The Comprehensive Guide to Home Medicine Cabinets for Parents

Children are not just little adults and need special care when they are ill. This is something to bear in mind at home too. In her book *Fit for Paediatric Emergencies: From Fever to Resuscitation*, A&E doctor Katharina Rieth explains what should be in every home medicine cabinet – and what to look out for when choosing and using medicines. Here is an extract.

Medicines – organised by topic

• Respiratory problems
• A cold ( rhinitis)

Decongestant nasal drops/spray ( xylometazoline, oxymetazoline): Dosage: Different strengths depending on age; follow the instructions on the package leaflet; if in doubt, ask your paediatrician or pharmacist. Always 1 drop (measuring dropper) or 1 spray per nostril, 3 times a day, for a maximum of 5 to 7 consecutive days.

If you have a cough, make sure you drink plenty of fluids. This is still the best and side-effect-free way to loosen phlegm.

Saline nasal drops (0.9% NaCl): Dosage: As required, e.g. between doses of decongestant nasal drops.

Balm: Angelica balm is particularly suitable for children (warming, anti-inflammatory, antibacterial, helps clear the airways): for children aged 6 months and over, apply a thin layer to the sides of the nose; for younger children, massage into the soles of the feet.

Important for respiratory problems and colds

Not all balms are suitable for children. For children under one year of age, it is best to apply the balm to the back, never to the chest (risk: irritation of the airways).

• Cough

Mucolytics and cough suppressants: The market offers countless mucolytics and cough suppressants whose effectiveness has not been scientifically proven. Furthermore, caution is advised, as these products – which are often available over the counter – can lead to serious problems if combined incorrectly or used carelessly.

Important when you have a cough

Never administer cough suppressants and expectorants at the same time (risk of mucus build-up!). Ensure adequate fluid intake, as this remains the best and side-effect-free way to thin mucus. For children over one year of age, honey is considered an effective, evidence-based home remedy for relieving acute coughs. Ensure correct use of balms (e.g. thyme and myrtle balm) and compresses (e.g. beeswax compresses).

• Inhalations

Saline solution (0.9% NaCl): Dosage: If necessary, saline inhalations may be administered several times a day to moisten the airways.

Aspirin must never be given to children under the age of 15 who have a fever!

Important points to note when using inhalers

Saltwater inhalation is not evidence-based; in other words, there is no evidence to suggest that inhaling saltwater shortens the duration of the illness. Subjectively, however, inhaling a 0.9 per cent saline solution does provide relief for some children.

There are also higher-concentration saline inhalation solutions, such as 3% NaCl. You should only use these after consulting your paediatrician. This higher-concentration saline solution is generally used for children with cystic fibrosis to thin and loosen the thick mucus in the airways, making it easier to cough up.

Bronchodilators (salbutamol, ipratropium bromide): If used incorrectly, these medicines can harm your child. You should therefore only add these medicines to your home medicine cabinet once your local paediatrician has examined your child and prescribed the relevant medicine following a serious diagnosis such as bronchitis or bronchial asthma. Salbutamol can also be prescribed in the form of oral drops if you do not have an inhaler at home.

Fever/Pain

There are a number of painkillers suitable for children; two of them are:

• Ibuprofen (anti-inflammatory, pain-relieving, fever-reducing): Dosage: 10 milligrams per kilogram of body weight every 6 to 8 hours as required, as a suppository (rectally) or as a syrup (orally). Approved for use from 3 months of age.
• Paracetamol (pain-relieving, fever-reducing): Dosage: 15 milligrams per kilogram of body weight every 6 to 8 hours as required, as a suppository (rectal) or as a syrup (oral). Approved for full-term newborns weighing 3 kilograms or more.

Important to note if you have a fever and are in pain

• Never giveaspirin to children under 15 years of age who have a fever (rhabdomyolysis), and only do so after consulting the treating doctor.
• Please only usemetamizole after consulting your doctor, as it has a wider range of side effects compared to other fever and pain relievers (allergic reactions, agranulocytosis).
• Diclofenac, whether in the form of liquid, suppositories or gel, should never be used in children under the age of 12 to 14, and only after consulting a doctor; in particular, it should not be used in combination with other painkillers. It has a strong anti-inflammatory effect.
• Opioid-based painkillers are subject to the Narcotics Act, require a prescription and should never be taken without medical advice.

Antihistamines, which are used to treat allergic reactions, can make your child feel tired and cause nausea and dizziness.

febrile convulsion

Diazepam: Dosage : For children weighing less than 15 kilograms, 5 milligrams once. For children weighing more than 15 kilograms, 10 milligrams once. Administer as a rectal suppository. When removing the suppository, keep it pressed in to prevent the active ingredient from being reabsorbed.

Important: This is a prescription-only emergency medication. It may cause severe drowsiness. It is only available if a sibling has already had a high fever. Consult a doctor after use.

Allergic reactions

antihistamines

• Cetirizine (approved for use from 2 years of age): Dosage: Children aged 2 to 12 years (weighing under 30 kilograms): 5 milligrams; adolescents over 12 years of age (weighing over 30 kilograms): 10 milligrams; to be taken at night as drops/syrup or tablets.
• Dimetindene maleate: Approved for use from 1 year of age: 2 drops per kilogram of body weight, divided into 3 oral doses daily. Dosage in gel form: Regardless of age group, apply a thin layer to the affected area 2 to 4 times daily.

Important in the event of an allergic reaction

Antihistamines can make your child feel tired and may cause nausea and dizziness. However, in the event of an allergic shock (anaphylaxis), they can provide relief, much like cortisone, until the emergency services arrive and life-saving adrenaline is administered.

