By: Diane E. Hindman, MD, PharmD, FAAP FACMT
The medicine aisle has all sorts of over-the-counter (OTC) products labeled for infants or children. They can help with minor problems like a fever, pain, stomachache or allergies.
You do not need a prescription to buy OTC medicines. However, just like prescription medications, OTC medicines can be dangerous if someone takes too much. It's important to follow directions closely and store them safely. Before giving these products to your child, always read the label first and ask the doctor or pharmacist any questions you may have.
Read on to learn about common types of OTC drugs for infants and children and ways to use them safely.
How to read the drug facts label on OTC medicines
To be sold in the U.S., the Food and Drug Administration requires OTC medicines to have a
drug facts label on the box or bottle.
The label gives important details about the medicine, such as the type of medicine, what it's used for, what's in it, who can use it and warning information. The label also has directions on how to take the medicine, including how much, how often and how long the medicine can be taken.
Before you buy or give the medicine to your child:
Check the label to make sure the medicine is safe for your child's age. Some products should not be given to infants or young children.
Use your child's weight to figure out the dose. If you do not know your child's weight, you can give the dose on the label that is recommended for your child's age. Use the cup or syringe that's included in the package when measuring liquid medicine.
Avoid "multi‑symptom" combination products to help prevent double‑dosing the same ingredient.
Ask the doctor, especially if it is the first time you are giving OTC medicine to your infant or young child. If your child takes other OTC or prescription medicine, the doctor or pharmacist can let you know if it's safe to give them at the same time.
Common over-the-counter medicines for children and what they do
Antihistamines
- Examples: Cetirizine, loratadine, fexofenadine, levocetirizine, diphenhydramine
- Helps with: Runny nose, itchy eyes, sneezing from allergies, itching from bug bites, hives or other allergic reactions.
- What else to know: Some products can make children sleepy and can be toxic if taken in excess.
Aspirin and other salicylate-containing products
- Examples: bismuth subsalicylate, oil of wintergreen, acetylsalicylic acid (ASA)
- Safety warnings: Do not give aspirin or other salicylate-containing products to your child unless the doctor tells you it's safe. Here's why:
- Salicylates are linked to a very serious disease (Reye's syndrome) in children with viral illnesses like the flu and chickenpox.
- In addition, salicylates can be toxic if taken in excess. The amount of salicylate in a small bottle of oil of wintergreen can be fatal to a young child. Just 1 teaspoon (5 mL) of pure oil of wintergreen contains approximately 6–7 grams of salicylate, which is equivalent to nearly 20 to 22 adult-strength (325 mg) aspirin tablets.
Other pain and/or fever medicine
- Examples: Acetaminophen/paracetamol, ibuprofen, naproxen
- Helps with: Fever, headache, body aches, pain from injuries, soreness from a shot, menstrual cramps.
- Safety warnings: Dose by weight and use the included measuring device for the product.
- Acetaminophen: Follow AAP's
dose table; avoid giving more than 5 doses in 24 hours.
- Ibuprofen: Do not use under 6 months unless your doctor says so.
- Naproxen: this is approved only for children 12 years and older.
Cough and cold medications
- Age limits: NOT RECOMMENDED for children under 4 years old unless advised by your child's doctor. DO NOT USE in children under 2 years old.
- Examples: Dextromethorphan, guaifenesin, brompheniramine, chlorpheniramine, diphenhydramine, phenylephrine, pseudoephedrine
- Helps with: Some claim to help loosen mucus or calm a cough. Multi-ingredient cold medications may also claim to help with runny nose, congestion, fever and pain.
- What else to know: There is little evidence that cough medicine helps with mucus. Ask the doctor if your child needs this type of medicine and which one to use. Also:
- Always check what's in the medicine before use. Cold medicines may have mix of ingredients in one product, such as an antihistamine, decongestant, cough suppressant and/or fever medicine. Make sure you don't give fever or pain medicine to your child twice.
- If your child has asthma, do not give OTC medicine with anti-cough ingredients. In some children with asthma, these medications can actually worsen the condition.
Decongestants (oral liquid or pills taken by mouth)
- Examples: phenylephrine, pseudoephedrine
- Helps with: Nasal congestion or stuffy nose.
- What else to know: If your child is sleeping and eating well, there's no need to treat a stuffy nose. Some decongestants can make children fussy, nervous or restless. They can have other side effect risks, especially for children with heart problems, and may even affect mood or behavior.
Decongestants (nose drops or spray)
- Helps with: Stuffy nose and easier breathing.
- Examples: Oxymetazoline, phenylephrine, medication-free saline (saltwater) solutions
- Safety warnings: Never give medicated decongestant nose drops or spray to a baby. Medicated decongestant nasal sprays and drops are not recommended for children unless advised by their doctor. They have side effect risks, especially for children with heart problems, and may even affect mood or behavior.
- What else to know:
- If your older child is using them, don't give medicated drops or spray for more than 2 to 3 days. The more you use medicated nasals sprays and drops the less they work. Symptoms can come back worse than before (called rebound congestion or rhinitis medicamentosa).
- Saline nose drops and spray are a safer option if your baby or child has trouble eating or sleeping because of congestion. Put 1 or 2 drops or sprays in each nostril. For babies, you can use a bulb syringe or other device to help remove fluid and mucus. Do not do it too often because it can make their nose sore and swollen.
Hydrocortisone
- Examples: hydrocortisone 0.5 or 1% cream and ointment
- Helps with: Insect bites, mild skin rashes, poison ivy, eczema.
- Safety warnings: Never use these products on burns, infections, cuts or broken skin. Don't use in or around the eyes, since hydrocortisone can increase the risk of cataracts. Ask the doctor how often you can put it on your child's skin.
Stomach medicine
- Helps with: Heartburn, gas, not being able to pass stool (constipation), loose or runny stools (diarrhea).
- Safety warnings: Talk with your child's doctor before using these medications.
- Do not give your child stomach medicines with salicylates.
- Antidiarrheal medicines are usually not helpful for infectious diarrhea and may prolong the illness.
- What else to know: The type of medicine to use depends on the symptoms. Most symptoms go away on their own. Changing your child's diet may help with symptoms.
When to call the doctor or emergency responders
Get help right away if your child has these symptoms after taking any medication:
Trouble breathing
Vomiting
Face or mouth swelling
Rash
Even if a medicine is safe, your child may be
allergic to it. Let your doctor know if your child has any side effects with a medicine.
More information
About Dr. Hindman Diane E. Hindman, MD, PharmD, FAAP, FACMT, is a board-certified pediatrician and medical toxicologist, and registered pharmacist at Havasu Regional Medical Center in Lake Havasu City, AZ, and the University of Arizona Poison and Drug Information Center in Tucson, AZ. She is also an Associate Clinical Professor at the University of Arizona College of Medicine in Phoenix, AZ, and serves as a member of the American Academy of Pediatrics Committee on Drugs.
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