Medication for children - what parents should bear in mind!
It's late Sunday evening, the five-year-old is feverish, the packet of suppositories has been used up and the pharmacy on duty is on the other side of town. Luckily, there are still a few of his big sister's fever suppositories in the medicine cabinet. She's only eleven, so what could possibly go wrong? Quite a lot, say experts, and they strongly advise against giving children medication that is not authorised for their age.
A child's organism is growing. Organs are developing: the liver first has to adjust to its lifelong task, and the kidneys are also still fine-tuning in the first few years. The immune system and metabolic cycles do not yet function as they do in adults. And puberty brings with it a chaotic mix of hormones. Dirk Mentzer from the Paul Ehrlich Institute, the German Federal Institute for Vaccines and Biomedical Drugs, emphasises that all of this plays a role in how a substance affects the body.
The immune system and metabolic cycles do not yet function as they do in adults.
«It's only in the last twenty years or so that there has been more extensive research into the impact of medication on a child's organism,» says the paediatrician. For example, it has been discovered that the amount of certain enzymes in the liver that are responsible for breaking down the medication varies greatly depending on age. This sometimes means that children under the age of two have to take twice the dose recommended for adults. In other cases, however, this would be highly dangerous. There is no simple rule of thumb as to how doses can be scaled down from adults to children. «Between the ages of three and ten, however, children don't get fatter. So I can't calculate exponentially here, but have to take into account the changing ratio of height to weight,» explains Mentzer. And this is individual for each substance.
Five authorisation groups
So that parents can be sure that a medicine will not harm their child, the European drug authorities have been obliging drug manufacturers to test the active ingredients for use in children for ten years. A distinction is made between five subgroups:
- Neugeborene
- Säugling (0 bis 2 Jahre)
- Kleinkind (2 bis 6 Jahre)
- Kind (6 bis 11 Jahre)
- Jugendliche (11 bis 18 Jahre)
Whether this examination has taken place and the medicine is authorised for children is stated in the package leaflet under indications and indications for use. «The process is not yet complete, so it may well be that some medicines do not yet have a reference to authorisation for children,» says Mentzer. This does not automatically mean that the medication is unsuitable, but it is always advisable to consult your doctor.
One fifth not authorised
Mentzer estimates that around twenty per cent of the medicines that doctors in private practice regularly use are not approved for children. These include antihypertensives, anticonvulsants and certain antibiotics. However, such substances are also given to children in an emergency under medical supervision in hospital. Dirk Mentzer warns against well-intentioned medication that can quickly lead to an overdose. Hay fever drops, known as antihistamines, are a classic example.
«The most important rule: no attempts at self-medication»
Dirk Mentzer, paediatrician
«The child suffers from the allergy, the parents have the over-the-counter drops at home and give them to him. This is actually harmless. But then the parents give the drops again because they somehow don't seem to work - so an overdose is quickly reached, which can lead to respiratory arrest,» explains Mentzer. There have already been deaths after such accidental overdoses. The same applies to sprays that many children are prescribed for asthma, so-called betamimetics. If a single application has no effect, they are often sprayed repeatedly - this can lead to tachycardia and cardiac arrhythmia and thus to death. «The most important rule here is not to try to self-medicate, but to follow exactly what the doctor has said and, if in doubt, to consult with him or a pharmacist,» says Mentzer.
Substances may have a different effect on a child's body
Angela Caduff Good agrees that paediatrics is a poor relation when it comes to scientific research. «There are simply still a lot of information gaps, which means that we don't always know whether a medicine is safe for a child or not,» says the specialist pharmacist in hospital pharmacy at Zurich Children's Hospital. She points out that the side effects of a medicine listed in a package leaflet are often taken from studies with adults. «It may be that the substance has a completely different effect on a child's body and perhaps causes side effects that are not expected or that are not even described in this way in adults,» says Caduff Good.
«It is often difficult for laypeople to recognise an overdose»
Angela Caduff Good, specialist pharmacist at Zurich Children's Hospital
She therefore recommends always keeping an eye on a child who is given medication and reporting any abnormalities to the doctor or pharmacist. It is always possible for children or adolescents to have an allergic reaction to a medicine, just like adults, regardless of whether it has been dosed correctly or not. Or a medicine may be accidentally overdosed if, for example, parents reach for their older sister's antipyretic suppository with the same name but a higher dose. «It is often difficult for laypeople to recognise an overdose. You need a good indicator for this. For example, if the package leaflet says that a medicine makes you tired as a side effect, but my child really gets extremely tired, then I would be suspicious,» says Caduff Good. She is a mum herself and knows how quickly parents can become unsure and worried. «In such a case, you can contact Tox Info Suisse» (24-hour emergency telephone number 145). They provide very competent information, says the expert.
Syringes are better than spoons for precise dosing
In order to avoid over- or underdosing when administering solutions and syrups often used in paediatrics, for example, the required amount of medication should be measured as accurately as possible. The spoons supplied with juices in particular lead to inaccurate dosing, says Caduff Good. «Oral syringes, which can be used to draw up the medication precisely, are better.» Some pharmacies therefore replace the spoons supplied with medicines with a syringe of this type. In connection with the correct use of medication, it is also important to know the expiry date. Every medicine has an expiry date printed on it by the manufacturer.
Opened packs: If in doubt, the rubbish bin is the better choice.
However, this is only binding for liquids in particular as long as the medicine has not been opened. «As soon as you open drops or a juice, they often have a shorter shelf life than stated on the packaging,» explains Angela Caduff Good. She advises you to make a note of the opening date on the bottle. If the shelf life after the first opening is not stated on the package leaflet, the pharmacy can provide information.
If you are not sure when a bottle was opened or whether the medicine is still good, the following applies: If in doubt, take the medicine back to the pharmacy for proper disposal. Under no circumstances should medication be thrown in the rubbish or disposed of via the toilet. «It is also important to pay attention to how a medicine should be stored. A medicine may need to be stored at room temperature before opening, but in the refrigerator after opening,» says Caduff Good. She generally recommends careful handling of medication and advises parents to keep reminding themselves in this context: "Children are not small adults.
Age-appropriate dosage
The fact that many medicines for adults are unsuitable for children is often evident from their form: Tablets, suppositories and capsules are too large. Medicines that are primarily intended for children are therefore usually available in a corresponding dosage form; those that are equally suitable for children and adults are usually available in several variants. As a rule of thumb, children under the age of six should be given liquids, after which most are able to swallow a tablet. Ask your doctor which dosage form he or she prescribes. For example, if you know that your ten-year-old has problems taking a tablet, ask directly for a juice.
What you can do
Prepare yourself for an emergency. Use a regular appointment with the paediatrician to discuss important «what if...» cases. What if the child gets a high temperature after immunisation? If a suppository doesn't work? If the cough keeps getting worse anyway? This way you will know how and with which medication you can react in an emergency. If you have accidentally given your child an overdose, call the Tox Info Suisse emergency number 145. It provides free medical information around the clock in the event of poisoning or suspected poisoning.
Links
compendium.ch
The medicines compendium website is actually intended for specialists, but also provides laypersons with a quick overview of the age from which a particular active substance is authorised for children.
toxinfo.ch
The non-profit foundation Tox Info Suisse has summarised information on the prevention of poisoning and individual toxic substances on its website.
embryotox.de
The website of the Pharmacovigilance and Advice Centre of the Charité in Berlin provides information on the safety of medicines during pregnancy and breastfeeding.
