Pain and Fever reducing medications/ How to choose the right one

 

Acetominophen and Ibuprofen

It should go without saying that none of us want to give our kids medication unless it is necessary. I also always like to see if there are some natural remedies that can help us out. Many low grade temps will resolve with some cool compresses and a tepid bath. Of course there will be times that we need to move to plan B and break out the standard over the counter fever medications.   There are several options available for infants and children. Acetaminophen is most often found under the brand name Tylenol, ibuprofen manufactured under the names Motrin or Advil. Generic brands are acceptable. At the end of this post 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 usually based on the 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 500 mg Tylenol tablet, crush it and then dissolve it in a teaspoon (5 ml) of water, you will have 500 mg of Tylenol. If you take the same 500 mg tablet and dissolve it in a cup of water (240 ml). You will still have 500 mg. It is simply in a different concentration.   The first step is to see 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.   Infant and Children's Tylenol have the same concentration of 160 mg/5ml. The only difference is that the infant bottle comes with a handy syringe for accurate dosing. 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.  For kids over 6, there is a fairly new dissolving powder pack that works well.   Acetaminophen is usually given 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. These are NOT the same concentration. It is important to pay attention to which medication and dose you are giving. The infant formulation is about twice as concentrated. Ibuprofen is usually given every 6-8 hours. It can cause tummy upset if given on an empty stomach. This is challenging for sick kids with poor appetites. Ibuprofen is an anti inflammatory, so it is a better choice for treating an injury.   For fevers, 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.   Both of these medications come in a variety forms. Liquid is the easiest choice for the youngest kids. As they get older, many prefer chewable tablets. Acetaminophen also comes in a suppository form. This is very useful for a child who won't cooperate with oral medications. It is also a valuable option for someone who is vomiting. For kids over 6, there is a fairly new dissolving powder pack that is easy to give.     Eddie, from the Feel Good Pharmacy, offers options that you can't get in a standard drugstore:   ibuprofen suppository acetaminophen or ibuprofen gummies dye free/preservative free suspensions Compounded products need a prescription even though the medications are over the counter. He also can only ship within California.   If a fever is lasting longer than a few days in a row, it is worth getting seen by your doctor. If you are dealing with a stubborn fever and have a diagnosis, it is okay to alternate the medications. An example of this would be:   9 am Tylenol   12 noon Advil   3 pm Tylenol   If the fever is staying under control, spread out the doses:   9 am Tylenol   1 pm Advil   5 pm Tylenol     Medication errors happen more often than you can imagine. Consider 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. This is a good habit with antibiotics as well. Another option is to keep a notebook nearby and document your doses there. Figure out which method works best for you and make sure that all the caregivers stick with the plan.   It is worth having a syringe on hand for accurate measuring. These are easily available at any pharmacy or online.   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. To get up there you need to climb a ladder. You must climb high enough to actually get on the roof. Climbing halfway gets you nowhere aside from hanging on a ladder. With medicine, you need to give enough to be efficacious (enough to get you all the way up to the roof.)   In some cases your child might respond to a smaller dose. If that is the case, by all means give the smallest amount that you can get away with. In my experience, most kids need the full dose to achieve relief. The correct dose adjusts with your child's weight. That dose that the Dr. gave you when your infant came in for their first shots? It is not going to cut it for your 25 pound toddler!   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.   Most of the time, acetaminophen and ibuprofen are safe to give with other medications.   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.   A little bonus tip is that the benadryl dose is generally the same volume as Tylenol.   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.   If your child is teething,those symptoms can linger for weeks at a time. I try to reserve Tylenol and/or Advil for occasional use. Getting a good night's sleep if your child is having a ridiculously fussy day seems reasonable once in a while. There are many other comfort measures to try first.   Teething Blog post

Croup 2022

 

