Fever is the most common reason for parents to bring their children to my office.
Most of my patients are younger than 3 and are in the thick of the Petri-dish years, as they start daycare and school, and put everything in their mouths. I predictably spend half my day weeding through colds, flus and ear infections and discuss fever management routinely. In the emergency room, I suspect that 75 per cent of my time is spent with children suffering from fever.
Pharmacies sell many different versions of fever-reducing medication. I am thankful there are so many options, but one huge problem remains: dosing.
A commentary by two Montreal doctors published last week in Paediatrics & Child Health, the journal of the Canadian Paediatric Society, advocates for standard dosing of these medications. I couldn't agree more.
If you look at a bottle of your favourite fever medicine, you will find one of several dosing measurements. Your acetaminophen (Tylenol or Tempra) may contain 80 milligrams of medicine per 1 millilitre of liquid or 100 mg per 5 ml. That is a big difference. Similarly, your ibuprofen (Advil or Motrin) may have 100 mg of medicine in 5 ml of suspension or 200 mg in 5 ml. That is twice as much medicine in the same volume!
What's more, parents often choose to use non-standard measuring devices, such as a household spoon, to dole out the medicine. This only increases the inaccuracy and risk of underdosing and overdosing.
A common reason why physicians see kids in the hospital and office is underdosing and resulting persistent fever. More than 50 per cent of parents provide the wrong dose to their children, with at least 35 per cent of parents giving a sub-therapeutic dose of medicine and 15 per cent giving supra-therapeutic amounts of acetaminophen, according to an article in Pediatrics, the journal of the American Academy of Pediatrics.
Toxicity of acetaminophen can cause irreversible liver damage. We, as parents, must know what we are giving our kids. This is why authors Shadi Tamur and Sophie Gosselin used their commentary in Paediatrics & Child Health to encourage a more standardized way of delivering anti-fever medications to our children with appropriate, easy-to-follow instructions on the box.
So when faced with a feverish child, what measurement should a parent use?
Current evidence demonstrates that the most efficacious dose for acetaminophen is 15 mg per kilogram of body weight, and for ibuprofen 10 mg per kg. It makes sense to have a weight-based dosing method and established delivery devices in each and every package of anti-fever medicine. A single concentration of liquid acetaminophen and ibuprofen may enable parents to choose the appropriate, therapeutic amount of medicine while minimizing the risk of overdosing. Pretty simple if you ask me.
Until the pharmaceutical industry is forced to make these changes, please exercise caution when you give your child fever medicine. The dosing may be different on your current medicine bottle from the last bottle you used. Read the label. Identify the dosing and do some simple cross-multiplication to identify the correct dose. Use the provided measuring cup or syringe, or ask your pharmacist if he or she has an extra one. And never give your child ASA, or Aspirin.
When in doubt about how to properly dose your child, ask your pharmacist or doctor. In my own practice, I write it out for my patients; it is worth it to keep the fever down and keep your child healthy.
Of course, if you are concerned, or your child looks unwell, please see your doctor. That's what we are here for.