Drugs for Kids

Don’t let the title mislead you.  Honestly, I’m not a deviant, not some bad dude trying to sell dope to your kids.  I’m merely a run-of-the-mill Ear, Nose and Throat doctor trying to help you navigate the plethora of medications out there in the wonderful world of pharmaceuticals.  A more apt title might’ve been “Over-the-Counter Medications for Children,” but what fun is that?  “Drugs for Kids” sounds controversial, strikes a certain chord and captures one’s attention, I think.  Anyway, since my sense of humor is lost on some folks, let’s move on.

Parents often ask about over-the-counter (OTC) medications.  Many of these were once prescription only, but in their infinite wisdom, the F.D.A. (Food and Drug Administration)  determined these drugs are pretty safe in the pediatric population and thus can be used without a doctor’s blessing.

Most OTC medications will have age-based and sometimes weight-based dosing.  Below is a summary of of when and how these medications are used and dosing based on body weight.  I provided the generic name first, and trade name(s) italicized in parentheses.

For weight-based dosing, I listed milliliter (ml) dosing, but for certain medications, you can measure it by “teaspoons”; just be certain you’re using a teaspoon and not a tablespoon (this is the reason it’s best to use milliter dosing, as it’s more accurate and less prone to error).  If a measuring cup or syinge with milliliter markings is not available with the product, you should be able to purchase on in the pharmacy and medication section of the store.  I also use kilogram for weight, since this is standard in medical practice.  The conversion for this is: one kilogram (kg) = 2.2 pounds.  So simply divide the child’s weight in pounds by 2.2 (i.e., a child weighing 33 lbs, divided by 2.2 would equal 15 kg).  So if you want to calculated the dose of say ibuprofen, then multiply the child’s weight (in kg) by the dose per weight for ibuprofen, which is up to 10mg/kg.  The calculation is for this instance is: 15kg x 10mg/kg = 150mg of ibuprofen. 

Now if you are using a liquid (ie, a suspension or elixir) you need to do a little more calculating.  So for ibuprofen and if your are using the 100mg/5ml suspension (which is interpreted as “100 milligrams per 5 milliliters”) multiple the dose in mg by the inverse of the concentration of the liquid medication.  In this example, 150mg of ibuprofen suspension is multiplied by 5ml/100mg, or 150mg x 5ml/100mg.  Doing a little simple algebra to arrive at the amount of suspension to use in milliliters:
150mg x 5ml/100mg  =  150mg x 5ml/100mg  =  150 x 5ml/100  =  150 x .05ml  =  7.5ml
And you thought you’d never use that math you learned in high school. 

OTC pain medications are also often used nowadays for pain control after surgery, especially in children.   The following medications also are used to bring down fevers as well

Of note, the doses below are maximal doses per weight, and you can use less (but not more) than the listed dosing, particularly for pain medication.  For example, with the dosing for ibuprofen, one can use 5mg/kg first, and if not effective then going up to the maximal dose.

Acetaminophen (Tylenol):
Dose for children: 10mg per kilogram (kg) every 4-6 hours (or 5mg per pound).
Comes in liquid form with concentration 160mg/5ml. 

Ibuprofen (Motrin, Advil)
Dose for children: 10mg/kg every 6-8 hours (or 5mg per pound).
Comes in elixir or suspension (liquid) of 100mg/5 ml or more concentrated at 40mg/ml.  Also comes in chewable tablets.

Used to thin mucous and secretions from nose, throat and chest.

Guaifenesin (Robitussin, Mucinex). 
Dose for children (2-3 years old): 50-100mg every 4 hours as needed for thick mucous, cough.  Make sure to take it with plenty of water.
Comes in elixir (liquid) usually of 100mg/5ml.  (½ to one TEASPOON every 4 hrs as needed)

Note: Guaifenesin also is combined with other medications labelled with a “D” (for decongestant) or “DM” (dextromethorpham).  For instance: Robitussin-DM or Mucinex-D.  Typically the plain versions where guaifenesin is the only active ingredient are more suitable for children.

Antihistamines are used for allergy or common cold symptoms such as runny nose, sneezing, itching, nasal congestion or nasal stuffiness.  They also can be used for urticaria (hives from environmental, food or drug allergies).  Loratadine and fexofenadin are considered nonsedating, while diphenhydramine will make one really sleepy.  Cetirizine causes sedation in some people and much less so than diphenhydramine.

