Wednesday, November 19, 2008

Infant Tylenol and the Mystery Dose

ERP has a little rant up about parents waiting to give Tylenol or Motrin for their children.  It is a frustration that I think all ER workers can understand, especially when a child is very febrile.  Go read his post.  Here is my response (also left as a comment on the original post):

To play a little bit of devil's advocate: When we had our first baby and we realized that she needed Tylenol, we pulled out the bottle and looked at the instructions: "for children under 2, ask a doctor"

This, of course, is ironic, because they are "infant" drops, designed, presumably, for "infants" (by definition, I believe, under 2 years old - confirmed by the fact that "children's" Tylenol starts at age 2).  Nonetheless the fact remains that for laypeople or those who do not often deal with infant dosing - or just people who don't fully understand medications and are understandably a little scared when the packaging wont even give them instructions on how to dispense the product - it can be a little scary to try to properly dose the child.

Add to that the confusion about what 10-15 mg/kg means when you are a layperson and may not know your child's weight in kilograms (or for that matter you may not even have an acurate weight in pounds), and even if you do, it can be confusing about when you give 10 and when you give 15.

Also, those droppers have lines for 0.8 ml but they are incredibly hard to get precise measurements on.

Now all that said, I'm big on personal responsibility and as a parent I took it upon myself to learn all I could about these meds and how and when to use them.  It was easier for me, being a nurse to get the information and to understand it, but it is out there and should be an important thing for all parents to know.  I just have a little sympathy for the parents who are confused and a little frustration at the drug company who is willing to put a product out there at outrageous cost (compare the per-mg cost of infant Tylenol with adult Tylenol) and not even provide instructions for the target age-range beyond "ask a doctor".  No wonder they show up at my ER with the bottle in hand not knowing what to do.

UPDATE: Link to original post added. Oops.


audrey said...

I have to agree, they are tough to figure out. And something I noticed is that when my daughter (now 5) was a baby the labels gave dosages for the weights and ages under 2 for the Infant drops.

I think the change took place when they ordered all the infants cold and cough medicine off the shelves. My only guess for the label change is that parents were OD'ing their kids going by age rather than weight. But here's the other part of that, if the parents don't know their kids weight then what good is a call to the doctor going to do? The doc obviously can't give an accurate dosage if the kids weight is not known.

Also I think that at the first well baby visit doctors need to make it clear to parents not to give Motrin before 6 mos of age and that OTC meds need to be dosed by weight.

I found this chart at on Infant Tylenol dosing:

Ambulance Mommy said...

My pediatrician actually handed out instructions on how to use Motrin and Tylenonl on your infants, but not everyone did that. My sister is a nighttime triage nurse for a pediatric office, and could recite the doses in her sleep....but yeah, for most people, its totally weird, totally confusing, and its why I've heard of several minor overdoes.

Amanda said...

If we as healthcare professionals are confused... just imagine how the average parent feels! I have noticed the "Ask a doctor for under age 2" thing myself and wondered, "Wow, that's stupid..." when as you said, it clearly says INFANT Tylenol!! Then with all the acetaminophen overdosing in the news and liver failure, etc., parents have every right to be scared/confused/over-cautious. Crazy.....

Good link Audrey. :)

Chris said...

This is quite an interesting post, i liked reading it, will definitely share it with my knowns thanks for posting it!

Rina from Avent Isis

Chris said...
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