Clinical reportPediatric pharmacologyAppropriate Use of Nonprescription Analgesics in Pediatric Patients
Section snippets
Uses
Acetaminophen and ibuprofen are used in children to reduce fever and to relieve minor aches and pains due to the common cold, influenza, headaches, sore throat, and toothaches. An acetaminophen product for children 6 to 12 years of age also lists relief of muscle aches, sprains, and overexertion among its indications. According to the Centers for Disease Control and Prevention (2006), either acetaminophen or ibuprofen may be used to reduce soreness at the site of immunization with tetanus and
Understanding fever
Body temperature is maintained at a relatively constant level, the thermoregulatory “set point.” The thermoregulatory center in the anterior hypothalamus receives information about body temperature from thermosensitive neurons located in the skin and central nervous system. When the temperature deviates from normal, physiologic and behavioral mechanisms that return the temperature to normal are triggered. These negative feedback mechanisms include (1) sweating, vasodilation, increased
Treatment of fever
Fever is the most common symptom of disease in children. Approximately 20% to 30% of calls from parents to pediatricians are about fever, and it is the most frequent reason for office visits by children under 2 years of age. One out of five emergency department visits for children is related to fever (Takiya, 2006); many of those visits are unnecessary (Krantz, 2001).
Whether and when fever should be treated is the subject of considerable debate. Fever usually poses little danger to the
Treatment of pain
It has been a longstanding myth that children—infants in particular—do not feel pain the way adults do. In fact, the mechanisms of pain perception in infants, children, and adults are similar. Pain may be even more intense in young infants because of differences in the nerve fibers involved in pain transmission and modulation of pain in the spinal cord.
Children are most likely to experience acute pain as a result of illness, injury, or medical procedures. Acetaminophen and ibuprofen both are
Product selection and dosing considerations
Considerations in choosing a nonprescription analgesic product for a pediatric patient with fever or pain include patient-specific factors and product-specific factors. Patient-specific factors include the child’s age, weight, and medical history (especially allergy to analgesics). Many parents and caregivers are not aware that weight-based dosing is most accurate. Pediatric formulations generally are marketed according to age groups (e.g., “children’s” products for ages 2 to 11 years), so
Product administration
The inaccuracies of measuring liquid medications using household spoons have been known for at least 25 years. Since then, more accurate dose-measuring devices such as medication cups, cylindrical dosing spoons, oral dosing syringes, and oral droppers have become widely available. Given the obvious benefits of these devices, health care providers may be surprised to learn that they apparently have not been adopted by a majority of parents and caregivers. In 1996, a team of family practice and
Caregiver counseling points
Counseling of parents and caregivers seeking to medicate children with nonprescription analgesics should include medication-specific concerns and disease-specific concerns. Counseling points that will help to ensure safe and appropriate use of acetaminophen and ibuprofen in children are listed in Table 6.
Health care providers should never assume that parents and caregivers will read the package instructions thoroughly. Therefore, health care providers should be sure to point out information
Conclusion
Nonprescription analgesics are safe and effective when used occasionally to reduce fever and relieve pain in pediatric patients. Common dosing errors involving acetaminophen and ibuprofen have identifiable causes that can be overcome through education and counseling of parents and caregivers by health care providers. Providing such education and counseling can reduce caregiver anxiety and empower parents and caregivers to make wise decisions in caring for their child with fever or pain (Bieri &
Cynthia Knapp Dlugosz is President, CKD Associates, LLC, Ann Arbor, Mich.
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Cited by (19)
Self-medication, self-prescription and medicating «by proxy» in paediatrics
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2009, Anesthesiology ClinicsCitation Excerpt :An intravenous acetaminophen preparation may soon be available in the United States, and has also been shown to be effective for treating postoperative pain in a variety of clinical situations and is not associated with pain at the injection site.29–33 Of concern is that acetaminophen is frequently misused, and acetaminophen overdose can lead to hepatic necrosis and failure.34 Under normal circumstances, acetaminophen is metabolized in the liver primarily by glucuronidation and sulfation.
Liver enzymes after short-term acetaminophen error in critically ill children: a cohort study
2022, European Journal of PediatricsLiver Enzymes After Acetaminophen Error in Critically Ill Children: A Cohort Study
2021, Research SquareIbuprofen as an antipyretic and analgesic drug in pediatric practice (a literature review)
2021, Modern Pediatrics. Ukraine
Cynthia Knapp Dlugosz is President, CKD Associates, LLC, Ann Arbor, Mich.
Rebecca W. Chater is Director of Clinical Services, Kerr Drugs, Inc./KDI Clinical Services, Chapel Hill, NC.
Janet P. Engle is Associate Dean for Academic Affairs, Clinical Professor of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, Ill.