Just adding to the discussion (from my perspective)
I routinely don't recommend any OTC cough or cold medications to children under 6 years of age who have viral illnesses. I tell the parents they don't work (and run the risk of overdoses). Saline nasal spray, bulb suction, and time is what I tell them. Besides, arent most infant OTC cough and cold medications now off the shelves?
Young infants with rashes should be examined by a healthcare provider. While children are known to develop rashes at a drop of a hat, rashes are clues to illnesses and may not necessarily be confined to allergic reactions. If the rash is Fifth Disease instead of an allergic reaction, benadryl (or claritin) will not help. If a parent brings a child with red eyes, fevers, red tongue, and rash, and you miss Kawasaki Disease (or Scarlet Fever), there can be long-term consequences for the child.
In regards to Benadryl, it's a relatively safe drug and used often in kids under the age of 2. A recent survey of primary care pediatricisn showed that roughly half of the participants have recommended Benadryl for sleep issues in kids between the age of 0-2.
The american association of poison control centers published an out of hospital guideline in 2006 for Benadryl overdoses in children and validated in a recently published article (n=305). Kids who ingested less than 7.5mg/kg generally did fine and didn't require any treatment nor were they admitted. I think the current dose of benadryl that most pediatricians use are based on old ancedotal experiences and not any well-studied pharmacokinetics or pharmacodynamic studies.
Incidentally, in 2005 the FDA placed a black box warning on Phenergan, which includes a contraindication in children younger than 2 years old because of continued reports of serious adverse events, such as respiratory depression and central nervous system reactions, including seizures.
In office, I generally tell the parents the child's weight, and then tell them how much Tylenol or Advil to give (both in mg and in amount depending on infant or children version). I also write down the weight (in kg) on a piece of paper for the parents to take, and tell them that if they have questions about dosing, to ask the pharmacist. Hope you guys/gals don't mind
🙂
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