What’s in a teaspoon?

medication-teaspoonWhen I was growing up, no one used syringes or measuring cups to dole out medication. As a result, a child could easily be over or under dosed. Why? Because the spoons used for ice cream and yogurt can vary a lot in terms of what they hold. Nowadays, doctors and parents need to be more precise in the way they give medicine to kids.

If a doctor tells you to give your child a teaspoon of Motrin for fever, he means you should administer 5 ml, not what fits in the spoons you use at mealtime.

Modern parents know this, but I thought it was worth blogging about. A measured teaspoon is 5ml. It can be given with a syringe, a measuring cup like in the picture above or in measuring teaspoon.

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Is it OK to give kids fever (or other) medicine before a doctor’s visit?

kid's tylonol before doctor visitLots of parents think that giving a child acetaminophen or ibuprofen prior to seeing the doctor will compromise the visit. This is not true. Fever reducing medicine won’t make it harder for the doctor to figure out what’s wrong. In fact, reducing a child’s fever usually makes it easier for the doctor because the child is more likely to cooperate if her temperature is lower during the visit.

The same thing is true for asthma medicine or any other drug your child is taking. Unless the doctor or nurse specifically tells you not to give a medicine before a visit, you should do what you can to control your child’s symptoms.

Why do kids have to be fever-free for 24 hours before returning to school?

Why do kids have to be fever free for 24 hoursBody temperature varies throughout the day whether you’re sick or healthy. If you take your daughter’s temperature three times a day for a number of days, you will see that the highest readings come in the evening. Similarly, if she is sick, you are more likely to find high temperature at 9pm rather than 9am. This diurnal variation in body temperature causes two problems for parents. First, it’s harder to manage high fevers at night when everyone is trying to get some sleep. Second, if your feverish child wakes up cool, you may think all is well until the fever returns in the afternoon or evening. Although it’s not always clear when a child isn’t contagious, most schools have adopted a 24-hour fever free policy because they know temperatures can come back as the day progresses. That’s why you shouldn’t take your kids to school the morning after a feverish night.

Are spider bites dangerous?

Spider BiteAlthough a fear of spiders is on everyone’s top ten list of phobias, most spider bites are (a) not dangerous and (b) occur without the victim even knowing it happened.

Because I’m a pediatrician, most of the spider bites I see happen to children. I have also noted that the ear is the most common place where these bites occur. (The above picture is one of my patients.) I’m not sure why this happens, but I’ve often wondered if it’s because the ear has a large, convoluted surface area that attracts the spider or gives it a place to hide. It’s also possible that the warmth of the ear attracts spiders.

Spider bites usually occur when kids are outside playing or at night while they’re asleep. However, don’t worry that Aragog is stalking your children at night. (Aragog is the name of Hagrid’s spider friend from the Harry Potter books.) The spiders that bite people are tiny ones that are easy to miss even in the daytime.

The typical spider bite presents as a red, swollen area that is warm or hot to the touch, but doesn’t hurt much. In fact, most of the time, they itch more than they hurt.

The bites from black widow spiders and brown recluse spider scan be very dangerous, but in 30 years, I have never had a patient in this region of the country bitten by one of these species.

Parents often give children Benadryl for spider bites assuming the child is having an allergic reaction to the bite. Benadryl doesn’t usually work because the swelling that accompanies spider bites is a local inflammatory reaction to venom rather than an allergy. However, Benadryl may help if the bite itches. The main first aid treatment is to put something cold on the area to reduce the swelling. My favorite remedy is a bag of frozen peas because it conforms to the swollen area.

Kids who get spider bites are often treated with antibiotics because of a concern that the area is infected. Although this is possible, “garden variety” spider bites rarely get infected, possibly because the venom kills any bacteria in the area.

If a spider bite is very swollen, oral steroids may help because they are anti-inflammatory medication.

Swallowing capsules versus pills

PillsThis is a simple tip, but one that makes a big difference when you have to take a medication for 10 days. The basic difference between capsules and pills is that capsules float and pills sink. If you put a capsule in your mouth, take a sip of water and throw your head back to swallow the capsule, it will be hard because the capsule will float on the water and move away from the back of your throat. The best way to take capsules, therefore, is to take a mouthful of water, put the capsule in your mouth and then lean your head forward as you swallow. When you do this, the pill will still float on the water, but now it will be at the back of your mouth and go down more easily.

Because tablets sink, the best way to swallow them is with the opposite maneuver. Take a mouthful of water, put the pill in your mouth and lean your head back when you swallow.

If you have trouble swallowing pills and capsules, I discussed a trick for doing this in an earlier blog.

When does medication really expire?

when-do-medications-expireMost medicine cabinets contain a variety of prescription and nonprescription medication. Some drugs, like allergy medicine, are used intermittently or for long periods of time. Other drugs, like antibiotics, are generally used short-term for an infection. If a doctor prescribes medicine for intermittent use, you’re supposed to keep the pills or liquid on hand for whenever you need it. If a doctor prescribes a drug for acute use, such as a strep throat, you’re supposed to throw away any remaining medicine so you’re not tempted to use it in the future without the doctor’s advice.

All drugs have expiration dates. With nonprescription drugs, the expiration date is printed somewhere on the bottle or tube. With prescription drugs, the expiration date is printed on the instruction label that tells you how to take the medicine.

If the medicine has a short lifespan, the pharmacist will put the appropriate expiration date on the bottle. This is common with antibiotic suspensions that are used with children for ear or sinus infections. However, even if the medicine has a long shelf life, like most pills, the pharmacist is required by law to indicate that the prescription expires one year after it was filled. The reason for this is to reduce the risk that a patient will use the drug inappropriately.

In some cases, it’s okay to use the true expiration date instead of the one listed by the pharmacist. The best example of this situation involves medicine that comes in a tube. In addition to the one-year expiration date provided by the pharmacist, all tubes have the “real” expiration date stamped on the crimp, which is the folded metal part at the bottom of the tube. That being said, it’s always a good idea to check with your doctor before using a prescription medicine.

Why creams sting

CreamI get lots of calls that children complain when parents use either prescription or non-prescription creams to treat eczema and other rashes. In many cases, parents think their kids are just being difficult, and there is no way a cream can sting. Your kids are not making this up.

Most creams contain a substance called propylene glycol. Although propylene glycol is not dangerous, it can sting if a child has tiny cuts or cracks in his skin. The best way to deal with this is to use ointments instead of creams.

I prefer ointments not only because they don’t sting, but also because they do a better job moisturizing the skin. Parents are often hesitant to use ointments because they are greasy. You can manage the greasy quality of ointments by being careful to only apply a thin layer to the skin. The best way to do this is to rub some ointment onto your palms before applying it to your child’s skin.