Can a 2-year-old receive oral lidocaine (local anesthetic)?

From the Guidelines

Oral lidocaine is not recommended for 2-year-old children without specific medical supervision. While lidocaine products exist for oral pain relief, they can be dangerous for young children due to risks of toxicity, which can affect the nervous system and heart. According to the most recent guidelines from the American Academy of Pediatrics 1, local anesthetic agents, including lidocaine, are cardiac depressants and may cause central nervous system excitation or depression. The guidelines emphasize the importance of calculating the maximum allowable safe dosage before administration and using lower doses in very vascular areas.

The guidelines also note that doses of amides, such as lidocaine, should be decreased by 30% in infants younger than 6 months, and that long-acting local anesthetic agents should not be used for intravenous regional anesthesia. The maximum recommended dose of lidocaine with epinephrine is 7.0 mg/kg, and the duration of action is 90-200 minutes. However, these guidelines are general and may not apply to every individual situation.

In the context of a 2-year-old child, it is essential to prioritize caution and avoid using oral lidocaine without medical supervision. The FDA has warned against using over-the-counter oral lidocaine products in children under 3 years old. If a child has mouth pain, safer alternatives include children's acetaminophen or ibuprofen at age-appropriate doses, cold foods like popsicles, or teething rings for teething pain. Always consult a pediatrician before giving any medication to a 2-year-old, as they can recommend appropriate treatments based on the specific condition.

Some key points to consider when administering local anesthetic agents to children include:

• Calculating the maximum allowable safe dosage before administration
• Using lower doses in very vascular areas
• Decreasing doses of amides by 30% in infants younger than 6 months
• Avoiding the use of long-acting local anesthetic agents for intravenous regional anesthesia
• Monitoring the child closely for signs of toxicity or adverse reactions

It is crucial to follow the most recent guidelines and consult with a pediatrician before administering any medication, including local anesthetic agents, to a 2-year-old child. The guidelines from the American Academy of Pediatrics 1 provide the most up-to-date information on the safe use of local anesthetic agents in children.

From the FDA Drug Label

For infants and in children under 3 years of age, the solution should be accurately measured and no more than 1. 2 mL be applied to the immediate area with a cotton-tipped applicator. Life-threatening and fatal events in infants and young children Postmarketing cases of seizures, cardiopulmonary arrest, and death in patients under the age of 3 years have been reported with use of Lidocaine Hydrochloride Oral Topical Solution, USP (Viscous) 2% when it was not administered in strict adherence to the dosing and administration recommendations In the setting of teething pain, Lidocaine Hydrochloride Oral Topical Solution, USP (Viscous) 2% should generally not be used. For other conditions, the use of the product in patients less than 3 years of age should be limited to those situations where safer alternatives are not available or have been tried but failed.

Lidocaine administration in a 2-year-old is not recommended due to the risk of life-threatening and fatal events, as reported in postmarketing cases 2 2. The use of Lidocaine Hydrochloride Oral Topical Solution, USP (Viscous) 2% in patients less than 3 years of age should be limited to situations where safer alternatives are not available. Caution is advised, and the product should only be used under strict adherence to dosing and administration recommendations.

From the Research

Local Anesthetic Use in Children

• The use of local anesthetics, such as lidocaine, in children is a common practice in clinical medicine to minimize pain in various procedures 3, 4.
• However, pediatric patients are at an increased risk of local anesthetic systemic toxicity (LAST) due to their reduced muscle mass and the depot effect of systemically absorbed anesthetics 3.
• LAST can present with seizures, cardiac dysrhythmias, and ultimately cardiovascular collapse, and requires early recognition and understanding of appropriate treatment modalities 3.

Lidocaine Overdose in Children

• Lidocaine overdose can be particularly hazardous in pediatric patients due to altered pharmacokinetics, including increased absorption, decreased clearance, and prolonged half-life 5.
• Doses that are safe for adults may pose a significant toxic hazard in children, and physicians should be aware of the adverse effects and high risk for overdose in pediatric patients 5.
• The American Association of Poison Control Centers reported 8576 exposures to local/topical anesthetics in 2003, with 67% of cases in children under 6 years old, highlighting the potential for toxicity in this age group 6.

Safety Precautions and Alternatives

• To minimize the risk of overdose, specific instructions should be given to parents regarding the amount, frequency, maximum daily dose, and mode of administration of lidocaine preparations 5.
• Benzocaine may be considered a safer alternative to lidocaine for infants and children due to its low incidence of side effects 5.
• The use of topical anesthetics, including lidocaine, should be approached with caution in children, and parents should be educated on the potential risks and proper use of these medications 6.