Wednesday, September 25, 2013

Tylenol

Baby Miriam got her first fever when she was a few months old. Late at night, I went to the store to get some Tylenol. It was the first time I had ever bought medicine for a baby, and I found the offerings on the shelf very confusing. There were all kinds of bottle sizes and flavors and formulations, but I ended up buying something called "Children's Tylenol" because Miriam was, after all, a child.

When I got home, I opened the package and checked to see how much medicine to give Miriam. To my disappointment, the package simply directed me to "ask a doctor." What the? It was the middle of the night. Miriam was irritable and feverish and I was beyond tired. I wanted to give her medicine to help her, not dig up the pediatrician's after-hours number and spend 30 minutes on hold waiting for a nurse. But that's what I did. It took a long time, but I finally got the instructions I needed.

But then, THEN, when I tried to administer the dose of medicine, Miriam coughed and vomited it up because it was so much fluid for an infant. It took a long time over another 30 minutes to administer the medicine in small enough portions that she wouldn't gag on it.

It was only later that I realized that what I should have bought at the store that night was Infants' Tylenol, which is a completely separate product. Infants' Tylenol is highly concentrated, which means that the dose for a baby Miriam's age would have been something like 0.8mL rather than something like 5mL for the Children's Tylenol. That would have been a lot easier to administer.

Anyway, no harm done, and it was all part of the learning curve for a new mom. Over the years, however, I have remained irritated that most medications for children do not come with dosing information for babies under two years old. It's always that maddening "ask a doctor." If these drug manufacturers would stop to think about it, they might realize that a sleep-deprived parent dealing with a fussy, sick child at 3am is not inclined to call the doctor (IF they have one; IF they can even dig up the emergency number, etc.). Oh no. They are inclined to just guess at the dose, based on the amounts given for other ages. Yep.

Those of you who listen to This American Life may know where I'm going with this - TAL's latest episode was all about Tylenol and how easy it is to accidentally overdose, especially for children and especially because of those horrible "ask a doctor" labels. I was sad to hear stories like this, which could so easily happen to any new parent who, like me in 2005, had no idea of there being different Tylenol formulations for different ages of children.

Still, I thought I was up to speed on the confusing drug labels on children's/infants' medicine. I've been a parent long enough now that I know all the secret dosing amounts they don't dare print on the package itself.

However, I learned something new from the podcast - in 2011, Tylenol eliminated the Infants' formulation of its medicine. You can now only buy Children's Tylenol. I had no idea this had happened, but it explains why I was so confused this summer when I was stocking up on American medicine to take back home (liquid pain reliever medicines here taste horrendous and it's just easier to buy a few bottles in the US and keep them on hand, to the point that my kids actually ask before taking medicine, "this is the American kind, right?").

I thought I was buying the same old Infants' Tylenol (in the convenient concentrated formula that makes it easier to administer to a baby, in this case Sasha 3.0) and Children's Tylenol. But after listening to the podcast, I took another look. Here's what I have:
The one on the right is Costco brand, but you can see that one is called Children's, and one is called Infants'. However, they are the same formulation - 160mg of drug per 5mL, for both. This means I could have saved myself the trouble and just bought the Children's Tylenol - it was probably cheaper than the specially labeled Infants'. Even the dosing information is the same:
Except that the Infants' version (same liquid as the Children's, just in a pack labeled "Infants'") dosing only goes up to age 3...and completely eliminates dosing information for age 2 and under. So frustrating.

Just to make sure, I checked the ibuprofen I bought in the US. Same differentiation in the package designation (Children's vs. Infants'):
But look again! Ibuprofen has maintained two separate formulations, with the Infants' version being far more concentrated at 50mg per 1.25mL as opposed to the Children's 100mg at 5mL. At least the dosing information is a little more complete, with instructions on the Infants' box going all the way down to 6 months:

I'm glad I listened to that podcast, because it alerted me to the fact that the dosage for Infants' Tylenol will now be much higher than I was used to with my older kids. If I had stumbled upon this unawares in the middle of the night a few months hence, I would have been very confused, indeed.

To sum up: there is now only ONE Tylenol for children/infants, and good luck getting all that extra liquid down the throat of your tiny infant, especially if s/he is gag-prone like Miriam was. But ibuprofen still has two different formulations - keep them straight!

Oh, and for two long years, you will need to ask a doctor for dosing information for Tylenol. Ridiculous! Just put it on the package already, seriously. In my opinion, that would have been a better safety reform than eliminating the Infants' formula altogether.

13 comments:

Glenda The Good said...