Croup

Croup is making the rounds.  The official name is Laryngotracheitis. For obvious reasons most people simply refer to it as Croup. Much of the time Croup is viral rather than bacterial; antibiotics are not an appropriate treatment. This illness causes inflammation in the upper airway. The air passages in the throat narrow due to the swelling. This often leads to breathing that is noisy and sometimes labored. Croup is so common that it was actually one of the first illnesses that I addressed in a blog post many years ago. It tends to afflict patients between the ages of 6 months - 6 years, but anyone can get it. Many seasonal viruses can lead to infections in the respiratory tract such as Croup. The most familiar ones include RSV and parainfluenza. Now it seems that the Omicron variant of Covid-19, is on that list. Omicron settles higher up in the respiratory tract rather than deep in the lungs, so that makes sense. Having Covid involvement does not impact the treatment. Take comfort in the fact that doctors are quite familiar with this and know what to do! Croup is quite contagious. Usually kids will start showing some symptoms within a day or two after the exposure. Some children who get exposed to this virus will end up with the symptoms of the common cold. Others get the classic croupy cough. (Think Darth Vader) There are actually two distinct presentations. Many patients will start off with a cold, sore throat, hoarse voice and mild fever. This progresses to the deep barky cough. Most kids are sick for 4 - 7 days. It is normal for the cough to linger for a week or so even when they are otherwise on the mend. Others have acute spasmodic croup. With this, it is typical for the symptoms to start without warning in the middle of the night. Your child may have seemed fine when they went to sleep but then they wake up in the wee hours sounding like a seal. This can freak out a lot of even the most hardy parents. Your job is to keep your cool and do your best to keep your child from getting any more agitated. Head into the bathroom and run a hot shower. Sit there in a steamy room (you don't need to be in the actual shower) and sing in a soft voice. See if you can get them calm. It is time to head to the emergency room if your child is excessively drooling and has a tough time swallowing, seems agitated, or breathing is getting more labored or is showing signs of “stridor” at rest (when not agitated or crying). More than half of the time, your child will be dramatically better by the time you get to the ER. Somehow getting out in the night air is quite helpful. The spasmodic type of croup usually lasts about three days. The kids seem to be almost normal during the day but the cough comes back at night. Take a deep breath, the first night is usually the worst. Running a humidifier during the night is often very helpful. If you are nerdy enough to have a hygrometer, 50% humidity is the sweet spot. For mild cases rest, steam and fluids will get you through. For more severe cases your child will likely get a dose of steroids that will calm things down. Dr. Ted’s Tidbits Croup can be really overwhelming for my patients. As soon as they hear a barky cough, they’re sprinting to the doctor’s office.  The barky cough just tells me that there is swelling in the larynx and trachea, which is almost always due to one of a multitude of viruses. That in and of itself, does not always need treatment, but you can call your doctor to ask what they think. I’m the most curious about stridor, the high pitched noise that can be heard when breathing in. I recommend looking up stridor on youtube videos. This happens when the swollen tissue collapses inward during inspiration, and always needs a call to the doctor.

Keep a Journal 2022

 

