MEDICATIONS: KEEPING ACETAMINOPHEN SAFE AND EFFECTIVE FOR CHILDREN

October 1, 2001 — A new policy statement from the American Academy of Pediatrics (AAP) calls on pediatricians to educate themselves about the diagnosis and treatment of acetaminophen toxicity. Because its safety and effectiveness are widely established, parents and pediatricians alike often use acetaminophen (common brand names include Tylenol™ , Panadol™ and Tempra™ )to treat fevers and other ailments in children. But despite the very low incidence of toxic effects in children, overdose remains a concern.

Symptoms and signs of acetaminophen intoxication can include nausea and vomiting, abdominal pain and liver failure. U.S. regional poison control centers treated more than 10,000 cases — 4 percent of which were children — of acetaminophen overdose in 1997.

The policy notes the risk of developing toxic reactions to acetaminophen appears to be lower in children than in adults. But reactions do occur in pediatric patients — in part because of inappropriate dosing, delay in diagnosis and treatment of overdosage, and failure to recognize children at increased risk for acetaminophen toxicity. Children at risk include those with chronic diseases — especially liver problems — or chronic undernutrition.

Since acetaminophen is an over-the-counter remedy that parents often give to children without direct advice from health care providers, the AAP recommends that pediatricians give specific written information about acetaminophen to parents as part of well-child visits. This information should include:

· Recommended dosage, frequency and formulation (infant, junior, adult-strength) for each child.

· An emphasis on the danger of substituting alternative dosage forms, in particular, adult for pediatric preparations.

· A warning that rectal acetaminophen therapy should be avoided unless specifically ordered by the pediatrician. Rectal administration produces variable drug levels that could mislead caregivers into giving too much or too little of the drug.

· A warning that many over-the-counter cold and cough preparations contain acetaminophen, and the simultaneous use of more than one such product may be dangerous.

· A recommendation that parents inform pharmacists that their child is taking acetaminophen when getting a new prescription.

The AAP also reminds parents that although they may have some anxiety over fever, complete normalization of a child's temperature is often neither necessary, nor possible.

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