Home Medication Guide for Pediatric Respiratory Tract Infections

Respiratory tract infections in children have become more common recently. Young parents have to take care of sick children at home in addition to diet and daily care. Parents often fail to read prescriptions or instructions carefully before giving medicine to their children, resulting in wrong dosages, children taking medicine as candy, and parents often increase or decrease medication or stop taking medication on their own because they are anxious to treat the disease or the children are unwilling to take the medicine.

In order to improve the management of home medication for children's respiratory infections and enhance the health literacy of family members about medication, the Chinese Medical Association recently wrote the "Expert Consensus on Home Medication Guidance for Children's Respiratory Infections". Let the pharmacist interpret it for you!

1. Basic principles of medication for children's respiratory tract infections

Right patient, right drug, right dose, right time, right route of administration.

Correct patient: Before taking the medicine, you need to check whether it is suitable for your condition. For families with multiple children, you also need to check the identity of the children to avoid mixing up the medicines.

Correct medicine: You need to check the name of the medicine before taking it, and pay special attention to medicines with similar packaging or similar pronunciations.

Correct dosage: Read the prescription or instructions carefully before taking the medicine, and do not increase or decrease the dosage on your own.

Correct dosing time: Take the medicine strictly according to the prescription or instructions (do not deviate from the required dosing time by more than 0.5 hours), which can improve the efficacy of the drug while reducing the occurrence of adverse reactions.

Correct route of administration: oral, chewable, topical, etc. must be distinguished to ensure that the drug acts on the human body in the correct way and exerts the best efficacy.

2. What precautions should be taken when using antibiotics for respiratory tract infections in children?

(1) Antimicrobial drugs are prescription drugs. Parents should not use them on their own if the doctor believes that the child does not need them. Otherwise, not only will it have no effect on the child's disease, but it will also increase the burden on the child's liver and kidneys, which is not worth the cost.

(2) If the child has a history of drug allergy, parents must inform the attending physician.

(3) After the doctor prescribes antibiotics, please take them according to the doctor's instructions. Do not miss a dose or stop taking them at will. Failure to take antibiotics according to the course of treatment can easily lead to the emergence of drug-resistant bacteria and increase the difficulty of disease treatment.

(4) If children experience rash, nausea, vomiting, or other discomfort during medication, they should seek medical attention promptly to assess whether it is an adverse drug reaction.

(5) Antimicrobial treatment should follow the principle of individualization, and antibiotics prescribed by doctors for children should not be recommended to other children.

3. What precautions should be taken when using oseltamivir?

(1) Use within 48 hours of the first onset of influenza A or B symptoms. The earlier the better. Treatment after 48 hours also has certain clinical benefits.

(2) In an emergency situation where oseltamivir granules are not available, if children cannot swallow capsules, they can be opened and prepared into an oral suspension. A small amount (up to one teaspoon) of sweetened food, such as chocolate syrup, brown sugar water, etc., can be added to mask the bitter taste. After the mixture is prepared, it should be taken immediately according to the corresponding dosage.

(3) Taking the drug with meals may reduce gastrointestinal reactions in some patients. If the child vomits severely after taking the drug, it is recommended to consult a physician to change to other drugs.

(4) Live attenuated influenza vaccine should not be administered within 48 hours after taking oseltamivir. In principle, oseltamivir should not be administered within 2 weeks after taking live attenuated influenza vaccine. However, oseltamivir can be used for treatment if influenza virus infection occurs. Inactivated influenza vaccine can be administered at any time while taking oseltamivir.

4. What should I do if the child still has a fever after taking antipyretic and analgesic drugs?

(1) Check whether the drug use process is correct, including whether the drug is within the validity period, whether the suspension is shaken before use, and whether the dosage is accurate.

(2) Appropriate physical cooling methods can be used in combination, such as fever-reducing patches, warm water compresses, and warm water baths.

(3) After the disease is relieved, the child's body temperature will gradually drop. If the condition worsens, it is necessary to seek medical attention in time to adjust the treatment plan. Parents should not increase the frequency or dosage of antipyretic analgesics beyond the instructions due to anxiety to prevent overdose of drugs from causing harm to the child. During the fever period, the appetite decreases and the oral intake decreases. In the fever state, water and electrolytes are easily lost, and the consumption of sugar, fat, protein and various vitamins increases. Attention should be paid to balanced nutrition, drinking more warm water appropriately, and increasing the intake of vitamins and trace elements appropriately.

5. What precautions should be taken when using dextromethorphan?

(1) Dextromethorphan is a centrally acting antitussive drug. The therapeutic dose will not produce analgesic effects or cause respiratory depression. This drug is a prescription drug and needs to be used under the guidance of a physician. Avoid using it in children with sputum to prevent sputum from blocking the airway.

(2) Long-term excessive use can cause addiction and dependence. There is abuse among adolescents, and caregivers should be vigilant about children's long-term medication behavior.

(3) Selective serotonin reuptake inhibitors (such as fluoxetine, sertraline), tricyclic antidepressants (such as amitriptyline), monoamine oxidase inhibitors (such as isocarboxazid), pethidine, lithium, clonazepam and the dietary supplement tryptophan can interact with dextromethorphan and cause serotonin syndrome. Dextromethorphan should not be used within 2 weeks of discontinuation of monoamine oxidase inhibitors. Dextromethorphan should not be used in children with a history of mental illness.

6. What precautions should be taken when using expectorants in children?

Before using expectorants, it is advisable to find out the cause of expectoration and choose the right medicine according to the properties of the expectorant. The duration of treatment should be determined according to the degree of improvement of symptoms. Depending on the mechanism of action, one of the two can usually be used. After using expectorants, the child's back should be patted to expel expectorant.

