New Acetaminophen Dosing, One Physician's Response
In the past few weeks, many changes have burst onto the front page concerning acetaminophen, the most commonly used over the counter medication for children. Infant drops are going bye-bye, yet dosing information for children under age 2 will be made more available for combination medications containing acetaminophen. Isn't this a mixed message? What are we to make of all this?
I think it is only fair for me to tell you what I make of all this. I cannot comment on what others are making it. I come to you as a physician and a mother.
Acetaminophen is one of the most useful and widely used medications in the US, and possibly worldwide. It is used for fever, pain and even for prevention of both. It is also the most common medication found in accidental ingestions. That's the medical term for poisoning. That's when your toddler, child or teen gets into the medication without your knowledge or permission. It also includes those times when a parent or grandparent accidentally or unknowingly gives a higher dose than what is indicated. If these overdoses are suspected immediately, they can be diagnosed by a series of timed blood tests and treated with medication. Unfortunately, this is not always the case. I will spare you the details, but this can result in a painful death by liver failure that can take several days. It's heartbreaking.
Acetaminophen is marketed in several different strengths. Tablets come in different strengths, as do liquid preparations. Dosing information for children under 2 years of age has not been available on the packaging. For Pediatricians and Family Practicioners, this has meant a lot of after hours phone calls for dosing information. The proactive physician will make this kind of dosing information available to parents before they need it. I have always given this to parents at the 2 month visit, and geared it toward the child's weight. I also discussed this in one of my first blogs. However, multiple preparations in multiple strengths definately causes confusion. Getting rid of the most concentrated strength will certainly increase safety. Even with this move, doses will need to be based on a child's weight, not on their age.
This means parents will need to know their child's weight at all times. Many of us don't do that. We don't weigh our children on a regular basis. We certainly don't weigh them when they are sick and miserable. Some of us don't have scales in our homes. I recommend two things. The first is that you check with your provider to see if they have a patient portal to your child's medical record. This is a way to access parts of the electronic medical record over the internet. The part that includes your child's weight, height and other vital signs is universally accessible in participating hospitals and clinics. Unfortunately, it is only as accurate as your child's most recent visit. Therefore, you should also consider getting a good set of home scales so that you can weigh your child at home when they are sick.
I am not a fan of over the counter cold medications. They don't work well in children, and they are fraught with side effects. This leads me to the combination medications with acetaminophen. Most of them are "cold" medications. Having dosing information available for children under age 2 years is convenient, because that means fewer phone calls to the physician in the middle of the night. However, it also means that more parents will be giving their children and toddlers medications that I don't think they should have. I think it is going to be difficult for the FDA to do this without sending a mixed message. It is just as unwise for the FDA to be giving mixed messages to parents and grandparents as it is for us, as parents, to give mixed messages to our teenagers. We need to push them to make a completely responsible decision.
Furthermore, if we are going to talk about the safety of acetaminophen, let us not forget the teens. This is still a favorite medication to use in suicide and suicide attempts. While I admit that legislature can to little to address this, all this media attention could be a springboard for conversations. Let's start talking about teens and their use of acetaminophen. Let's talk about their use of over the counter medications in general.
There is a lot of new information out there. A spotlight has been thrown on acetaminophen. I think that is a good thing. I'm not sure it is enough. I have mixed feelings about the withdrawal of acetaminophen infant drops from the market, but I think it is the right thing to do. I am not certain that it is right to post dosing information for children under age 2 for combination medications containing acetaminophen. I also think the conversation needs to move forward concerning the different strengths of tablets. Finally, keep this, and all medications, out of the reach of children and teens. Perhaps that should be the topic of my next blog.
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