I work at a Pharma Company so I thought it is prudent that I post this article for the parents on EF.

Danger of headache pills for children; Misplaced fever 'fear'

Parents should not give children with a mild fever regular spoonfuls of paracetamol and ibuprofen, doctors advise today, as they warn that doing so could extend their illness or put their health at risk.
A misplaced "fever phobia" in society means parents too frequently use both medicines to bring down even slight temperatures, say a group of American paediatricians, who warn that children can receive accidental overdoses as a result.
As many as half of parents are giving their children the wrong dosage, according to a study carried out by the doctors. In new guidance, the American Academy of Pediatrics advises that a high temperature is often the body's way of fighting an infection, and warns parents that to bring it down with drugs could actually lengthen a child's illness.
Family doctors too readily advise parents to use the medicines, known collectively as "anti-pyretics", according to the authors of the guidance.
GPs also often tell parents to give their children alternate doses of paracetamol and ibuprofen - known as combination therapy - believing the risk of side effects to be minimal.
In its official guidance, the National Institute for Health and Clinical Excellence (Nice) says the use of the drugs "should be considered in children with fever who appear distressed or unwell".
Although Nice says that both drugs should not "routinely" be given to children with a fever, it states that this approach "may be considered" if the child does not respond to being given just one of them.
Children's paracetamol solutions such as Calpol and ibuprofen solutions such as Nurofen for Children are sold over the counter in chemists. Recommended dosage quantities vary by age. There is a range of solutions for different age groups, meaning it is possible for parents with children of different ages to mix up which they are giving.
According to the British National Formulary, which GPs consult when prescribing or advising on medication, children should receive no more than four doses of the right amount of paracetamol in a 24-hour period, and no more than four doses of ibuprofen a day.
In its guidance today, however, the American Academy of Pediatrics notes that both medications have potential side effects and says the risks should be taken seriously.
Doctors, the authors write, should begin "by helping parents understand that fever, in and of itself, is not known to endanger a generally healthy child". "It should be emphasised that fever is not an illness but is, in fact, a physiological mechanism that has beneficial effects in fighting infection."
Despite this, the academy says, many parents administer paracetamol or ibuprofen even though there is only a minimal fever, or none at all.
"Unfortunately, as many as half of all parents administer incorrect doses," the authors say. A frequent error is giving children adult-sized doses, while children who are small for their age can also receive doses that are too high even if their parents follow the instructions correctly.
Paracetamol has been linked to asthma, while there have been reports of ibuprofen causing stomach ulcers and bleeding, and leading to kidney problems .
"Questions remain regarding the safety" of combination therapy, say the authors, led by Dr Janice Sullivan, of the University of Louisville Pediatric Pharmacology Research Unit, and Dr Henry Farrar, of the University of Arkansas.
Dr Clare Gerada, the chairman of the Royal College of GPs, said: "In my experience of 20 years as a GP, parents are usually pretty careful.
"I think the most important thing to be worried about is keeping medicines out of the reach of children, because some taste quite nice."

Interesting, but any chance of telling us where it's from?

Hi DB,

It came up at the Daily Telegraph.

Hi,

a scientific journalist, I can only recommend being extremely skeptical when reading science as reported in the media. I have not read this research, but in general newspaper present medical science as a series of conflicting facts (one day red wine is good, the other day it's not). Science progresses slowly, and naturally with some conflicting results until consensus is established (if). Because of this, you will also be able to find on the internet a study comforting you in your views (vaccine is dangerous, BPA is dangerous, etc).

Unless you want to spend your life second guessing medical knowledge, the easiest is to find a doctor you trust, and trust him.

An amazing source of sober thinking is:

www.badscience.net (a column in The Guardian).

Enjoy!

I see your point. Being part of this industry I am, as you can imagine, subscribed to all types of different information sources and this one came up this morning so I thought I should share.

Also back in the US I see a lot of parents incorrectly administering these medications to their kids specially because they are Over-the-Counter type of drugs.

But I see your point and thank you for sharing the link below.

In fact, science as reported in reputed scientific outlets can also be wrong at alarmingly high proportions. Why Most Published Research Findings Are False

The type of tabloid (and not so tabloid) headlines that get me are the "PEOPLE WHO xxxx ARE FIFTY PERCENT MORE LIKELY TO DIE OF LURGY" when what they mean is the chances go from virtually nil to virtually nil.



