By Jodi DeLong
When I was very small, my mother caught me lining up children’s aspirins on the windowsill. That wasn’t yesterday—aspirin has been contraindicated for children for at least a generation—but my poor mother got quite a fright until I insisted I hadn’t eaten any of them.
That said, there are many cases of children becoming sick from accidental overdoses of common medications that are purchased over the counter (OTC) at any pharmacy. In 2018, the region’s largest Poison Centre at the IWK Health Centre in Halifax, NS had 2,380 exposure calls for children five years and younger. Of these, 46 per cent were medication related (both prescription and OTC) and the remaining 54 per cent were due to other causes such as fumes, cleaning products and such.
A confusing selection
Take a walk through your pharmacy and you’ll be confronted by shelves upon shelves of OTC medications—picking the right product can be overwhelming.
Kurt Buckland is a pharmacist with the IWK. “Many OTC medications contain multiple ingredients, some of which may not be necessary for your child, and may even be harmful,” he says. “Ask your pharmacist what product is right for your child.”
The number one OTC overdose in young children (under five) is analgesics, says Laurie Mosher, registered nurse and clinical leader at the IWK Regional Poison Centre. “Acetaminophen (Tylenol) is the number one overdose—and there are hundreds of products available in Canada containing acetaminophen—and ibuprofen is second,” she says.
There are many other products that can cause problems, like muscle and pain relief lotions with analgesics like ASA (active ingredient in aspirin) or capsaicin, derived from hot peppers; laxatives, and vitamins containing iron.
These latter are the most concerning for chronic overuse of vitamins, says Mosher, meaning higher than the recommended dose for age and weight on the package. Typically, ingestion of extra children’s vitamins can cause upset stomach, nausea, vomiting, diarrhea and brightly coloured urine.
Did you know that cough and cold products have not been shown to be effective in children under six years of age? Kurt Buckland says if a child is older than six, one medication can be used to relieve symptoms, under the advice of a health care professional. There are cough and cold products on the market that contain opioids such as codeine, hydrocodone and normethadone, “which should not be used in children or adolescents under 18 years of age,” he adds.
We often think that our medicine cabinets are safe because prescription and OTC medicines come in child-proof containers. Think again. “There is no such thing as ‘child-proof’ containers,” Mosher says. “Children can open child-resistant containers, especially if they have played with them, watched an adult open the container, or if it wasn’t secured properly. Lock medications up away from children.” Interestingly, she adds, packages are only “resistant” for the number of doses and shouldn’t be reused. Mosher served on the CSA child resistant committee, whose guidelines were recently updated.
Pharmacist Buckland says that OTC medications used by adults don’t necessarily require a child-resistant container by law. “Prescriptions, however, are dispensed in child-resistant bottles unless, in the professional opinion of the pharmacist, a child-resistant container is not needed. The community pharmacy documents this,” he says. A locked medicine cabinet, drawer or other location that is locked (and the key out of children’s reach) is the best way to keep little fingers away from medicines.
If you suspect your child has ingested an accidental overdose, immediately get in touch with the IWK Regional Poison Centre at 1-800-565-8161. “This is a
24/7 service to both the public and health care professionals. No call is too small,” says Buckland. Even if you think it is a small amount of medication involved, it could still be harmful or fatal. The expert staff at the Poison Centre can offer information and treatment advice.
Laurie Mosher says that symptoms of medication poisoning do not always manifest right away, depending on what the child has ingested. “A lack of initial symptoms doesn’t mean the child will be okay,” she says. “It’s very important to call the Poison Centre immediately. There can be immediate or delayed life-threatening symptoms which can affect breathing, blood pressure or heart rate, liver or other.”
Education and prevention
Sometimes something as simple as a
parent or guardian not being able to
read the tiny fine print on an OTC product’s label can lead to problems. Keep a magnifying glass or reading glasses with the medication, or take a photo with your smart phone and read it from the screen. Pharmacists are always available to help with instructions on dosing and storage.
It’s important to use the proper measurement for a liquid product, so
don’t use a teaspoon from the silverware to measure out a dose. Don’t give extra doses, or doses too close together, says Mosher. “If the instructions say every eight hours, there is a good reason for this.”
Kurt Buckland urges parents to
consult their neighbourhood pharmacist, who will have many resources to help them. “This could
include detailed information on intended use, possible adverse effects, how to administer and store medications, and what to do if a child misses a dose,” he says.
Other strategies could include medication dose calendars for patients with multiple medication, helping with unpleasant tasting medication, and telephone follow-up with parents after the medication has been started. Parents and guardians should bring unused and expired prescription drugs, over the counter medications, and so-called natural health products to your local pharmacy for proper disposal. “Do not flush medicines down the toilet or sink,” Buckland stresses.
Like the cannabis discussed in our previous issue, there’s another newish artifact that is posing danger to young children—vaping products. The liquids used in vaping devices contain very concentrated nicotine, and the amount in a bottle is enough to seriously harm or even kill a young child, says Mosher.
The risk is increased because many liquids have added flavours that could be tempting to a young child, like chocolate, bubble gum and fruit flavourings. “A child could easily drink a toxic amount very quickly,” Mosher says, “Products currently are not well regulated, with packaging and labelling inconsistent.”
Header credit: Bigstock/TernavskaiaOlga
Intro credit: Courtesy of Laurie Mosher
Caption: Laurie Mosher (centre) and some of her staff at the IWK Poison Centre.