New Delhi, February 3
Powerful medicines may not necessarily be safe. And its always sensible to be all the more judicious when giving such medicines to children, warn experts. They suggest a greater role of doctors and community in choosing medication that is not only effective but also safe. Also important is the need for following correct dosage of medicines being administered to children, especially for common ailments like fever, cold and cough.
Appropriate dosage, they suggest, assumes great importance in optimal efficacy of any medicine. Fever in children is the commonest form of ailments, which prompt parents to resort to unnecessary strong medications. It usually is prudent to give only simple and safer medicines for fever, rather than jumping over to strong NSAIDs, which may mask clinical symptoms and do more harm than good. In such cases, it may be worthwhile to follow the KISS principle, which is “Keep It Simple, Stupid”!
Explains Dr. Meherban Singh, former Professor and Head, Department of Pediatrics, AIIMS, here, and past president Indian Association of Pediatrics (IAP), “Fever is the commonest symptom or signal of disease in children. There is no need to panic, because fever is a protective response on the part of the body to fight an infection. Most fevers occur due to a self-limiting viral infection and they resolve spontaneously. Fever is diagnosed when mouth temperature is more than 1000F. It is important to remember that skin temperature (armpit or groin) is about 0.750F lower than mouth temperature while rectal or ear drum temperature is 0.750F higher than oral temperature.”
Commenting on the guidelines for choosing a safe medicine for child fever, Dr. Singh adds, “An antipyretic should be given when temperature goes about 1010F or there is associated discomfort due to headache or body aches. According to WHO and American Board of Family Practice, paracetamol is recommended as the drug of first choice for symptomatic relief of fever and it should be given in a dose of 15 mg/kg body weight every 4-6 hours.” The drug should be administered with the help of a graduated plastic measure provided by the manufacturer instead of using teaspoons, which vary widely in their volumes with a potential risk of causing under-and over-dosing, he says.
Agrees Dr. Simon Fradd, Principal in General Practice in Nottingham and Joint Deputy Chairman of the General Practitioners Committee (GPC) of the British Medical Association, who is currently in India, “There are no patients in whom paracetamol is contraindicated and it is used even in the very young child, which cannot be said of other analgesics or anti-pyretics. Paracetamol is recommended as the first line choice by the UK Royal College of Paediatrics and Child Health.”
Dr. Singh cautions particularly against use of medicines that may harm the child. He points out, “Ibuprofen can be used as a second line drug while other non-steroidal anti-inflammatory drugs (NSAIDs) are not recommended as antipyretic agents by the US FDA and the drug controlling authorities of several other developed countries. Aspirin should not be used as fever medicine in children because it may cause serious damage to the liver and brain (Reye syndrome) in children suffering from certain viral infections like influenza and chicken pox.”
Clarifying concerns regarding liver toxicity and other adverse reactions of such medicines, he says, “In therapeutic doses, paracetamol is entirely safe without any risk of toxicity to the liver. On the other hand, hepato-toxicity may occur in certain individuals, when NSAIDs are taken in the recommended therapeutic doses due to an unexpected or idiosyncratic effect.” Although he recommends use of paracetamol in fever, yet he prescribes judicious use of any medicine, howsoever safe. Says he, “In view of its time honored safety record and assured efficacy, paracetamol remains the drug of first choice for the treatment of fever and pain not only in children but at all ages. However, paracetamol as a first aid home remedy should be given for 2-3 days and child must be taken to the family doctor as soon as possible to identify the cause of fever so that specific treatment is given without any delay.”
The child with fever should be kept in a cool, well-ventilated room and should not be excessively clothed or covered with a blanket. It is advisable to give him plenty of water, liquids and nutritious diet of his liking without any restrictions. When fever shoots above 1040F despite the use of an antipyretic medicine, sponging of the body with tap water helps in lowering the body temperature.
Dr. Fradd expressed concern over many scheduled drugs being sold over the counter in India, without proper knowledge of their possible side effects.
Commenting on the importance of appropriate dosage of medicines, Dr. Meherban says, “Ironically, many households have their own definition of teaspoons, which varies from 3ml to 6ml. To avoid any errors in dosing, the graduated dispensers provided by the manufacturer should be used because the teaspoons available in different homes vary in their size, which can lead to serious errors in under and over dosing. In children, the dose of a drug must be calculated on the basis of age and body weight.” The recommended dose of paracetamol in children is 15 mg/kg/dose every 4-6 hours (up to a maximum of 60 mg/kg/day). Similarly, the recommended dosage for ibuprofen is 10mg/kg/dose every 4-6 hours.
Temptation to get faster results with lesser dose has also unwittingly encouraged the usage of very strong drugs among parents and even some doctors, cautioned experts. No NSAID is safe for use in children, and it is the responsibility of the doctor to tell the possible side-effects with such NSAIDs, and parents should not buy any NSAIDs without consulting the doctor. The possible side effects of NSAIDs in children include gastritis, ulceration in the GI tract, harmful effects on kidney and liver, and blood vomiting (haematemesis). Similarly, mefenamic acid, another NSAID at times used in children, is known to possibly cause convulsions.
Dr. Simon Fradd and Dr. Meherban Singh were speaking at a conference on “ Emerging Practice in Antipyretic Therapy” in Delhi, recently.
