Fever medicines given too readily to children

[flyingcloud]

Link here

Another thing for me to panic over? DD is currently sick with her second chest infection in three months. Should I just let her ride it out without help from medication?

well SOH - all I can say is that I hope the DM hasn't got it's own version...........as I can imagine some feckless parents reading it as "don't give calpol etc because it's bad for them" - and ending up with distressed children that could be made much more comfortable with a dose of calpol (or other brand name) inside them.

It's quite a useful article I think - it's good to remember that you don't HAVE to get a fever down. DD2 will rarely take medicine, and I work on the basis that if she's well enough to refuse it, she's probably well enough to do without it.

This was on the Wright Stuff today and a woman on the panel (can't remember her name now) said that parents do sometimes give more than 4 doses in 24 hours because they've been up all night with a sick child and can't remember the times they've already dosed them . When Matthew Wright rolled his eyes at that she said he'll understand when he's the one up all night with a sick child. Total rubbish I thought, everyone knows how important it is to make sure you're not overdosing your child. I don't think parents just forget like that and blame it on their tiredness.

Anyway, this is a battle I have with dh everytime the DC have even a slightly raised temperature and they're playing happily as normal. Even if they so much as cough he'll make a really sad and concerned face and say we need to see the GP.

I wish the message could be given in a factual, non-frightening way. That article doesn't at any point say not to give medication to an ill child but repeatedly states that fever alone is not worth medicating. That fever is normal. That doctors should be better at advising about fevers.

But even that article has people on here interpreting it as 'don't medicate ill children' and the op is already asking if she should be frightened to 'panic' levels.

I do sort of understand how overdose is easier than you'd think with an ill child. Because when one parent has been up and exhausted and struggling and finally hands over to the other parent perhaps they wrongly say the dose they've given or the times or they plain don't say anything and the other parent just medicates without thinking. Just an example but sleep deprivation can play tricks on you. I doubt that as many parents are accidentally overdosing as implied though. However, I have seen advice on here lots of times to alternate ibuprofen and calpol 2 hourly. And that's overdosing because ibuprofen is 6 hourly minimum. And I think the maximum dosage in 24hrs is sometimes easier to exceed than the individual overdosage as when you're up all night with a poorly child, perhaps the routine of medicine continues when it shouldn't iyswim.

yes Show - but how many parents know when their child has a fever in isolation - yes you may do - but many of us don't. For most parents I know a fever comes alongside an illness where the child is visibly unwell/distressed.

You have to go a long way through that article before

"In Britain, the National Institute for Health and Clinical Excellence (Nice) advises that the use of anti-pyretics "should be considered in children with fever who appear distressed or unwell".
However, they "should not routinely to used with the sole aim of reducing body temperature in children with fever who are otherwise well"."

It is also assumed in the article that parents only use calpol for fever reduction - when in fact many parents also use it for pain relief. Obviously the same medicine is going to have the same "consequences" regardless of what it's used for so you're not just going to panic parents over fevers - but over pain as well.

It doesn't actually state anything other than a panicked view of pain/fever relief medicine and briefly mentioning a study (the only detail that it mentions likely to panic parents even more - DS3 was 9 months old when they hospital gave him Calpol - thankfully I'm not the panicking type - not over stuff like this anyhow - but as he's only 3 I could easily end up stressing over whether me letting them give him that was going to mean he'll end up with asthama)

SOH
I though ibuprofen was four hourly? Off to check the bottle.

The headline: "Parents should not dose up children who have a simple fever on regular spoonfuls of paracetamol and ibuprofen". It then opens with mentions of people giving meds for low fevers, that doctors advise meds too readily. It is a crap article and could be much, much clearer but it's making a stab in the right direction. There are much, much better articles out there about anti-pyretics.

And actually I think it's not just fever in isolation that is the problem. People do give meds very quickly for simple bugs that probably don't warrant it. You do see it on here a lot ie 'dd has a snotty nose and bit of a cough but is fine within herself and playing normally. Temp is 38.5, coming down to 37.9 with calpol'. Or 'ds has a bit of a cold but is eating, drinking and playing happily though has a temp of 38' and the responses are 'try calpol and if it doesn't work, try ibuprofen'. And advice to give meds before baby jabs and to try calpol if a baby is waking up in the night repeatedly with no signs of illness/distress at all. I don't medicate simple colds or viruses, even when there are symptoms beyond a temperature. But people often persevere with meds because of the temp, focusing on that and the numbers on the thermometer, while admitting that their dc are okay, if slightly under par.

