Vent: dosage not on children's medicine

[busymama7]

I know I know. It's all liability. But it really annoys me that they can't just put it on there and trust the parents to be smart enough to read it.

 

My almost 13 month old just broke out in hives. Minor and no need to rush in but I wanted to give him some Benadryl. Of course he is to young to have a dosage listed. So I call the nurse line with our insurance co. She won't tell me because he's under 3. Advises me to call our ped or a pharmacy. I call my ped but the nurse doesn't answer and it goes to voice mail. I know from experience that it often takes hours for them to call back. I can't decide if a pharmacist is likely to give that info out over the phone and as this is an obvious allergic reaction I'm really not wanting to delay any further. I google it and just give him the dosage I find online.

 

How is this safer or better than just putting it right on the bottle?!?!

 

JAWM. Thanks ;)

[Tap]

I know I know. It's all liability. But it really annoys me that they can't just put it on there and trust the parents to be smart enough to read it.

 

My almost 13 month old just broke out in hives. Minor and no need to rush in but I wanted to give him some Benadryl. Of course he is to young to have a dosage listed. So I call the nurse line with our insurance co. She won't tell me because he's under 3. Advises me to call our ped or a pharmacy. I call my ped but the nurse doesn't answer and it goes to voice mail. I know from experience that it often takes hours for them to call back. I can't decide if a pharmacist is likely to give that info out over the phone and as this is an obvious allergic reaction I'm really not wanting to delay any further. I google it and just give him the dosage I find online.

 

How is this safer or better than just putting it right on the bottle?!?!

 

JAWM. Thanks ;)

Yes, call the pharmacist.  They are exactly who will have the information you need.  Give them the weight of the child and they will calculate the appropriate dose.   If for some reason the first pharmacist you talk to won't give you the dose, call another pharmacy.  

 

 

[Excelsior! Academy]

Agree.  In situations like this we use our pharmacist as a doctor. 

 

 

 

 

 

 

 

 

 

Please, don't read that as we avoid the doctor.  With 9 dc our doctor, dentist, and optometrist know us well.

[busymama7]

Yes, call the pharmacist. They are exactly who will have the information you need. Give them the weight of the child and they will calculate the appropriate dose. If for some reason the first pharmacist you talk to won't give you the dose, call another pharmacy.

Ok thank you! I will next time. I was just irritated after two calls and didn't want to waste any more time. The chart I found was by weight so hopefully its all good.

 

I just wonder why the nurse couldn't tell me. She should be able to calculate dosages.

[LMA]

My doctor gave me a chart that says Benadryl can't be used for under 2. If needed for under 2, I was told he has to go to the ER. The pharmacist told me that it can't be used for under 2.

[Χά�ων]

I feel you.

 

DS does not take the manufactors reccomended dose on OTC meds and I have to call if his weight goes above or below a certain range to avoid over or under dosing him, or if he is taking something new to make sure it does not react with his current medication.

[NicAnn]

This American Life did an excellent piece on this topic. Worth listening to for sure.

[Spryte]

It's such a pain in the rear.

 

We use Ask Dr Sears often for dosages by weight.  

[Tap]

Ok thank you! I will next time. I was just irritated after two calls and didn't want to waste any more time. The chart I found was by weight so hopefully its all good.

 

I just wonder why the nurse couldn't tell me. She should be able to calculate dosages.

The nurse is not an expert on medications.  The pharmacist is.  Medication dosages have been changing the past few  years on some meds and there has been some confusion for parents who have used both the 'infant strength' and the 'childrens strength' and the 'adult strength' of liquids like Tylenol. I know you are using Benadryl but confusion still exists across the board.   The nurse cannot legally give medication advice because she does not have a licence to do so.  Your nurse may be able to compute the dose just fine, but I have to tell you, there are MANY who cannot do the math and I would not trust one to do so accurately.   Just because someone completed nursing school doesn't mean they are good at math LOL.  

