 years of collaborative research from health care professionals, including naturopaths, acupuncturists and chiropractors. It combines modern day science with 3,000 year old traditional acupuncture principles.

We are a holistic allergy assessment and treatment center dedicated to resolving the symptoms associated with allergies and sensitivities.  Utilizing Advanced Allergy Therapeutics our services are non-invasive (no cream, no shots, no blood work), safe and effective for all ages, including children and infants. Our youngest patient to date was 2 weeks old!

At Advanced Allergy Solutions, we assess the body to see what allergens are triggering negative reactions. Through a system that works like acupressure, we recondition the body to have a positive association to a substance.

Here are some common symptoms we see at Advanced Allergy Solutions:


 Asthma

 Night cough

 Hay Fever

 Congestion

 Pet allergies


 Eczema

 Hives

 Acne

 Rashes


 Infantile reflux

 Colic

 Tummy aches

 Diarrhea


 Headaches

 Food allergies


 Behavioral problems

Our goal is to bring long-lasting relief to those who suffer from allergies and other sensitivities. We are conveniently located in the neighborhood of Hayes Valley in San Francisco and are thrilled to be bringing this leading edge holistic allergy therapy to Northern California.   

Click here to visit the website. 

If you end up checking them out, I would love your feedback!
~Nurse Judy