I guess it's like anything, that often responding to your child and their needs is best but often it gets pushed aside in favour of numbers on a thermometer. Like guidelines for average babies' development or average menstrual cycles or average weight gain for bf babies. How many threads a day do we see where a baby/child doesn't match arbitrary figures/guidelines etc and how often do we urge parents to look at their child and make a judgement. It's a similar thing. Sometimes a fever does need medication, sometimes it's too high but often looking at a child and their symptoms will tell you everything you need to know about whether they need medication. And whether one medication is enough. Because you also see 'dd's temp is only coming down to x no with calpol, shall I give ibuprofen' when there's no mention of other symptoms, if the pain/discomfort etc is reduced.

I'm not anti-calpol or anti-medication, just wish they could give better, more explicit advice about when it's necessary.

I think the mistake of 2 hours arises from the fact you should start the doses 2 hours apart so they don't wear off at the same time.
paracetamol was every 4 hours and ibroprufen was every 8 hours. Dosage worked out by body weight for maximum for a 24 hour period.

Just read my ibuprofen leaflet (well dn's), it says you can in certain circumstances give it 4 hourly where absolutely necessary but never more than 3 doses in 24hrs and should really only be given in 6-8 hourly intervals unless under medical instruction.

yes - but for most of us (well me anyhow) a "simple fever" is accompanied by very sick child.

I'm not sure crap articles about health matters are really very helpful to be honest - because quite frankly it's not very helpful. Maybe to educated people like you and I we can see around what they're trying to say - but I'm sure many more people wouldn't.

And your 2nd paragraph - for me - that's the 1/2 of people who don't medicate properly - and quite frankly if they're that daft I'm not sure even a well written article is going to be any good let alone a crap one

Oh I couldn't agree more Baroque and it's rubbish that they can't get the message across in a better way. NHS guidelines are pretty clear actually about not medicating fevers but you rarely meet a GP that's explaining them thoroughly. Maybe because they get 10 minutes with an exhausted parent and it's not the time to get the message across adequately.

SOH
Checked my leaflet too. The UK one says the same as yours and the French one says:

Children under 25 kg : 1 scoop filled to the scale indicating the weight of the child, 3 or 4 times a day.

No mention of 4 hourly. I must have been mixing it up with calpol. I normally only give nurofen at night anyway, or at most 3x a day.

Hi, I have 2 Foster Boys, who both have been over medicated on Calpol previously by others, to keep them quiet!. This now causes problems when I do need to use something to bring down Fever, with pain. temps of 39.2 are a regular with 1 of them.

I do know that calpol can be used to pacify children, get them to sleep, quieten down. The article didn't mention that though, it just talked about people not understanding dosages or when it should be used which is a quite different issue.

I am ready to believe that plenty of people have misused calpol TBH.

ShowOfHAnds - I have just re-read my 2nd paragraph of the post you agree with - and am seriously impressed you understood enough of what I was saying it it to be able to agree (that's what happens when you break off to answer the phone mid typing lol)

How do they know that 'one-half' of parents medicate wrongly? (one-half, ffs, its half, mutter) How exactly would they measure that?

I always write down what medication I give DC as I don't entirely trust myself to remember properly. My brain doesn't remember times and numbers too well. Same as I write down what times to put various bits of dinner on when cooking a meal. Its not tricky and means no mistakes. Surely thats what most people with crap memories do?

DC only have medicine once in a blue moon though, if they are properly ill. We're lucky really.

I also know that DD is naturally quite a hot person so what is technically a fever in her probably isn't really.

I only ever medicate if the child is in pain (and ear infections can be extremely painful or if temp is over 38.5 and they've gone off food as well - once they are eating normally again, I assume they're on the mend and temp becomes pretty irrelevant as long as any pain is also gone.

My older DD suffers horribly with growing pains - at one point she was having painkillers far too often so I tried some alternatives - massage and hot ( not ridiculously hot) packs - this has now replaced painkillers for this specific ailment.

I've certainly never used meds to keep the peace, I've always found that the best way to get that is for me to be in the bed with them - parental placebo effect, anyone?