I thought they had agreed to put dosing on there because they finally realized it wasn't always continent to ask a doctor in the middle of the night when your kid gets a fever. Seriously so frustrating. I guess we should just ask while are at the hospital before we even bring our babies home. What a joke :(. What always drive me nuts is the doctor would say to do .5 or .75 but all that is marked on the dropper is .4, .8 or maybe just 1. I mean it isn't that huge of a deal and I can estimate but would I really have killed them to mark a few more lines. These are thing I've learned from being married to a pediatrician....you can actually alternate tylnol with with Iprophen closer then just giving tylnol or Ibprophen if they have a super high fever that won't break. What I consider a high feaver, physicians don't. Anything under 102 he's really not concerned at all and says to me really it is better to just let the body fight the infection but if I insist on giving medication for comfort "ok."...begrudgingly. The exceptions to this, brand new babies maybe three months and younger and prolonged feaver that last several days.

Bridget said...

YES, and that is something that drove me nuts about our nanny. At any sign of the slightest fever, she was pressuring me to medicate medicate medicate. She probably thought I as a horrible mother because I preferred to wait if/when the fever got up to 101 or so before giving medicine. So I agree with your husband, I guess. :)

It really is so frustrating to have to "ask a doctor" in the middle of the night!

Liz Johnson said...

I haven't been to this pediatrician's office since we left Utah, but I still use their dosage charts all the time, since they include the amounts for kids under 2.

I'd much rather they put the appropriate dosage on then tell parents to ask a physician - that just means we're all going to guess at 3am. That can't be good.

Suzanne Bubnash said...

It has to be about liability, that they don't put those dosages on the box anymore. If the manufacturer doesn't tell you how much is right for an infant (and infants are more likely to react badly to medicine), then they can't be blamed if something goes wrong, because they didn't imply it could be used for infants. My own kids are lucky they survived--sometimes in the middle of the night with the lights off I just guessed at the dosage in the dropper, never knowing then that it could make a negative difference to give too much at a time.

Bridget said...

OK, I am taking a screen shot of that webpage NOW before they take it down.

Nancy said...

Yes! Our doctor here was a...very young doctor, single, doing her residency. When I asked her how much tylenol to give Benjamin she said to just look at the chart on the bottle according to his weight. I explained to her that they don't do that for babies and SHE has to look it up in her chart and tell me. She said that was ridiculous (also, how do you get to be a pediatrician and not know that?).

I agree that there's less of a risk of overdosing if it's just stated loud and clear how much to give and when, rather than deflecting.

It's as annoying as how EVERYTHING says to ask your doctor if you are pregnant or breastfeeding. :)

Ariana said...

Yeah, infant dosage is based on weight, and since babies can have huge variations in weight from kid to kid, they say ask a doctor. Annoying! I wish the manufacturers would just put the chart on the box, with instructions for how much medicine per pound of kid!

Hannah said...

That's interesting. Not having children, I hadn't stumbled across the problem of children vs. infant formulas. I have heard about increased concerns of adults overdosing on acetaminophen, especially when they take more than one multi-symptom product for a cold or flu.

Jennifer said...

I went through this a few years ago when I stocked up on Children's Motrin beacuse it was on sale, but Ellen was only 9 months old. It wasn't until I opened them up that I realized this wasn't the same as the Infant Motrin I'd been giving her. My cousin sent out a chart like what Liz posted that I've had saved on my computer for 4 years now and I always just reference that. It really is unnecessarily confusing.

One more thing, according to my understanding (which could be wrong), the reason that the Ibuprofen has dosages starting at age 6 months and not younger is because you're not supposed to give Ibuprofen to infants under 6 months. Up until then, it is Tylenol only, which I guess now means giving them enormous amounts of Children's Tylenol. Nice.

Jennifer said...

And to add on to my comment, I'd love to hear about other things that are different/have surprised you having a baby this time around since you've been out of the baby loop for 5 years. My kids have been so close together, I feel like I've never really left that phase, but it is starting to feel distant to me (because my youngest is all of almost 2 years old). I love that kind of perspective. :)

Andrew said...

Here's the chart we pilfered from some prescription Miriam had a while ago: https://www.evernote.com/shard/s1/sh/bdc8e6aa-e616-43a8-a514-ba3d406cec60/f7754fed0a4b1ba5e20440f8797d8f1d

Jen said...

My insurance company has a 24-hour nurses hotline where you can call for information like that. It's pretty fantastic. (also? totally doing the screen shot, too!)

Bridget said...

I have thought a lot about this, too! Things are different out there now. For example (I know you'll understand this) - when I bought a Woombie for Majd 5 years ago, there was just one. A Woombie. It was white with a yellow collar. Now there are about a bajillion woombie styles and swaddlers and blankets etc. It was overwhelming, but of course I got one! I still remember worshiping that thing with Majd. :)

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