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. It is easier to give the correct amount of medicine when using a syringe than when using a kitchen teaspoon or tablespoon. If a tool does not come with the medicine, ask your pharmacist for one.
Avoid "multi‑symptom" combination products to help prevent double‑dosing the same ingredient.
Check with 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
Helps with: Runny nose, itchy eyes, sneezing from allergies, itching from bug bites, hives or other allergic reactions.
Safety warnings: Some antihistamines can make children sleepy and can be toxic if taken in excess. Do not give diphenhydramine (Benadryl) to children younger than 6 years unless your pediatrician advises you to. For routine allergy symptoms, newer antihistamines are generally a safer choice.
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.
Salicylates can be toxic if taken in excess. Oil of wintergreen can be especially dangerous. 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 for babies under 6 months old unless instructed by your child's doctor.
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, 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 note: If your child has asthma, do not give OTC medicine with anti-cough ingredients without talking with their doctor first. In some children with asthma, these medications can actually worsen the condition.
- Safety warnings: Remember to 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.
Decongestants (oral liquid or pills taken by mouth)
Examples: phenylephrine, pseudoephedrine
Helps with: Nasal congestion or stuffy nose.
Age limits: NOT RECOMMENDED for children under 4 years old unless advised by your child's doctor.
Safety warnings: 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.
What else to know: If your child is sleeping and eating well, there's no need to treat a stuffy nose.
Decongestants (nose drops or spray)
Examples: Oxymetazoline, phenylephrine, medication-free saline (saltwater) solutions
Helps with: Stuffy nose and easier breathing.
Age limits: Never give medicated decongestant nose drops or spray to a baby. Medicated decongestant nasal sprays and drops are NOT RECOMMENDED for children under age 6 unless advised by their doctor.
Safety warnings: These products have side effect risks, especially for children with heart problems, and may even affect mood or behavior.
What else to know: Saline nose drops and sprays 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.
What is rebound congestion?
If your older child is using medicated nasal drops for sprays, don't continue past 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).
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, such as bismuth subsalicylate, unless they are at least 12 years old.
Antidiarrheal medicines are usually not helpful for infectious diarrhea and may prolong the illness.
What else to know: Oral electrolyte solutions are often the safest and most helpful OTC treatment for diarrhea because they help prevent dehydration. Most symptoms go away on their own. Changing your child's diet may help with symptoms.
More children’s OTC medication safety tips
- Use a log to keep track of what times you gave medicine to your child. This is especially helpful when there is more than one person taking care of a child. It is easy to accidentally give a double dose of medicine! Work with other caregivers to plan how you will keep track of what medicines are given, how much was given, and when.
- Remember to always store medications out of sight and reach, preferably in a locked cabinet or container. That way, children are less likely to get into them when you are not watching.
- Check the medicine label and read the expiration dates. The expiration date is the date after which the medicine should no longer be used. Expired medicines may not work as well and can hurt your child.
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.
Call the Poison Center if you're not sure
If you're worried your child may have swallowed some medicine they weren't supposed to, but aren't sure, you can call the Poison Center in any state at 1-800-222-1222 at any time of day or night. The Poison Center can help you find out if this could hurt your child. Do not wait until your child is sick to call the Poison Center.
Don't use syrup of ipecac
If you have syrup of ipecac in your home, flush it down the toilet and throw away the bottle. Years ago, people used syrup of ipecac to make children throw up if they swallowed poison. Now we know that you should not make a child throw up.
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, Arizona, 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 and serves as a member of the American Academy of Pediatrics Committee on Drugs.
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