Children's medicine: Give pills the push
Most over-the-counter remedies for children are of little use – and some may even be harmful, says A&E medic Dr Simon Reilly. So what are the best ways to treat a sick or feverish child?
Tuesday 14 April 2009
The MHRA (Medicines and Healthcare products Regulatory Authority) recently issued new guidance on the use of over-the-counter cough and cold remedies in children, and has banned the use of many products in the under-six age group. There still isn't any effective treatment for the common cold, but that doesn't stop manufacturers marketing dozens of remedies that they claim will alleviate symptoms. Most do not work, and some can even cause harm unless used very carefully.
So when are over-the counter products worth buying – and how should you really go about treating your sick or feverish child?
Coughs and colds
According to the Department of Health, it is not unusual for children to contract as many as eight viral respiratory tract infections per year in their early lives, as a result of their still immature immune systems. As these infections are not caused by bacteria but by viruses, antibiotics do not help. Most episodes will get better all on their own in five to seven days, and when it comes to "treatments" available, the bottom line is that anything other than the most basic interventions are at best a waste of time and money.
Saline drops in the nose can help loosen secretions, but decongestants should be avoided. All cause "rebound" nasal congestion when stopped. "Cough medicines" simply do not work, and some contain ingredients that have unpleasant side-effects. Besides, coughing is a natural reflex designed to move infected mucus out of the lungs, so suppressing it doesn't seem like a good idea. Make sure plenty of fluids are encouraged, as mouth-breathing and a raised temperature can lead to increased fluid loss.
Advice on the treatment of childhood fevers has changed dramatically. The emphasis in the past was to reduce the temperature, but this is no longer thought necessary.
There is even some suggestion that raised body temperature actually helps the body fight infection, so struggling to bring it down may actually prolong the illness. Some young children suffer from "febrile convulsions" (brief epileptic-like fits) when they have a high temperature, but even this is no longer thought to be a reason to cool them down. Surprisingly, advice on fevers from the MHRA and NICE websites differs slightly, but NICE guidelines are regarded by most as being authoritative and backed by hard research.
"Tepid sponging" is no longer advised. The child should neither be under-dressed, nor wrapped in extra layers. Fever-reducing medicines such as paracetamol or ibuprofen may be used, but only for children who appear distressed, and not given purely on the basis of the temperature. Indiscriminate over-use of paracetamol has recently been linked to the dramatic rise in cases of childhood asthma.
For a child with a fever, it is vital more than anything else to determine whether the child has a serious underlying infection, and whether they need active and aggressive medical intervention.
It used to be common practice to wash the hair of children in the organophosphate (OP) insecticide malathion to rid them of this relatively harmless infestation. OPs are closely related to nerve gas, and when farmers use similar compounds as sheep dip, they must wear protective clothing. Besides the possible toxicity issues, some studies have shown malathion to be only 36 per cent effective on lice.
Good old "nit combs" can be very useful, especially when used on wet hair. Newer, non-toxic silicone-based products (such as Hedrin) partly suffocate the lice, and make the hair slippery. This can prevent nits (lice eggs) from sticking to the hair shaft. A device called the LouseBuster uses hot air to destroy both lice and nits, and claims a very high success rate.
Diarrhoea and vomiting
The vast majority of gastro-intestinal infections in children get better with supportive treatment only – that is, replacing fluid that has been lost. The younger the child, the more quickly they can become dangerously dehydrated. This is a particular concern in babies under the age of six months. It is vital to replace salts and sugars as well as water, and preparations such as Dioralyte contain the correct mix when prepared according to instructions. Children usually become noticeably ill when even a little dehydrated, so a child who is active and happy is very unlikely to be at risk from dehydration no matter how many nappies they are filling. Drugs that are designed to stop diarrhoea or suppress vomiting are dangerous if used in young children and should never be used by parents.
As with fevers, the most important thing in these cases is to spot those that are caused by a serious infection such as Salmonella. Once again, how "ill" the child appears is a good rule of thumb. Blood in the stool is unusual in simple cases of gastroenteritis and should always be a signal to seek medical advice.
Inflammation or infection of the ear (otitis) is the usual cause of earache, and is split into two broad groups – otitis externa, affecting the area outside the eardrum, and otitis media, affecting the middle ear, the region behind the eardrum.
Otitis externa can be caused by water getting into the ear – especially when swimming – or by minor injuries to the ear canal. These often occur during attempts to clean inside the ear, a procedure which is both unwise and unnecessary. Don't ever be tempted to use cotton buds to clean children's ears. The best rule when it comes to cleaning out ears is to never stick anything in your ear that's smaller than your elbow. Children with otitis externa will need pain relief, and possibly drops prescribed by their GP.
Otitis media (OM) is a more concerning condition, and if left untreated over a period of time can lead to hearing loss. Some children are prone to developing OM because their eustachian tube (which connects the middle ear to the back of the throat) is not yet working properly.
Of particular concern is OME, or otitis media with effusion, more commonly known as "glue ear". The standard treatment for this for a long time was (often repeated) courses of antibiotics, but is not now thought to be effective, and may in fact lead to more serious infections with unusual bacteria.
Some cases of OME do not actually cause much ear pain and can be difficult to spot. The first sign may be under-performance at school, simply because the affected child cannot hear properly. While some cases of glue ear will clear up without treatment, children with repeated episodes need specialist treatment which may involve the insertion of grommets in the ear drum to help drain secretions and ventilate the middle ear.
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