My ds has been almost continuously sick with one thing or another since last September. Throat infections that require antibiotics, ear canal infection, awful virus (high temp), chicken pox, another nasty virus, cold, then a break of about 3 weeks, then nasty cold and temp, tonsilitis (antibiotics), and two vomiting bugs over two weeks. During this he has had about 12 teeth break through with considerable pain and agony over that - head banging, won't/can't eat, crying all day long etc. I have an older daughter so have something to compare him too.

It has horrified me just how much calpol and ibuprofen I have given him, but that is the doctors recommendation and when he is in so much pain it is heartbreaking not to give it.

I sometimes have joked that if he was sliced open, his insides would be pink from all the Calpol.

And now I read that there are asthma and other associated issues with 'antipyretics'. So why is that not on the bottle? Why has my doctor never mentioned that? I am stunned and in tears. How do you win in this madness of ongoing children's sicknesses? What am I supposed to do?

(Note: like others I do not forget what I give or when I give it, and often write it down on a piece of paper so I cannot forget).

ramblingroses
Don't panic. The research showed a possible link between those children given calpol before 15 mths having 50% increased chance of developing asthma.

As thingumybob said earlier, that sounds rather unlikely.

First, we would be seeing a lot more asthma cases if this were the care - almost 50% of children would be asthmatic - as I very much doubt there are many children who did not at least once receive Calpol before they were that age.

Second, children who go on to develop asthma (or who later have it diagnosed) are often prone to chest infections when babies so are actually more likely to have been given Calpol as a baby.

If your child is ill and needs paracetemol then continue to give Calpol. Or nurofen, depending on what is wrong.

What the article is saying is that we should not be giving Calpol willy-nilly, but when needed.

I remember being totally at an otherwise well educated and together mum who told me she gave calpol as a matter of course when her ds woke up crying in the night. 'But do you know he is ill or in pain?'- no she didn't, this was just the default position. I saw no point in asking whether she had tried a lullabye instead- clearly, a toddler who woke in the night was "wrong" and therefore had to be medicated.

Around out toddler groups every child who had a cold or slight temperature or was slightly off-colour was dosed with Calpol as a matter of course. No suggestion of trying to soothe a sore throat with warm milk or just letting a mild fever run its course.

mmslindt - I am pointing out that my son has had a (ridiculously) disproportionately large amount of ibuprofen and calpol. I sincerely doubt even 1% of the child population have had as much as he has. I don't think you can compare him to a child who has had it 'once'. They are talking about 'overuse' not 'normal use'.

And my son has been prone to every infection going as explained, many viruses infecting throat and chest.

And your last comment makes me think you didn't even read my piece. Your flowery comment about using painkiller 'willy nilly' makes it sound like it's a decision about whether to go for a walk on a sunny day. It has been WHEN NEEDED but at the same time it has been ALMOST CONTINUOUS given how sick he has been. Hence my concern. I have another daughter and friend's daughter's to compare to. I am not exaggerating nor over reacting.

Please stop being patronising.

I don't think MmeLindt was patronising at all, she pointed out that your child needed the medicine and it is ok for you to give it. even though it was a lot because your child was ill a lot.

ramblingroses
I read your post.

I am sorry if you found my reply patronising, it was not meant to be.

Of course it is worrying if you have to constantly medicate your child, but only you know if you are giving it at the right time. You are the one with the sick child in front of you. If you feel that he needs it, and your GP is recommending this then that is your decision to make.

There is nothing in that report that says that it is the frequency that is dangerous, or how much the child is given.

I don't really know why you reacted so aggressively to my post, it was meant as a comfort to you.

Suchffun:

"How do they know that 'one-half' of parents medicate wrongly? (one-half, ffs, its half, mutter) How exactly would they measure that?"

It's US research, I've not been able to access the original paper, but AFAIK The American Academy of Pediatrics is reputable and so unlikely to promulgate faulty research.

But there is no reason to suppose it is also an accurate reflection of what happens in the UK population.

But the general advice - don't medicate when it is solely a mild fever - is valid.

The link given said there was no evidence that paracetamol caused asthma just that there was a higher proportion of children with asthma who had used paracetamol in the first 15 months. This just be because they are more sickly children anyway and more likely to have been given paracetamol than other children. It just calls for more research to find out why.