Keep a Journal

It’s the first week of the New Year. This is often the time when people find themselves making all sorts of plans for how to generally improve aspects of daily life. And then there are most parents who don’t want to hear about resolutions. Getting through the day intact is a win. Having five minutes of privacy when you poop would be an even bigger win (dream on). I hear you. All those grandiose plans about cutting down on sugar and screen time don’t end up lasting all that long anyway. But for any of you who are feeling ambitious, I have a suggestion for one resolution that is fairly easy to keep. This will be useful and has the potential to bring plenty of smiles in the years ahead. Start keeping a journal! Sure, we all take a lot of photos and movies these days, but there is nothing like the written word. If you haven’t done it from the beginning, it is never too late to start. Having things written down can be a valuable resource. I am not advocating keeping a list of every time your child pees (yes there are parents who do that; you know who you are) but knowing how often your child has had strep throat, an ear infection or any significant illness can be quite handy. Especially if you have more than one child, it is often easy to get things mixed up. I have had more than one patient who has said, “I know one of my kids got a rash on Amoxicillin, I am just not sure which one.” I actually started keeping a general journal when I found out that I was pregnant for the first time. Clearly you don’t need to write things daily, but keeping track of milestones and fun things that kids come up with can create a wonderful database of stuff that you are sure to refer to and enjoy as your children grow. My journal unfortunately does have some huge gaps, when I never got to it; just do the best you can. Keeping record of milestones and illnesses alone makes keeping a journal worth the effort, but immortalizing memories and anecdotes is what makes it fun and even more valuable. We have tracked all kinds of odd statistics. My daughter Lauren has been on 428 flights. My youngest daughter Alana has been on 287. Two of Lauren’s flights were skydiving expeditions and both of my girls have managed to be at the controls flying a private plane. (This mom knows how to feel somewhat proud and somewhat horrified at the same moment.) Yes of course we are tracking my grandson Elliot who is already up to 9 flights! If you give me a moment I can also retrieve all sorts of random facts, like the first movie they ever saw in a movie theater and when they lost their first tooth. Is there something fun about the milestone? Write it down!  For Elliot, I was lucky enough to be with him when he crawled for the first time. He didn’t seem all that interested in getting from point A to point B and Lauren had just invested in a little crawling ‘master class’ from a physical therapist that she follows on instagram. As those things go, buying it was the only thing necessary, because the crawling happened before she had a chance to even look at it. We were playing in their living room when the baby spotted a small but nasty little piece of a chewed up dog toy a few yards away from him. You could almost see his little brain working as he locked on that target and off he went. He never looked back, and as is often the case, most of his early destinations were not towards the little toys that we would shake enticingly. But let him spot a little piece of fuzz, and he was off on a mission. What started out as my personal musings written in a notebook, morphed into a family journal when I transferred it to a word document. If you like you can create a shared document that both parents can add to. Google drive worked for us, but there are tons of apps out there that would do just as well. (Make sure you backup any important documents!) In our journal (both kids share the same one) daddy’s voice was written in italics. My husband Sandy had the wonderful habit of documenting conversations. The following was from when Alana was seven and daddy was picking her up from school: Alana: I'm doing a picture in reds and pinks. Sandy: Why? Alana: Because Van Gogh had a red period. Sandy: You're learning about Van Gogh? Alana: Yeah. And then I'm going to do a painting in different shades of blue. Sandy: Why Alana: Because Van Gogh also had a blue period. Sandy: Well that's terrific. Alana: And Miss Price is going to bring a real artist to class so he can teach us. Sandy: Well that will be very exciting. Alana: But it won't be Van Gogh because he's dead! In our case I am delighted that we were able to track early milestones like first words and motor skills. Over the years random facts like teachers names, the revolving door of boyfriends and life events have all been documented. One of my favorite posts recounts about the time that 5 year old Lauren and I took a family ceramics class at the local Randall museum. At the start of the first class, the instructor had everyone get a feel for the clay. We stretched and pulled it into all sorts of shapes. As we played, the teacher asked ”Who knows where clay comes from?” Lauren was never shy. Without missing a beat, she called out the answer in a loud, authoritative voice. “Cows! Clay comes from cows!” There was a moment of stunned silence as all the grown ups at the table did our very best not to break out in laughter. “Hmmm”, said the teacher, handling it very nicely. “Great guess, but it actually comes from the earth.” Cows?? I remember that being one of the hardest giggles I ever had to stifle. Laughing in the face of my five year old was not something I wanted to do. Kids do come up with some wonderful stuff. Another one that became part of family lore was the time that 3 year old Alana bit her sister: Mommy: “Alana, why did you bite your sister?! You know you shouldn’t bite!” Alana: “I forgot not to.”  That “I forgot not to” line still comes up every once in a while. When does it stop?? My kids say never. They especially insist that I keep up with their flight tallies! (We still count every take off.) You might be dealing with any of the more challenging aspects of parenting like sleep deprivation, the “terrible twos” or teens that are giving you a run for your money. Warning - time zips by. Blink and they are out of the nest. Carpe Diem! The online journal is a great way to capture moments forever. Grandparents might want to start their own version. A new friend that I met on my recent trip recounted an experience. Her twin grandsons were visiting. Clearly she wasn't in the habit of locking the bathroom door. One of her 5 year old grandsons showed up in her bathroom while she was in the shower. He was wearing a hat and carrying a fishing pole: “Grandma, You need to stay where you are for a bit. There is a triceratop in your bedroom, but don’t worry about it, I’ve got this.” Capture your moments!!