P.S. People who eat fruit and veg are 2.3 times more likely to die in a greengrocer related accident.

To cite another example, runners are 43% more likely to bump into a building wall or a tree in broad daylight, than a walker of similar visual acuity

Some adults have a very careless attitude when it comes to medication. I knew one guy who'd cut open slow release pain relief pills, so as to get instant - and bigger - pain relief. Some people work on the principle that if two pills is the normal dose, then four pills must be even more effective.

There are two seperate points in the article.

One, that people don't read / ignore medication labelling and/or doctor/pharmacy advice.

Two, that a fever isn't, in and of itself, a medical issue - rather it's the body's immune system's response to infection. Sometimes it's better to just let it burn.

__________________
Down with racism. Long live miscegenation!

hmnn,

Personally, I would have a hard time NOT giving my baby with a fever something: i/e nature taking its course and letting the fever help fight infection. It has been my experience that children are pretty darn uncomfortable when acting like a pot roast -- mine usually throw up. But I am not a doctor. Maybe that is the best way...

What about meta-science? How often is that wrong?

If that is analysed, wouldn't it be meta-meta-science? How often is that wrong?

I think what gets me with all these kind of reports is that it scares parents and makes us feel like we're risking our childrens health when actually most of us are quite sensible when it comes to medication.

First of all, we're not in the UK here, and it's not nearly so easy to get kids medications. In the UK you can get pretty big bottles of calpol and calprofen in supermarkets for example. Over here you have to go in a pharmacy and speak to a pharmacist before they'll even give you some paracetamol. For babies forget it - they'll usually tell you to see the paediatrician. They always ask questions and they give advice. I have even been instructed by a pharmacist here how to use a syringe accurately to measure antibiotics for kids because it's more reliable than a spoon. Once when I had my younger son with me and was asking for some ibuprofen for his ear infection the pharmacist even had me weigh him in the shop so she could help me with the dose - because he's a little small for his age. Sometimes they even recommend herbal remedies instead.

And then, the other thing is for kids under 6 suppositories are a lot more common than liquid medication. And it's a lot easier to dose correctly then.

I don't doubt that in the UK where it's very easy to get all kinds of medications in the supermarket - and dirt cheap - that people use them a lot more frequently (be interesting to know the figures are here compared with UK).

But all the same, if you've ever been up all night with a kid with an ear infection, or the flu, or even chickenpox if they get it badly, then you'll know that fever medication for kids is a godsend. But I have to say I do think it's much better (even though sometimes annoying!) to be grilled by a pharmacist before you get it.

You're kidding right? I often buy 2-3 bottles of algifor and/or dafalgan at a go with no probs.

Change pharmacy if they are giving you grief.

It was about time somebody spelled it out. I've been saying that for years, but without success. It doesn't mean I don't give them medication when their fever is really high - but my kids had (when they were little) sometimes a little temperature for one day that went away by itself.

Nope - our pharmacy would never give us stuff when the kids were under 1 - not unless we'd seen the paed first (actually I sometimes told them that we had seen him ....). Over 1 they seemed to stop caring . But they are still quite "helpful".

EDIT: actually they also gave me stuff once after I told them I'd been to the Mutterberatung and she advised xyz.

Very interesting reference - it's exactly why I wrote about here: http://xrl.in/7cij (must register to read).

I must stress that this skeptical analysis is not general, but mainly when studies rely heavily on statistics while failing to present sound mechanism to explain what is being reported. Not everything is junk, and it's important that it should be published in science journals to help other scientists know what is being found -- but should be taken with a grain, no, a pinch, well, a handful of salt.

Interesting discussion ...

I second many of the posts: as a parent, how do I know when to give medication to my baby and when not; when is a fever dangerous, when not;
But, fever can be an issue, despite the fact that it is the immune system's response to "intrusion".

Admittedly, as a medical doctor, I did have a big advantage when raising my own three children. Often, the decision of what to do when is based on knowledge and I decided a long time ago, that I want to share my professional expertise and my personal experiences.

I now run a small first aid and health coaching company and regularly offer first aid courses, including courses for first aid on children (all in English). My courses always include some introduction to "gentle remedies", things you can find in your kitchen cupboards which help you or your child to get better again. I am a believer of alternative methods but you need to know when to stop and seek medical advice from a school medicine professional.

If you want to know more, contact me at luitgard@holzleg.com