From the Guidelines
Medications for children should be given only under healthcare provider guidance, as children require specific dosing based on their age, weight, and condition. When treating community-acquired pneumonia in children, the choice of medication depends on the suspected pathogen and the child's age, weight, and condition. For example, for Streptococcus pneumoniae with MICs for penicillin >2.0 μg/mL, the preferred parenteral therapy is ampicillin (150–200 mg/kg/day every 6 hours) or penicillin (200 000–250 000 U/kg/day every 4–6 h) 1. In contrast, for children with asthma, inhaled corticosteroids are the preferred long-term control medication, and the dose should be titrated to as low as needed to maintain control 1. For pain and fever, acetaminophen (Tylenol) is typically dosed at 10-15 mg/kg every 4-6 hours, and ibuprofen (Motrin, Advil) at 5-10 mg/kg every 6-8 hours for children over 6 months. Some key points to consider when giving medications to children include:
- Always use measuring devices that come with medications rather than household spoons
- Store medications safely out of reach
- Check expiration dates
- Children metabolize medications differently than adults due to their developing liver and kidney function, which is why proper dosing based on weight rather than age alone is crucial for safety and effectiveness
- For allergies, children's antihistamines like cetirizine (Zyrtec) or loratadine (Claritin) are available in age-appropriate formulations
- When treating coughs and colds, it's best to avoid multi-symptom medications and instead address specific symptoms; honey (for children over 1 year) can help with cough 1.
From the FDA Drug Label
Directions • take every 4 to 6 hours, or as directed by a physician• do not take more than 6 doses in 24 hours agedose Adults and children over 12 years of age10 mL (25 mg) to 20 mL (50 mg) Children 6 to under 12 years of age10 mL (25 mg) Children under 6 years of ageDo not use For children, the recommended medication is diphenhydramine (PO), with the following dosage:
- Children over 12 years of age: 10 mL (25 mg) to 20 mL (50 mg)
- Children 6 to under 12 years of age: 10 mL (25 mg)
- Children under 6 years of age: Do not use 2
From the Research
Medications for Children
- Paracetamol (acetaminophen) is a commonly used analgesic and antipyretic drug in children, especially for those under 12 years of age who cannot be treated with non-steroidal anti-inflammatory drugs (NSAID) 3.
- For the common cold, antihistamine-decongestant-analgesic combinations may have some general benefit in older children, but there is no evidence of effectiveness in young children, and the risk of adverse effects must be considered 4.
- Ibuprofen is consistently superior to paracetamol at conventional doses in a range of painful conditions, including acute post-operative pain, dysmenorrhoea, and osteoarthritis, although paracetamol may still be used as a first-line analgesic in some cases 5.
- For acute cough in children, the American College of Chest Physicians recommends a "wait, watch, review" approach, and cough medications are not recommended due to the risk of side effects and adverse reactions 6.
- While there is evidence for the efficacy and safety of ibuprofen plus paracetamol in a fixed-dose combination for acute postoperative pain in adults, similar analyses in pediatric patients are limited 7.
Considerations for Medication Use in Children
- The use of over-the-counter medications, including cough and cold medications, is not recommended in young children due to the risk of side effects and adverse reactions 4, 6.
- Parents should be educated on the expected duration of illness, the risks of using over-the-counter medications, and safe, supportive care measures to alleviate the child's discomfort 6.
- The efficacy and safety of medications, including paracetamol and ibuprofen, should be carefully considered in children, and medication use should be guided by evidence-based guidelines and recommendations from healthcare professionals 3, 5, 7.