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10 Tips To Help Your Child Make The Medicine Go Down

Written by Denise Somsak MD
Explain that medicine needs to be taken to make your child feel better.  Around the age of three years old, this explanation will have much more meaning and may increase ease of compliance. In the words of Yoda, “Truly wonderful, the mind of a child is.”  They sense your compassion and conviction.  You don’t need luck.
  1. Ask your doctor before you start.  Better to avoid screaming than to manage it.  Some kids do better with liquid others chewable.  Many medications can be crushed and put in food.  Pharmacist can add flavoring to liquid medications.  This is usually better than adding the medication to juice or milk because not all meds can be mixed in other beverages and more importantly, the child might taste it and refuse the rest leaving you with an even larger amount of liquid to get down.  Rectal medication is sometimes an option, but few medications other than tylenol, anti-emetics and seizure medications are made for this route.
  2. Know you can.  There is no try.  Only Do or Do Not.
  3. You need a syringe.  No, not to give the child a shot.  An empty syringe that you can fill with the correct amount of medicine.  The pharmacy should have given you one.  Always ask especially for children less than 3 years old.
  4. Make sure the child is not afraid of the syringe.  Let him hold it.  Fill it with water and let him sip it and drip it into his hand.
  5. If the child will try a little medication willingly, give a little more.  If the Force is with you, that’s all it takes.
  6. If the child does not like it, promise a chocolate milk chaser or some other highly desired treat that the child can only earn after the medication and at absolutely no other time.  This technique only works for children who can understand cause and effect and delayed gratification, about 2.5 to 3 years old and up.
  7. If the child spits the medicine back at you immediately or vomits within 10 minutes, you need to repeat the dose.  Call your doctor with variations on this theme.
  8. To avoid the spitting, lie the child on her back.  You might need a holder to steady her head.  Slowly drop the medicine in a little at a time by putting the syringe at the back of the throat, but DO NOT GAG the poor girl.  A few drops at a time even during crying should get the job done.  It will feel like forever, but I promise you it is less than a minute.  She might cough a little.  Go slow.
  9. If she will not open her mouth, gently hold her nose until she does.
  10. Do not reward the child for protesting.  In other words, refusing and protesting the first dose should not mean that he never has to take it again.  In the words of Mary Poppins, “Be firm but kind.”

Always keep medicine safely out of the reach of children and never confuse them by calling medication candy.  Apparently this is confusing enough according to recent research presented at the National AAP conference which showed that both kindergartners and teachers had difficulty telling the two apart.

 

Dr. Somsak was born and raised in the heartland. She describes herself as a no frills, practical gal.  She writes regularly at http://www.pensivepediatrician.com

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Doctor, Back Slowly Away From That Sandwich!

Written by John Moore MD

In American health care, the era of the free drug-company sponsored lunch is definitely over. Gifts from companies to physicians and hospitals have essentially vanished. Samples have disappeared from our offices. Corporate-sponsored CME budgets have dried up. Next year, as a part of the Affordable Care Act, companies will be forced to disclose any gifts to physicians that cost more that $10. Physicians who accept those small gifts will be listed on a searchable database. No more sandwiches for us!

I am not an apologist for drug companies by any means. The negative impact they have on health care cannot be ignored. There is a lot of scientific data that support the claim that even small items may influence prescribing practices. Our journals are unfortunately full of bogus scientific studies claiming to “prove” one product is better than another with poor scientific support. We have all heard prepared lectures from paid physician spokespeople which provide no educational value beyond brand recognition for the sponsor. Transparency in any industry is good; patients should be able to know whom their physicians are taking money from.

However, we need to bring some balance back into this discussion. First, the headaches of maintaining such a database for small gifts seem far out of proportion to any benefit that patients can receive. Second, we need to remember that pharmaceutical companies can provide useful information to doctors. I know that it is out-of-style to mention anything positive that can come from talking to the local drug rep, but let’s think about it. I learn from my reps what vaccination strategies have worked in other practices in my area. I learn how disease-specific recall notes have worked for the group across town. I am not naïve enough to believe the slick brochures left on my desk (and in fact I throw most of them directly in the trash), but I do use them as a starting point to my own research.

We also should examine the effects of industry sponsorship on organized continuing medical education in America. While the potential biases are real, the positive impact of pharmaceutical industry money on CME is huge! From the most prestigious national conferences all the way down to local community hospitals, budgets for CME have been slashed, in part due to the lack of industry funding. Fees for participants have increased, and not surprisingly attendance has decreased at live CME events around the country.

The bottom line is that pharmaceutical companies and physicians have a complicated relationship, one that is not inherently good or bad. Like any business relationship, the association between pharmaceutical companies and physicians relies on real people on both sides doing what is right. No amount of oversight can force someone with questionable ethics to follow the rules. No amount of bribery can sway an honest doctor to prescribe a medication not in the best interests of their patients. The vast majority of pediatricians are caring advocates for their patients whose loyalty cannot be purchased by a pen or a sandwich.

 

Dr Moore is a pediatrician in Roanoke, VA. He schedules drug rep visits only one time per week and always ignores lunches, preferring to meet his family instead!

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Does the word “natural” on products mean the product is safe?

Written by Herschel Lessin MD

I am constantly amazed at the power of the word “natural”.  People seem to think that if something is “natural” then it must be completely safe.  If only it were true.  If “natural” means coming from herbal or other sources arising in nature, then most of our prescription drugs (made by the “evil” pharma companies) are “natural”.  “Natural” medicines, sold in “health food” stores, online, and in pharmacies are not without serious side effects ,and are not sold without profits in mind.  The heart drug, digitalis, comes from the foxglove plant.  This was used as a natural herbal remedy for years. If you eat too much of the “natural” Foxglove herb, you are likely to suffer a cardiac arrest, since it is the source of the drug Digitalis.

Just how do these “natural” remedies actually work?  If herbal remedies actually are effective (which a few certainly are), then they must have an active ingredient.  But many people, blinded by the word “natural” (and cursing the word “drug”) think they work without any such ingredient.  Do they work by magic?  Of course not.  Any compound that has effects on the body or brain is a drug, regardless of whether it is “natural”, or created in a lab.

Almost all drugs that exert good effects also exert some bad ones, known as side effects.  When I see people ingest an herbal remedy without any knowledge of how the drug it contains works, I get quite concerned.  They have no idea exactly what drug they are taking. There have no studies to determine proper dosing.  There have been no experiments to discover how the drug works (if it works at all). There have been no efforts to learn about side effects. The person taking such remedies is really taking a leap of faith that these compounds will do no harm.

Even with massive studies, many pharmaceuticals have unexpected side effects when taken by large numbers of people.  So do many herbal products when anyone bothers to take the time to examine them.  For example, the herb Ma Huang, or ephedra, taken by many, is associated with stroke, hypertension and cardiac arrest. St. John’sWort interferes with birth control pills. The list is quite long. What do we really know about these remedies?  When we take one, we are hoping it will work, without knowing how, without knowing the effective dose, and without knowing the side effects.  We are reassured, because it is “natural”.  Why would you give such a drug to your child?

Dr. Lessin has been practicing Pediatrician in the Hudson Valley since 1982. He is a founding partner and serves as both Medical Director and Director of Clinical Research at the Children’s Medical Group