[busymama7]

My doctor gave me a chart that says Benadryl can't be used for under 2. If needed for under 2, I was told he has to go to the ER. The pharmacist told me that it can't be used for under 2.

Oh crud. Now I'm stressed. He's asleep and the hives were mostly gone when he went to sleep.

 

ETA: ask dr sears says its not for under one year not two. And we are currently fighting the insurance co for refusing to pay an ER visit from last year. No way I'm going to run to the ER for some minor hives.

[busymama7]

The nurse is not an expert on medications. The pharmacist is. Medication dosages have been changing the past few years on some meds and there has been some confusion for parents who have used both the 'infant strength' and the 'childrens strength' and the 'adult strength' of liquids like Tylenol. I know you are using Benadryl but confusion still exists across the board. The nurse cannot legally give medication advice because she does not have a licence to do so. Your nurse may be able to compute the dose just fine, but I have to tell you, there are MANY who cannot do the math and I would not trust one to do so accurately. Just because someone completed nursing school doesn't mean they are good at math LOL.

Ok but it should be a requirement. Not only that they should be able to read a chart based on weight, right? I get it, no liscense. But they do tell you how much Tylenol to give after a vaccine with no problem.

[momto10blessings]

Yes I hate this. I printed out all the charts for Tylenol, Ibuprofen and Benadryl and keep them with the medicine. Luckily I noticed when they changed the concentration in Tylenol/ibuprofen. Always check the concentration!!

[gardenmom5]

you can find the dosage info on the net.  but do keep in mind, some of that has been pulled because that children's otc was found to not be as safe as previously thought.    was rather annoying that rx I'd given olders was no longer available when I needed it for dudeling.

 

I still remember when children's aspirin was easily available next to children's Tylenol.   then rhys syndrome happened and it completely disappeared from store shelves in the early 80's.

[gardenmom5]

The nurse is not an expert on medications.  The pharmacist is.  

neither are doctors.  that's what PharmD's are for.  they spend their time studying drugs, and dosages.

[Mergath]

The nurse is not an expert on medications.  The pharmacist is.  Medication dosages have been changing the past few  years on some meds and there has been some confusion for parents who have used both the 'infant strength' and the 'childrens strength' and the 'adult strength' of liquids like Tylenol. I know you are using Benadryl but confusion still exists across the board.   The nurse cannot legally give medication advice because she does not have a licence to do so.  Your nurse may be able to compute the dose just fine, but I have to tell you, there are MANY who cannot do the math and I would not trust one to do so accurately.   Just because someone completed nursing school doesn't mean they are good at math LOL.  

 

Yup.  When my dd had her tonsils out, we ended up having to bring her to the ER because with the pain she just couldn't get enough fluids down.  They gave us Tylenol w/ codeine for dd, and it was the nurse who figured and wrote down all the dosage stuff on the bottle.  What she wrote down was FIVE TIMES the max dosage for dd's weight.  If I hadn't known it was way too much and had followed the instructions, dd would have died.  Luckily, I was somewhat familiar with the medication and got it all sorted out before we gave dd any of the med.  But I'll never trust a nurse when it comes to medications again.

[Jenny in Florida]

This American Life did an excellent piece on this topic. Worth listening to for sure.

 

I was about to mention this, too. I had no idea how confusing the dosages for young kids could be or the awful consequences of getting it wrong. Listening to that episode made me very glad my kids are both adult sized now.

[Ottakee]

I am sure it comes down to liability. None of them want to give you a dose for a child under 2 as the "official" standing is that it is for children 2 and up.

[Catwoman]

Yup.  When my dd had her tonsils out, we ended up having to bring her to the ER because with the pain she just couldn't get enough fluids down.  They gave us Tylenol w/ codeine for dd, and it was the nurse who figured and wrote down all the dosage stuff on the bottle.  What she wrote down was FIVE TIMES the max dosage for dd's weight.  If I hadn't known it was way too much and had followed the instructions, dd would have died.  Luckily, I was somewhat familiar with the medication and got it all sorted out before we gave dd any of the med.  But I'll never trust a nurse when it comes to medications again.

