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?

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.



Fevers

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.



Head Lice

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.



Earache

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.

Voices
On the last day of campaigning before the polling booths open, the SNP leader has written to voters in a final attempt to convince them to vote for independence
scotland decidesIs a huge gamble on oil keeping First Minister up at night?
Arts and Entertainment
Rosalind Buckland, the inspiration for Cider with Rosie died this week
booksBut what is it like to be the person who inspires a classic work of art?
Life and Style
techApple has just launched its latest mobile operating software – so what should you do first?
News
A male driver reverses his Vauxhall Astra from a tow truck
newsThe 'extremely dangerous' attempt to avoid being impounded has been heavily criticised
PROMOTED VIDEO
Life and Style
ebooksA superb mix of recipes serving up the freshest of local produce in a delicious range of styles
Life and Style
ebooksFrom the lifespan of a slug to the distance to the Sun: answers to 500 questions from readers
Arts and Entertainment
Lionel Messi in action for Barcelona
filmSo what makes the little man tick?
Arts and Entertainment
tvReview: An undercooked end (spoiler alert)
News
i100
Arts and Entertainment
Pharrell dismissed the controversy surrounding
musicThe singer said 'the last thing I want to do is degrade'
Sport
Cesc Fabregas celebrates his first Chelsea goal
footballChelsea vs Schalke match report
Arts and Entertainment
Toby Jones (left) and Mackenzie Crook in BBC4’s new comedy The Detectorists
tvMackenzie Crook's 'Detectorists' makes the hobby look 'dysfunctional', they say
Life and Style
fashion

Olympic diver has made his modelling debut for Adidas

News
i100
Latest stories from i100
Have you tried new the Independent Digital Edition apps?

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Maths Teacher

    £110 - £200 per day: Randstad Education Leeds: Secondary Maths Teacher for spe...

    Maths Teacher

    £90 - £160 per day: Randstad Education Leeds: Secondary Science Teacher (mater...

    Maths Teacher

    £110 - £200 per day: Randstad Education Leeds: Secondary Maths Teacher for an ...

    Maths Teacher

    £22000 - £37000 per annum: Randstad Education Leeds: A West Yorkshire School i...

    Day In a Page

    Mystery of the Ground Zero wedding photo

    A shot in the dark

    Mystery of the wedding photo from Ground Zero
    His life, the universe and everything

    His life, the universe and everything

    New biography sheds light on comic genius of Douglas Adams
    Save us from small screen superheroes

    Save us from small screen superheroes

    Shows like Agents of S.H.I.E.L.D are little more than marketing tools
    Reach for the skies

    Reach for the skies

    From pools to football pitches, rooftop living is looking up
    These are the 12 best hotel spas in the UK

    12 best hotel spas in the UK

    Some hotels go all out on facilities; others stand out for the sheer quality of treatments
    These Iranian-controlled Shia militias used to specialise in killing American soldiers. Now they are fighting Isis, backed up by US airstrikes

    Widespread fear of Isis is producing strange bedfellows

    Iranian-controlled Shia militias that used to kill American soldiers are now fighting Isis, helped by US airstrikes
    Topshop goes part Athena poster, part last spring Prada

    Topshop goes part Athena poster, part last spring Prada

    Shoppers don't come to Topshop for the unique
    How to make a Lego masterpiece

    How to make a Lego masterpiece

    Toy breaks out of the nursery and heads for the gallery
    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Meet the ‘Endies’ – city dwellers who are too poor to have fun

    Urbanites are cursed with an acronym pointing to Employed but No Disposable Income or Savings
    Paisley’s decision to make peace with IRA enemies might remind the Arabs of Sadat

    Ian Paisley’s decision to make peace with his IRA enemies

    His Save Ulster from Sodomy campaign would surely have been supported by many a Sunni imam
    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    'She was a singer, a superstar, an addict, but to me, her mother, she is simply Amy'

    Exclusive extract from Janis Winehouse's poignant new memoir
    Is this the role to win Cumberbatch an Oscar?

    Is this the role to win Cumberbatch an Oscar?

    The Imitation Game, film review
    England and Roy Hodgson take a joint step towards redemption in Basel

    England and Hodgson take a joint step towards redemption

    Welbeck double puts England on the road to Euro 2016
    Relatives fight over Vivian Maier’s rare photos

    Relatives fight over Vivian Maier’s rare photos

    Pictures removed from public view as courts decide ownership
    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    ‘Fashion has to be fun. It’s a big business, not a cure for cancer’

    Donatella Versace at New York Fashion Week