Most parents have given their children
paracetamol at one time or another, yet paracetamol overdose is
the leading cause of liver failure in children. So how safe is
this commonly used medication and when should we give it to
children?
By Dr Jocelyn Lowinger
If you have young children, then chances are you have paracetamol
in your medicine cupboard and use it to treat some of the many
ailments that are part of childhood.
In fact, few parents wouldn't have used this common medication to
bring down a child's fever or ease the discomfort of teething
pain, colds and flus, or ear aches.
Yet while paracetamol is a very safe medicine when it is given
correctly, if children are given too much it can be dangerous and
in very rare cases deadly.
A recent study found paracetamol to be the leading
cause of liver failure in children in Australia and New Zealand.
The researchers identified 54 cases of liver failure in two
children's hospitals between 2002 and 2012, 14 of these cases were
related to paracetamol overdose, and 12 were in children under
five years old. While the overall number of cases of children that
experienced liver damage was low, the researchers are calling for
a review of the safety practices around paracetamol use.
Associate Professor Madlen Gazarian, a consultant in Paediatric
Clinical Pharmacology & Therapeutics and an Honorary Associate
Professor at the University of NSW, has extensively researched the
appropriate and safe use of medicines in children, including use
of paracetamol.
She says accidental harm from paracetamol is generally the result
of:
- a single large overdose
- a number of doses that are slightly too high.
"The first thing parents and carers need to know is whether and
when it is appropriate to use paracetamol, including when they
should seek medical advice for an unwell child."
In her view, people need to understand it isn't always necessary
to give paracetamol to young children when they have fevers, which
are often caused by common viral illnesses.
As well, she says parents and carers also need to know how to use
paracetamol safely – including making sure the dose, formulation
and strength are appropriate, how long to use it for and how to
make sure storage and administration are safe.
She answers some common questions parents have when it comes to
treating fever.
Take your child to the doctor if they have a fever (eg
temperature greater than 38.5oC, under the armpit) and:
See your doctor if your child becomes unwell while taking
paracetamol.
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Can a fever harm my child?
"Parents and carers can be reassured that fever, by itself, is not
harmful to a generally healthy child," Gazarian says.
Fever is a common symptom of many childhood illnesses and is part
of the body's normal response to help fight off an infection. But
that doesn't mean you can ignore a fever altogether, as it can be
a sign of an illness that's serious if not treated. So it's
important to watch for any additional signs and know when to see
the doctor.
While many parents worry their child may get fever fits (febrile
convulsions) if their temperature gets too high, there is no
evidence that bringing down a child's temperature can prevent
them, Gazarian says.
When should I use a medicine to treat fever?
Treating fever is not about lowering the number on the
thermometer, Gazarian says.
"The aim of any treatment for fever is to improve the child's
overall comfort, rather than trying to just bring the temperature
down to normal."
"Most children tolerate low-grade fever (up to 38.5°C) well and
usually don't need any medicine to treat it".
"Some children with a viral illness might have a temperature of
39°C and are running around happy as Larry. They don't need
anything given to them," she says.
Gazarian recommends paracetamol for children who have a fever over
38.5°C (measured via the armpit) and if they are uncomfortable,
such as if they have a headache or feel miserable.
How does ibuprofen compare to paracetamol for fever?
While paracetamol and ibuprofen are equally good at reducing a
child's temperature, Gazarian says, "paracetamol is the first
choice".
That's because paracetamol has been used for a lot longer and
there's better data on how effective it is; it's still not clear
if ibuprofen works as well. It's also not yet known if there are
any differences in the overall harm to children.
As well, the potential harms of using ibuprofen to treat fever are
different from those of paracetamol, Gazarian says.
While paracetamol is known to cause liver damage if you give too
much of it, ibuprofen (like other non-steroidal anti-inflammatory
drugs) can cause gut problems and kidney damage in some children,
even when it is given at the recommended dose.
"Dehydrated children or those with complex medical illnesses may
be at greater risk of kidney problems with ibuprofen," she says.
Do not give:
- ibuprofen to children under 6 months of age,
- paracetamol to children under 3 months of age.
While some medical professionals recommend alternating paracetamol
and ibuprofen when treating a fever, Gazarian does not agree. It's
not known if this is helpful to children and it may cause
confusion and mistakes in giving children accurate doses.
What else can I do to help treat a fever?
If your child has a fever, encourage them to rest. Dress them
lightly, but make sure they aren't cold or shivering.
Give them plenty of clear fluids so they don't get dehydrated.
Children younger than 6 months can have extra cooled pre-boiled
water, breast milk or formula.
Sponging them down is not recommended, as
it can make them start to shiver and may increase their
temperature.
Gazarian recommends parents and carers consider the
following before giving paracetamol to their children:
When should I consider using paracetamol?
How do I use paracetamol correctly?
1. Choose the right product for the age of your child
2. Choose the right dose
3. Measure the dose correctly
4. Give the dose at appropriate intervals
5. Take care with other medicines
6. Avoid confusion
7. Store medicines safely
8. Keep an eye on your child and see your doctor if:
If you think you have given too much paracetamol then
either:
Do this even if your child does not seem sick.
*This advice has been developed from Gazarian's previous
work – Long-Term
Reduction in Adverse Drug Events: An Evidence-Based
Improvement Model and Promoting
safe use of paracetamol in children.
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