:eek: :eek: :eek:

 

Thank goodness you had the good sense to doublecheck the dosage! Another parent might have just trusted the nurse.

[peachskittles]

My doctor gave me a chart that says Benadryl can't be used for under 2. If needed for under 2, I was told he has to go to the ER. The pharmacist told me that it can't be used for under 2.

 

I am going to disagree with this.  My son has been using Benadryl since he was, hmmm, at the very least 12 months old.  His doctors have helped me keep up to date on the dosage for his weight, so I don't have to call in every time he breaks out in hives.  He's made it to the age of six with no problems.

[katilac]

I am going to disagree with this.  My son has been using Benadryl since he was, hmmm, at the very least 12 months old.  His doctors have helped me keep up to date on the dosage for his weight, so I don't have to call in every time he breaks out in hives.  He's made it to the age of six with no problems.

 

My kids are teens now, but we most definitely used it well before the age of 2. I'm guessing that's a new rec. 

 

I have always found calling the pharmacy to be the quickest and most helpful. 

[Murphy101]

My pediatrician lists it on his website and gives it to new moms at well checks.

[Mergath]

:eek: :eek: :eek:

 

Thank goodness you had the good sense to doublecheck the dosage! Another parent might have just trusted the nurse.

 

It horrifies me to think that it could have happened to someone else who didn't know and that they might have lost their child.  I made quite a fuss about it, too.  The nurse supervisor told me the nurse responsible would be written up and have to redo parts of her training, so hopefully they were more careful after that.

[Rubix]

We used Benadryl based on weight for our DS when he started having hives.  He was 11-12 mos the first time.  I find, now that he is 4 that the dosage based on weight is even much higher than the dosage on the bottle.  We'll decide between the two, or aim for middle ground. 

 

 

 

We calculated it based on mg per kg.  The problem is here in the US, it is a calculation that required steps - convert pounds to kg, which tells you the number of mg.  Then you have to figure out what the concentration is, to figure out how many milliliters/cc's you need.  Our bottle is 12.5mg per 5ml.  Math was not the strong subject for many of my fellow nursing students, and as a RN that CAN calculate doses, I always double check anything I'm given.  It's too easy to miss a step, like the pounds to kg thing, or move a decimal point! 

[Murphy101]

My opinion on ANY medication, is go by current weight, never age.

 

And dr rx trumps Internet opinion. Many meds are given to children bc for the most part, they can't run clinicals on young children, not necessarily bc it is in fact dangerous to children.

[Tap]

My opinion on ANY medication, is go by current weight, never age.

 

And dr rx trumps Internet opinion. Many meds are given to children bc for the most part, they can't run clinicals on young children, not necessarily bc it is in fact dangerous to children.

 That is actually not acurate.  Both age and weight must be a factor. Young children and elderly often need special consideration aside from weight due to the age of the organs processing the medication.  

 

DD7 is almost 100lbs.  DD14 is just over 100lbs. My 85yo grandmother was 100lbs.  There is a big difference in what medication dose is appropriate (of the same medication) for each person based on age.  There are some medications that would not even be given to the young or elderly person, which would be completely fine for my 15yo.

[Murphy101]

I agree but for CHILDRENs medications, I go by weight. I'm not dosing Grammy with children's medications. ;)

[Murphy101]

Also, obviously, over all health condition, age, weight makes a difference.

 

For the purposes of THIS thread, I was onky directing my response to

 

Children getting children's medications without other medical needs interfering.