If your child has a known history of anaphylaxis, please always carry the prescribed emergency kit with you and, in an emergency, use the adrenaline auto-injector as demonstrated. An adrenaline nasal spray is now also available as an alternative.

Corticosteroid (abbreviated to corticoid)

Cortisone (glucocorticoid): Dosage in suppository form: 100 milligrams of prednisone administered rectally, as a single dose, regardless of age group. Dosage in liquid form: betamethasone or prednisolone as per the package leaflet (as there are many different manufacturers).

Adrenaline in inhalation solution does not belong in the medicine cabinet. If used incorrectly, it can cause cardiac arrhythmia.

Important information about cortisone

In this form, the cortisone suppository is an emergency medication and should not be administered several times in succession. As a general rule, you should consult a doctor if your child uses it to treat an allergic reaction. With cortisone syrup, you should ensure that the child is actually able to take it in the given situation (not if they are coughing so severely that they are vomiting or experiencing severe shortness of breath).

Some manufacturers also offer adrenaline as an inhalation solution for home use. Caution is advised here, as incorrect use can lead to cardiac arrhythmia. For this reason, this medicine should under no circumstances be kept in the home medicine cabinet.

Stomach ache

Vomiting

Medicines for nausea and vomiting should not be administered to treat acute infectious gastrointestinal disorders due to potential side effects. The German Federal Institute for Drugs and Medical Devices (BfArM) now warns against their use, particularly in children under the age of three.

Dimenhydrinate or diphenhydramine lower the seizure threshold, cause drowsiness and thus prevent fluid intake; for this reason, they should never be taken on their own without consulting a doctor.

Diarrhoea

Electrolyte solution: Dosage : Dissolve the contents of the sachet in water or tea as per the package leaflet and give to the child by the spoonful over a period of 2 to 4 hours.

Important to note if you have diarrhoea

Many people keep probiotics, such as lactic acid bacteria, in their medicine cabinet. However, there are currently no treatment recommendations for this, due to the mixed results of studies, some of which show no effect or only a minimal one. Dosage of lactic acid bacteria: Follow the instructions on the sachet as per the package leaflet. For infants and young children under the age of 2, use only after consulting the treating doctor. Many babies refuse electrolyte solutions but will happily drink Moro-style carrot soup.

If you are constipated, start with: abdominal massages, drinking plenty of fluids, a high-fibre diet, a diet rich in pome fruits, plenty of exercise, cutting down on sweets and «toilet training».

Constipation

• Glycerine suppositories: Dosage: As per the package leaflet (generally available over the counter at pharmacies, but this does not mean you should treat babies with them on your own all the time).
• Lactulose (milk sugar): Dosage: Only after consulting your doctor.
• Macrogol: Dosage: Only after consulting your doctor.
• Glycerol enema («mini-enema» using a rectal tube): Dosage: As per the package leaflet.

Important in cases of constipation

In cases of constipation, conservative treatment options (abdominal massage, drinking plenty of fluids, a high-fibre diet, a diet rich in pome fruits, sufficient exercise, limiting the consumption of sweets, and «toilet training») should be tried first.

In addition, a food diary should be kept, and the time, consistency and appearance of bowel movements, as well as any accompanying symptoms, should be recorded. If there is no improvement despite consistently following these measures, you should take your child to see a paediatrician for further diagnosis and treatment.

If the paediatrician has started treatment with Macrogol, it should never be stopped abruptly and should only be discontinued after consulting the treating doctor. Children taking Macrogol for the first time often pass very loose stools during the first one to two weeks and experience a more frequent urge to pass stools.

Nevertheless, this should not lead to you reducing the dose or stopping the medication altogether on your own. In this case, the paediatrician can adjust the dosage. The treatment is typically carried out for six months.

Conjunctivitis

Saline solution (0.9% NaCl): Dosage: Soak one sterile swab in the solution and wipe both eyes from the outer corner towards the inner corner; use three times a day for 2 to 3 days.

Important: If there is no improvement and you experience an increase in purulent eye discharge and/or visual disturbances, consult a doctor. Antibiotic eye ointment or drops may then be prescribed, or further diagnostic tests may be required. If there is a concomitant deterioration in general health or warning signs, particularly if the redness spreads from the conjunctiva to the surrounding soft tissue with a risk of inflammation developing, seek immediate medical attention.

Stye (hordeolum): Apply dry heat using a red-light lamp (available to borrow from many pharmacies). If necessary, use antibiotic eye ointment or drops. If the eye becomes severely swollen, there is a risk of infection developing: consult a doctor immediately.

Injuries (trauma)

Painkillers (see above)

Wound and healing ointment: Dosage: Apply a thin layer to the affected areas three times a day. If there is no improvement, or if signs of infection or other warning signs appear, consult a doctor.

Important in the event of injury

Treat swelling and pain caused by injuries using cold therapy (ice packs), rest, elevation and medication. Furthermore, ensure that movement (motor function), sensation (sensitivity) and blood circulation in the affected area are maintained.

If, following a fall, your child is unable to put weight on or move their arm or leg, or if – contrary to their usual behaviour – they no longer want to play but instead sit quietly in a corner and/or complain of a persistent «strange tingling sensation», it is advisable to consult your paediatrician to determine whether further diagnostic tests (ultrasound or X-ray examination) is required.

Katharina Rieth is a paediatrician, intensive care specialist and emergency doctor who has been passionately dedicated to caring for the youngest patients both at home and abroad for over 15 years. Drawing on her wealth of experience and specialist knowledge, she works tirelessly every day to save children's lives. Further information on what to do in an emergency can also be found in her online course, «The ABC of Paediatric Emergencies».