What are the considerations for using benzocaine in a pediatric patient?

From the Guidelines

Benzocaine is not recommended for use in pediatric patients due to the risk of methemoglobinemia, and alternative treatments such as acetaminophen or ibuprofen should be considered for pain management. When considering the use of benzocaine in pediatric patients, it is essential to weigh the potential benefits against the risks, particularly the risk of methemoglobinemia, a rare but serious blood disorder that reduces oxygen delivery to tissues 1. The guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures emphasize the importance of careful consideration of the risks and benefits of using local anesthetic agents, including benzocaine, in children 1.

Some key considerations when using local anesthetic agents in pediatric patients include:

• Calculating the maximum allowable safe dosage (eg, mg/kg) before administration to avoid excessive doses 1
• Using lower doses when injecting into vascular tissues 1
• Avoiding the use of high doses or injection of amide local anesthetics without careful monitoring 1
• Considering alternative treatments for pain management, such as acetaminophen or ibuprofen, which may be safer and more effective for pediatric patients 1

The maximum recommended doses and durations of action for local anesthetic agents, including benzocaine, are provided in the guidelines, and it is essential to follow these recommendations to minimize the risk of adverse effects 1. Additionally, the guidelines emphasize the importance of monitoring patients closely during and after sedation, including the use of pulse oximetry, ECG, and capnography, to quickly identify any potential complications 1.

In terms of specific recommendations for benzocaine use in pediatric patients, the guidelines do not provide explicit guidance, but the FDA has issued warnings against using benzocaine-containing products in children under 2 years of age due to the risk of methemoglobinemia 1. For older children, benzocaine should only be used with caution, under healthcare provider supervision, and for short durations, and alternative treatments should be considered whenever possible 1.

From the FDA Drug Label

Warnings Allergy Alert: do not use this product if you have a history of allergy to local anesthetics such as procaine, butacaine, benzocaine or other "caine" anesthetics When using this product avoid contact with eyes do not exceed recommended dosage do not use for more than 7 days unless directed by a dentist or doctor Stop use and ask doctor or dentist if sore mouth symptoms do not improve in 7 days irritation, pain or redness persists or worsens swelling, rash or fever develops Keep out of reach of children. If swallowed, get medical help or contact a Poison Control Center right away.

The main consideration for using benzocaine in a pediatric patient is to keep it out of reach of children due to the risk of accidental ingestion, which requires immediate medical attention or contact with a Poison Control Center 2. Additionally, the product should only be used under the direction of a dentist or doctor if needed for more than 7 days. Allergy to local anesthetics such as benzocaine is also a consideration. Key points to consider are:

• Allergy alert: history of allergy to local anesthetics
• Accidental ingestion: keep out of reach of children
• Dosage and duration: do not exceed recommended dosage and do not use for more than 7 days unless directed by a dentist or doctor
• Medical supervision: use under the direction of a dentist or doctor if needed for more than 7 days 2.

From the Research

Considerations for Using Benzocaine in Pediatric Patients

• Benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites 3.
• Pediatric exposure to high concentrations of benzocaine may result in methemoglobinemia, leading to anemia, cyanosis, and hypoxia 3, 4, 5.
• Methemoglobinemia is a rare but potentially fatal disorder where the blood has a reduced ability to transport oxygen 4, 5, 6.
• The majority of exposures to benzocaine in pediatric patients are accidental ingestions by young children, and most exposures result in minor to no effects 3.
• However, some patients may require treatment with methylene blue and admission to a critical care unit 3, 4, 7, 6.
• Therapeutic application of benzocaine by parents or caregivers may lead to adverse effects, highlighting the need for careful consideration and monitoring when using benzocaine in pediatric patients 3.
• The methemoglobin-forming metabolites of benzocaine, such as benzocaine hydroxylamine, have been identified and may contribute to the development of methemoglobinemia 5.