 

 

 

I am not a dr, a nurse or a pharmaDR, tho I play one every day in my role as Super Mom. :)

 

ETA: that was an odd autocorrect

[Tap]

I agree but for CHILDRENs medications, I go by weight. I'm not dosing Grammy with children's medications. ;)

There are medications like cough syrup or decongestants that are no longer used in children under 4yo.  The studies show that they have minimal effectiveness in younger children and are dangerous if given in the wrong doses.Even normal doses affect respiration, drowsiness and heart rate.  Young organs metabolize medications different than adults.  A medication that is marketed to older children is not appropriate to give to a toddlers.  SO, yes, even with Children's medications, age absolutely must be taken into account just as importantly as weight. 

[lavender's green]

I really, really like my pediatrician, and young guy with a few small children of his own.  I just feel like he understands our situation from a more practical than theoretical view.  He caculates those dosages for us based on weight and writes it down at every appointment without being asked.  Sure, I could google it, but it's nice to have the officialness of it!  Makes me feel much better!  And I don't have to call the nurses line and wait for hours, then.

[EKS]

I'm guessing that the reason there's no dosage given for young children on the Benedryl container is that they're trying to discourage people using it to knock their kids out.  I'm serious.

[StephanieZ]

I am not a lawyer, but I am pretty well educated in the legalities of prescription and OTC prescribing due to me managing our vet hospital. . . I may have the exact legal stuff fairly muddled, but I am confident that the general principles I describe are correct.

 

To my well-educated understanding, ANY use of ANY drug (including OTC) in ANY way that it is not labeled for is technically an act of "prescribing" and requires, ethically and legally, a licensed physician with a legal patient-client relationship to prescribe it. Essentially, by using a drug off-label, you've transformed it into a prescription drug. It is only OTC when used as directed. In fact, it is no more or less illegal for a nurse to tell you to give benadryl off-label (i.e., for an age not included in labeling) than it is for her to tell you to give the same person a prescription antibiotic.

 

Thus, in reality, when any doctor, vet, etc, who has prescribing authority, tells you to use an OTC drug (such as benadryl) in any way not included in the label directions, then they really have a requirement to have the medical records, etc. to back that up.

 

Thus, if you call your pediatrician and ask what you've asked . . . if the nurse (or anyone, even an MD, who hasn't recently examined the patient) tells you the dosage and how to do it, they are probably risking their license and livelihood. If the doctor him or herself instructs the nurse to give you dosage, or does it herself, then that could be legal so long as the doctor has recently examined the patient and feels comfortable with the prescription (as much as she might prescribing any other drug), BUT, the doctor better be damn sure they feel confident in the prescription, because if anything goes wrong (say, the sedative effect of the benadryl ends up covering up some serious problem, and the kid gets worse or dies or has an allergic reaction, or the hives simply get worse go into anaphylaxis and the child's life is jeopardized . . .) Well, in any of those cases, the doctor's ass is grass, and they would have zero zippo nada defense in front of their board or a jury.

 

So, really, your option, if you want to use drugs off label, is to go to the actual doctor for an actual exam and let them prescribe it, keep their records, cover their butt, etc. 

 

Besides, hives are really dangerous. Anaphylaxis is no joke, and at 13 mos, presumably you don't have enough experience with her allergies to know for certain that it is not a life threatening event. Also, there are MANY drugs that do NOT behave in weight-dependent ways for infants. Many drugs are not tested for infants or small children, and using them off label carries substantial risk. You shouldn't do it w/o specific prescription from an MD who has done a risk/benefit analysis for your specific patient. (Thus, the legal requirement that off label use of OTC drugs be prescribed.)

 

It is not kind or reasonable to ask anyone to risk their livelihood and license in order to save your a small inconvenience. I realize that very few lay people understand that this is what you are doing, but it is, indeed what you are doing. 

[unsinkable]

you can find the dosage info on the net. but do keep in mind, some of that has been pulled because that children's otc was found to not be as safe as previously thought. was rather annoying that rx I'd given olders was no longer available when I needed it for dudeling.

 

I still remember when children's aspirin was easily available next to children's Tylenol. then rhys syndrome happened and it completely disappeared from store shelves in the early 80's.

Oh, I love orange flavored baby aspirin. When I'm sick i want that and my mom. And I can't have either one.