Children with rare hereditary fructose intolerance should not take oral ambroxol containing sorbitol. Children with asthma are prohibited from taking acetylcysteine ​​orally, and nebulized acetylcysteine ​​should be used with caution. The aqueous solution of acetylcysteine ​​has the smell of rotten eggs and may cause nausea, vomiting, runny nose, gastritis, etc. When using acetylcysteine, the child's condition should be carefully observed, and the drug should be discontinued in time if the above adverse reactions occur.

Acetylcysteine ​​can reduce the efficacy of some antibiotics, such as penicillin, cephalosporin, erythromycin, etc., and should be avoided from mixing or taking with antibiotics. If oral use is necessary, an interval of at least 2 hours should be maintained.

7. What precautions should be taken when using nebulization at home when children have respiratory infections?

Home nebulization can save parents time and transportation costs, avoid cross-infection in hospitals, and make up for insufficient hospital resources. Families with nebulizers should perform nebulization inhalation treatment for their children according to the doctor's prescription and follow the doctor's instructions. The following matters should be noted during home nebulization treatment.

(1) Nebulized drugs do not contain antibacterial agents and cannot be stored in the nebulizer for a long time. They must be used immediately after opening. The appropriate amount for each nebulization is 3-4 ml. A large volume will cause the nebulization time to be too long, affecting children's compliance.

(2) If the physician prescribes multiple nebulized drugs at the same time, please pay attention to whether the different nebulized drugs can be mixed. Please refer to Table 1.

(3) Avoid excessive eating 30 minutes before nebulization treatment, and do not apply oily facial creams before using hormone drugs.

(4) Children should receive nebulizer inhalation treatment in a quiet state, preferably in a sitting position. For those who cannot sit, their heads should be raised and at an angle of 30° to their chests. Infants and young children can sit in a semi-recumbent position.

(5) After the atomization is finished, clean the face immediately to remove the medicine attached to the face. Rinse the mouth with clean water 3 times or more immediately and spit out the mouthwash. For infants who cannot rinse their mouths, use a cotton swab to wipe the mouth for care.

8. What should you pay attention to when using Chinese patent medicine for children’s respiratory tract infections?

(1) Chinese patent medicines need to be used rationally through syndrome differentiation, disease differentiation, or a combination of syndrome differentiation and disease differentiation, so parents are advised to consult a physician before using them.

(2) Read the drug instructions carefully to understand the drug ingredients, avoid choosing Chinese patent medicines with greater adverse reactions, avoid using Chinese patent medicines with the same function or duplicate ingredients together, and avoid inappropriate compatibility.

(3) Give priority to medicines specifically for children, such as those with words such as "children", "children", or "baby" in their names. It is recommended not to use Chinese patent medicines that do not have clear usage and dosage for children.

9. How should children be given medicine and what precautions should be taken?

(1) When feeding children medicine, special attention should be paid to their emotions and comfort, and a safe, warm, and comfortable environment and method should be provided as much as possible. Some professional medicine feeding aids (Figure 3) can be used to increase children's compliance with medication and ensure accurate medication. It is recommended to use medicines with measuring cups or droppers with subdivided scales.

(2) For uncooperative infants and young children, do not pinch their noses to force medicine in, and do not feed medicine when they are crying or laughing. It is best to hold the child in an adult's arms in a semi-recumbent position when feeding medicine, and do not lie flat to avoid choking. Pinch the chin to open the mouth, and use a dropper or syringe to feed the medicine to the inside of the cheek, so that the medicine flows down the cheek and is swallowed. Give a small amount each time, and continue to give the medicine after the child has swallowed it. If choking occurs, stop feeding the medicine immediately.

(3) For children over one year old, you can cater to their preferences, prepare some rewards or give them appropriate education to encourage them to take medicine.

(4) After taking the medicine, the child can be allowed to sit up and patted on the back or lie on his side and observed for 10-15 minutes to prevent the child from aspirating after vomiting.

10. Can commonly used medicines for children’s respiratory infections be taken with juice or milk?

(1) Read the drug instructions carefully before taking the medicine to understand whether the absorption of the drug is affected by food. Generally, if it can be taken with juice or milk, there will be corresponding instructions in the drug instructions.

(2) If the drug instructions do not specify, it is best to take the drug with boiled water at an appropriate temperature.

(3) If a child has difficulty taking medication and needs to use juice or milk to assist in taking the medication, he or she should first consult a doctor, pharmacist or other professional to obtain the correct method and advice.

11. How to store medicines at home?

(1) The drug should be stored in accordance with the specific requirements under the "Storage" section of the drug instructions, in a cold place (usually 2-10℃ or 2-8℃), in a cool place (not exceeding 20℃), in a dark place (not exceeding 20℃ and away from light), or at room temperature (10-30℃).

(2) Pay attention to the classification and storage of medicines. Store oral medicines separately from external medicines, children's medicines separately from adult medicines, and separate them from food, beverages, cosmetics, etc.

(3) Keep the medicine out of the reach of children. After using the medicine, tighten the bottle cap and restore the child-proof cover to the safe state.

(4) Provide children with safety education and cultivate their awareness that they should not take or play with medicines at will.

(5) Check the expiration date and quality of medicines regularly. If medicines are expired or have changed in properties, they should be cleaned up and replaced in time.

There is a lot of knowledge about family medicine. Parents should pay twice as much patience and energy for their children's health. If you encounter any confusion, you must seek help from doctors and pharmacists. We will work with you to fight diseases and protect your children's health.

References:

Expert consensus on home medication guidance for children with respiratory tract infections