Loratadine (Claritin)
Comes in 1mg/ml liquid, or 10mg ODT (oral disintegrating tablet), 5mg chewables
Dose for children:
2-6 yrs old: 5mg (5ml or one teaspoon) once a day
Older than 6 years:  10mg  (two teaspoons) once a day, or one ODT per day.

Fexofenadin (Allegra)
Comes in suspension 30mg/5ml
2-11 years old: 30mg every 12 hours
12 years and older: 60mg every 12 hours

Cetirizine (Zyrtec)
Comes in 1mg/ml liquid, 5mg and 10mg chewables.
Dose for children:
2-5 years old: 2.5mg (2.5ml or ½ teaspoon) per day
6-11 years old: 5mg (5ml or one teaspoon) per day
12 and older: 5 to 10mg (5ml to 10ml or 1-2 teaspoons) per day.

Diphenhydramine (Benadryl)
Comes in 12.5mg/5ml liquid or 25mg and 50mg tablets.  Caution: can case drowsiness and sleepiness.
Dose for children:
2-5 years old: 6.25mg (2.5ml of the liquid form) every 4-6 hours as needed; 37.5mg maximum per day.
6-11 years old: 12.5-25mg (5-10ml of the liquid form) every 4-6 hours as needed; 150mg maximum per day.
12 and older: 25-50mg (10-20ml of the liquid form) every 4-6 hours as needed; 300mg maximum per day.

Used for nasal congestion/stuffiness.  It’s works by vasoconstriction (narrowing of blood vessels) and thus reducing blood flow to stuffy, nasal tissue.

Pseudoephedrine (Sudafed). 
Comes in 15mg/5ml or 30mg/5ml liquid
Dose for children:
2-5 years old: 15mg every 4-6 hours as needed.
6-11 years old: 30mg every 4-6 hours as needed.
12 and older: 60mg every 4-6 hours as needed.
Caution: decongestants can cause insomnia, increased heart rate, irritability.

Saline solution is a natural product that is similar to what your nose normally produces.  “Saline” means salt, which is naturally found throughout your body as well as your nasal secretions.  The level of salt is balanced to be “physiologic” (a fancy medical term loosely meaning “in tune with your body”).

Nasal saline (ie, Ocean, Ayr, Neil Med saline kit, Neti Pot): 1-2 sprays each nostril 2-3 or more times a day, or if using an irrigation device, gently squirt some of the solution into each nostril. 

Nasal gel (ie, Ocean, Ayr): apply pea-size amount twice a day to nose on both sides with clean finger or qtip.  This can be purchased over the counter.

Used for nasal stuffiness/congestion, to improve nasal breathing, sometimes can help with nasal drainage.

Fluticasone  (brands are Flonase, Allerflo (Kirkland-Costco brand)):  
Ages 4-11 years old:  1 spray each nostril once a day
                                Ages 12 years and older:  2 sprays each nostril once a day

Triamcinolone (brand is Nasacort):  
Ages 2-11 years old:  1 spray each nostril once a day
                                Ages 12 years and older:  2 sprays each nostril once a day

     NOTE (for any of the above nasal steroid sprays): Use the spray for at least two weeks consecutively; it will not work right away.  May decrease to one spray a day afterwards if it is still helpful in keeping the nose open or ever other day in younger kids.  If one spray a day works well, you may then try decreasing it to every other day. 

     NOTE: To best deliver the nasal steroid spray to the nose, direct the spray a little towards to outside (ie, place nozzle gently in the nose and point it roughly in the direction of the outer corner of the eye) or if the child is able deliver the spray him/herself, then use the opposite hand to spray the opposite nose (i.e., right hand for the left nose, left hand for the right).  

     Reminder: use nasal saline.  I can’t stress this enough.  Some of the side effects of the nasal steroid sprays include nasal dryness, nose bleeds, sore throat, headaches.  Use nasal saline spray (as discussed above) just prior to using the nasal steroid and several times a day after to keep the nose moist and cleansed.

So there we have in a nutshell—okay, a multi-page, mega-nutshell.  And hopefully this erases any first-impression of me being a drug-dealing perv.

©Randall S. Fong, M.D.