[kathkath]

I always use this site. http://www.cincoranchpediatrics.com/pediatric-web/medicine-dosages?tCategoryId=63

[Murphy101]

Oh, I love orange flavored baby aspirin. When I'm sick i want that and my mom. And I can't have either one.

I'm allergic to aspirin and got a whopping 6 of those and nitro tablets within minutes of entering the ER thanksgiving day.

 

Dh was filling out paperwork, I was gasping for every breath and holding my chest, opened mouth and got that orange flavor, didn't even think of aspirin.

 

Until my chest really really started to hurt within seconds and they gave me a second dose as my dh walked in and they told him what they were giving me and he spazzed that I'm allergic to it. All I could do was go more bug eyed. No air and in too much pain to do anything else.

 

Sigh.

 

Yeah.

 

Thanksgiving this year kinda sucked.

 

Until that second I didn't even know aspirin came flavored.

 

And why the heck can't they flavor nitro tablets? *shudder from taste and resulting migraine that always followed them*

[unsinkable]

Oh, gosh, Martha! You've been thru the wringer!

 

I am sorry you suffered so much. ((Hugs))

 

Take it easy! Let everyone care for you. And I'm sorry about the unexpected baby weaning, too.

[bluemongoose]

I understand why they dont have it on bottles they dont want you to dose for kids under 2yo. What I cannot get over is the fact that my infant tylenol bottle no longer has ANY dosing amounts. It says to call your dr for use with infants. It is for infants, you know the tiny eyedropper kind...who else would i be giving it to but an infant?

[Caclcoca]

A pharmacist gave me a Benadryl dosage about six years ago for my then 16 month old. The on call doc was not from our pediatrician's office, and he was no help. We did end up at the ER the next day when he swelled. It was an allergic reaction to penicillin. I hope your little guy is doing much better soon.

[busymama7]

My baby is fine. The rash/hives were very very minor. They were gone quickly and didn't return. I kept a close eye on him all day. I do know how serious allergic reactions can be as we almost lost my sister many years ago.

 

He is fine today but what worries me more is that I have no idea what triggered it. That happens with me too(just this summer in fact) and I hate not knowing. We were making peanut butter cookies so it is possible he got some or someone touched him with it on their hands. He was shirtless at the moment. Up until now we have had no food allergies in the family :(

 

Thanks for all the input on the thread. I wasn't looking for threatening someone's job or lively hood or thinking I know better than doctors. I was just frustrated that it was so hard to get a dosage. Next time I will know to call a pharmacy first. Taking him in would have been overkill. I can't stress enough how minor it was. I almost didnt even give him anything but since I know it could change quickly I decided to be proactive and stop it in its tracks. I no longer trust my insurance co to pay emergency bills as we are currently facing a more than $6000 bill for what was definitely an emergency. If the nurse would have told me to take him in I would have. That is one thing I have learned. Never go to the ER without talking to the insurance co nurse. We wouldn't be in this mess if I had last fall :(

[kbutton]

 

It is not kind or reasonable to ask anyone to risk their livelihood and license in order to save your a small inconvenience. I realize that very few lay people understand that this is what you are doing, but it is, indeed what you are doing. 

 

I have a medical professional in the family, so I get this, BUT my family member is as irritated about all the new labeling as the parents are. It's not helping anyone. It makes all of it more complicated, and people can die from not being able to take Benadryl on the way to the ED for anaphylaxis for crying out loud. Not all ambulances stock epi pens, so calling for an ambulance doesn't necessarily help either.

[Murmer]

I just want to agree with your vent....My son has had multiple cases of unexplained hives (most likely environmental grass type allergy)...but no other issues...call the dr...and have to wait 1 hour to get the dosage for benadryl...yes 1 hour...at this point I have a chart from them so I don't have to do the whole wait to give my kid meds when he gets hives (yes the dr knows and doesn't seem to care every time I have told him about the hives).