When it comes to children and medication safety, one of the most important factors to remember is to keep all medications out of the reach of children. Pediatric deaths caused by some drugs used by adults are raising the question, “Just how toxic are some drugs in young children - even in small doses?” A cough medicine, benzonatate, comes in a little capsule that looks like candy to young children. Just one or two capsules can cause seizures, heart attacks and coma in kids under age 2.
The camphor in products like Campho-Phenique or Vicks VapoRub and Vicks VapoSteam contain enough camphor to be lethal in a small child. Vicks VapoRub should not be used in children under two years of age, period. In one case report, an 18-month-old child was brought to an emergency room with severe breathing problems. Despite treatment for what they thought was asthma, the child did not improve. Upon questioning, the caregiver reported that the breathing problem developed about 30-45 minutes after application of Vicks VapoRub under the nostrils. After treatment in the hospital, the child improved with time and was discharged.
The product labeling for Vicks cautions not only against ingesting it, but also against applying under the nose or in the nostrils, and against use in children less than 2 years of age, but these warnings often are ignored. As a result, there are about 10,000 annual reports of camphor toxicity, with some resulting in serious consequences.
Other adult drugs can be toxic in toddlers with just one or two doses, such as diphenoxylate with atropine (Lomotil - an antidiarrheal), clonidine, tricycle antidepressants, antipsychotics, calcium channel blockers (usually used for hypertension or prevention of migraines), quinidine, quinine, or sulfonylureas such as glyburide, glipizide and glimepiride (commonly used by diabetics). Sulfonylureas also can cause brain damage due to hypoglycemia.
In toddlers, a few tablets of strong pain medication (usually opioids or narcotics) can cause death, usually by respiratory depression. The commonly used allergy medication, Benadryl (diphenhydramine), can be toxic. Just three 25 milligram Benadryl tablets can be toxic in a 22-pound child. Iron and prenatal vitamins can be a real problem for children, even children’s vitamins. As few as 10 to 12 tablets can be toxic in a toddler.
Remember that patches look like Band-Aids to children. Patches containing nicotine, fentanyl (a strong narcotic) and clonidine can be very toxic if kids find and chew them, or can be toxic if they stick them on their bodies.
According to one medical publication, even homeopathic products may be a problem. A recent recall of a product called Hyland’s Teething Tablets is based on reports of possible belladonna toxicity in infants using this homeopathic product. Homeopathic products usually are diluted so many times that they contain only tiny amounts of any active ingredient. But some homeopathic products are not diluted much and contain appreciable amounts of active ingredients. A product can be sold as “homeopathic” if its ingredients are listed in the Homeopathic Pharmacopoeia of the United States, even if they are not super diluted. Do not assume that all homeopathic remedies are safe.
Always keep the national poison control number, 1-800-222-1222, at each phone in the home, or put it in your cell phone.
Read part III of this three-part series on children and medication safety in the Thursday, July 7 edition of Blount Today.
Barbara Kahn is a pharmacist and clinical staff educator in the Blount Memorial pharmacy department.