Over-The-Counter Medicines for Infants and Children

Over-the-counter (OTC) drugs are medications you can buy for your children without a doctor's prescription. They usually come as pills, capsules or liquids, and are sold in drugstores or supermarkets.

OTC drugs have information on the bottle or box. Always read this information before using the medicine. This information tells you:

• How much to give

• How often to give it

• What the drug contains

• Warnings about using the drug

• If the drug is safe for children of certain ages

Medication tips

Here are some tips from the American Academy of Pediatrics (AAP), the Pharmacist’s Newsletter and the U.S. Food and Drug Administration (FDA) on how to give OTC medicines to children:

• Medication doses for infants and young children are based on age and weight.  Know your child’s weight.

• Follow the directions for age and weight. If the recommended age is not your child’s age, don’t give the medicine.

• If no dose is given on the bottle or package for children under 12 years old, ask your doctor or pharmacist if it is OK to give the medicine to your child, how much should you give and when should you give it.

• Liquid medicines usually come with a cup, spoon or syringe to help measure the right dose. Always use these devices to give medicine to infants and very young children. Using a kitchen teaspoon is not an accurate way to measure. A teaspoon is usually considered to be 5 cc or 5 mL, but teaspoons can vary in size from between 2 mL and 10 mL.

• If you mix medicine in a bottle of milk or formula, first put the medicine in one ounce of milk and have the child drink it all. Then put the remaining amount of formula or milk in the bottle and let them finish however much more they want.

• Always use a good light when measuring or giving medication. Insufficient light could cause you to give the wrong medicine or the wrong dose.

• Never let young children take medicine by themselves.

Combo medicines

Many OTC cough and cold medicines contain a combination of ingredients to treat several symptoms. Your child might be getting some of the same ingredients in other medicines. For example, Tylenol and Niquil contain the same ingredient, acetaminophen. Be sure to read the list of active ingredients (the ingredients that make the medicine work) for each OTC medicine you give your child to make sure he or she is not getting the same medication in more than one. You need to make sure that the total amount of a medicine does not exceed the recommended dose.

Combinations of medicines found in multi-symptom medicines may cause side effects in children. The AAP says, for example, that the combination of antihistamines and decongestants in some "cold remedy" medicines can have side effects such as hyperactivity, sleeplessness and irritability in children. To be safe, don’t combine prescriptions, supplements or multi-symptom medicines without checking with your health care provider or pharmacist.

Watch the ingredients

Sometimes the ingredients for a medicine change but the name stays the same. For example, the Pharmacist’s Newsletter says Kaopectate, an OTC medicine for diarrhea, recently changed so it now contains bismuth subsalicylate. The older versions contained only kaolin and pectin. (Bismuth subsalicylate is also found in Pepto-Bismol, an OTC medicine for upset stomach and diarrhea.) Bismuth subsalicylate is NOT recommended for children younger than 16 because of the risk of a rare but sometimes deadly condition called Reye's syndrome.

Because of Reye's syndrome, DO NOT give a child younger than 18 any product with aspirin or similar drugs called "salicylates" unless your doctor tells you to. Instead of aspirin or other salicylates, you can give your child acetaminophen (sold as Tylenol, Datril and other brands).

Watch the amounts

Be sure to take into consideration the concentrations of ingredients when you determine the amount you give your child. Medicines with the same brand name can be sold in different strengths, including infant, children and adult formulas. Infant drops of some medicines, for example, are stronger than the liquid elixir of the same medicine for toddlers. Don’t make the mistake of giving higher doses of the infant drops to a toddler thinking the drops are not as strong.

Other tips

• Talk to your doctor, pharmacist, or nurse to find out what mixes well and what doesn’t. Medicines, vitamins, supplements, foods and beverages don’t always mix well with one another.

• Don’t call medications "candy." If children come upon medications at a later time, they may consider it "candy" and eat it without your knowing.

• Remember, a child who has a fever for more than 24 hours or a child younger than 2 months with ANY fever needs to be checked by a health care provider.

• Always use child-resistant caps and store medicines in a safe place. Relock the cap after each use. Be especially careful with any products that contain iron; they are the leading cause of poisoning deaths in young children.

• Before you give a medicine, check the outside packaging for damage such as cuts, slices, or tears; check the label on the inside package to be sure you have the right medicine. Make sure the lid and seal are not broken. Check the color, shape, size and smell of the medicine. If you notice anything different or unusual, talk to a pharmacist or your health care provider.

Classes of OTC medicines

• Analgesics treat pain and fever. Use caution with different forms of these drugs, because some are more concentrated than others. Common analgesics for infants and children are acetaminophen and ibuprofen. DO NOT give aspirin to children younger than 18, because it can cause a rare but sometimes deadly condition called Reye's syndrome.

• Antihistamines treat runny noses, itchy eyes and sneezing caused by allergies (but not colds). Some can cause sleepiness. These are not recommended for children younger than 2. Use only with your health care provider’s advice in young infants or children with asthma. Examples of antihistamines include brompheniramine (often in combination with decongestants such as pseudoephedrine as in Dimetapp and other medicines); chlorpheniramine (Chlor-Trimeton and other medicines); diphenhydramine (Benadryl and other medicines); and loratadine (Claritin and other medicines).

• Expectorants and cough suppressants may help loosen mucus. Coughing is necessary to clear mucus and debris bacteria from the lungs, so check with your child’s health care provider before using cough-suppressing syrups. Guaifenesin, an expectorant, promotes the production of thin mucus that is more easily removed by coughing.

• Decongestants can relieve stuffiness caused by allergies or colds by temporarily shrinking the membranes in the nose to make breathing easier. They should not be used for more than two to three consecutive days. Decongestants taken by mouth can have a number of side effects. Examples of decongestants include phynylephrine (found in Neo-Synephrine nose drops and other medicines); and pseudoephedrine3 (Sudafed, PediaCare Infant Decongestant Drops and other medicines).

• Medicines for diarrhea. These are usually not necessary. Instead, give your child plenty of fluids and let the disease run its course. Diarrhea, however, can be dangerous in newborns and infants. In small children, severe diarrhea lasting just a day or two can lead to dehydration. Because a child can die from dehydration within a few days, you should see a health care provider as soon as possible if an infant has diarrhea. Talk to your provider before giving these medicines to infants or children. One medicine for diarrhea, bismuth subsalicylate (Pepto-Bismol and other medicines) should NOT be given to a child younger than 18. Another medicine for diarrhea, loperamide3 (Imodium and other medicines) should NOT be given to a child younger than 2.

• Laxatives work by several methods. Some add fiber or water to stool to make it more bulky and easier for intestines to eliminate it; some coat the surface of the stool to make it more slippery; some soften the stool so it passes more easily; and others cause the intestines to contract more forcefully. DO NOT give infants or children laxatives without talking to your child’s health care provider. Examples of laxatives include glycerin suppositories; magnesium citrate; magnesium hydroxide3 (Milk of Magnesia and other medicines); mineral oil3 (Agoral, Kondremul and other medicines); psyllium3 (Metamucil, Fiberall and other medicines); senna3 (Senokot, Ex-Lax and other medicines); and sodium phosphate3 (Fleet and other medicines).