Tuesday, December 03, 2013

Parents warned against giving paracetamol and ibuprofen for mild fever

This is a long-overdue warning

A misplaced “fever phobia” in society means parents too frequently use both medicines to bring down even slight temperatures, say a group of American paediatricians, who warn that children can receive accidental overdoses as a result.

As many as half of parents are giving their children the wrong dosage, according to a study carried out by the doctors.

In new guidance, the American Academy of Pediatrics advises that a high temperature is often the body’s way of fighting an infection, and warns parents that to bring it down with drugs could actually lengthen a child’s illness.

Family doctors too readily advise parents to use the medicines, known collectively as “antipyretics”, according to the authors of the guidance.

GPs also often tell parents to give their children alternate doses of paracetamol and ibuprofen – known as combination therapy – believing the risk of side effects to be minimal.

In its official guidance, the National Institute for Health and Clinical Excellence (Nice) says the use of the drugs “should be considered in children with fever who appear distressed or unwell”.

Although Nice says that both drugs should not “routinely” be given to children with a fever, it states that this approach “may be considered” if the child does not respond to being given just one of them.

Children’s paracetamol solutions such as Calpol and ibuprofen solutions such as Nurofen for Children are sold over the counter in chemists. Recommended dosage quantities vary by age.

There is a range of solutions for different age groups, meaning it is possible for parents with children of different ages to mix up which they are giving.

According to the British National Formulary, which GPs consult when prescribing or advising on medication, children should receive no more than four doses of the right amount of paracetamol in a 24-hour period, and no more than four doses of ibuprofen a day.

In its guidance today, however, theAmerican Academy of Pediatrics notes that both medications have potential side effects and says the risks should be taken seriously.

Doctors, the authors write, should begin “by helping parents understand that fever, in and of itself, is not known to endanger a generally healthy child”. “It should be emphasised that fever is not an illness but is, in fact, a physiological mechanism that has beneficial effects in fighting infection.”

Despite this, the academy says, many parents administer paracetamol or ibuprofen even though there is only a minimal fever, or none at all.

“Unfortunately, as many as half of all parents administer incorrect doses,” the authors say. A frequent error is giving children adult-sized doses, while children who are small for their age can also receive doses that are too high even if their parents follow the instructions correctly.

Paracetamol has been linked to asthma, while there have been reports of ibuprofen causing stomach ulcers and bleeding, and leading to kidney problems.

“Questions remain regarding the safety” of combination therapy, say the authors, led by Dr Janice Sullivan, of the University of Louisville Pediatric Pharmacology Research Unit, and Dr Henry Farrar, of the University of Arkansas.

Dr Clare Gerada, the chairman of the Royal College of GPs, said: “In my experience of 20 years as a GP, parents are usually pretty careful.

“I think the most important thing to be worried about is keeping medicines out of the reach of children, because some taste quite nice.”


Miraculous survival of toddler who had to be cooled down before his parents could hold him

A mother whose baby’s life was saved by pioneering ice therapy has told how he was defrosted on Christmas Eve for his first cuddle.

Freddy Cooke did not breathe for 20 minutes after he was born and mother Nicky Symmonds was warned that even if he survived he would be severely brain damaged from lack of oxygen.

But then he was given revolutionary treatment to cool his core body temperature, putting him a state of induced hypothermia, in the hope it would allow his brain to recover.

Nicky, 30, says: 'When they started warming him up again we still didn’t know if it had worked.  'When they finally handed me a warm bundle to hold for the first time it felt like a true Christmas miracle that he had survived.'

The treatment was such a success that Freddy was allowed home on Boxing Day and Nicky says: 'To see your baby cold and shivering goes against all your mothering instincts. You just want to wrap them up and keep them warm, but it saved his life. Words cannot express how grateful we are.'

Freddy is now a perfectly healthy toddler and Nicky and partner Daniel Cooke will mark this Christmas by raising money to help save others.

But rewind to December 20, 2011, and they were sure they had lost him when he was born lifeless at home, just 30 minutes after Nicky went into labour.

She recalls: 'I was five days overdue when the contractions started but as I was a first-time mum I was expecting a very long labour.'  Midwives examined her, then left for labour to progress normally. But minutes later her waters broke and Daniel called them back.

They arrived just in time to deliver the baby’s head, but his shoulder got stuck and the umbilical cord snapped, starving him of oxygen. By the time he was finally born, weighing 9lb 2oz, he had stopped breathing and the medics called an ambulance.

Freddy was rushed to the Royal Berkshire Hospital, near the couple’s home in Reading, while one of the midwives tended to Nicky.

Five minutes later she had a call from the ambulance crew saying Freddy had finally started breathing 20 minutes after his birth.

His only hope was the cooling treatment to reduce swelling in the brain and prevent further damage.

He was put on a ventilator and transferred to Oxford’s John Radcliffe hospital for treatment to begin when he was four hours old.

The couple drove to the hospital, where Nicky was admitted for more treatment. But first she wanted to see her baby.

She says: 'When we saw him he was already on the ice bed. They said it was important for treatment to start within six hours of birth.

'He was wrapped in a cooling blanket which was pumped with freezing water to keep his temperature down to 33°C. 'His little hand was freezing and he was shivering and shuddering with the cold.

'Nurses assured me he couldn’t feel anything because he was sedated but I had to fight the urge to wrap him up and snuggle him.'

The parents kept vigil over the next few days as Christmas loomed. Nicky, a bookshop manager, says: 'It was heartbreaking because I had bought him a little Santa suit and imagined us all at home together for his first Christmas.  'Now all I could do was pray that he would live. I didn’t even think about Christmas.'

After 72 hours it was time to slowly warm Freddy up. Only then could they tell if the treatment had worked.  Daniel, 29, a lettings manager, says: 'We were warned it was a critical time as he might suffer a seizure or relapse. It was terrifying.'

Miraculously as he 'defrosted' over the next 12 hours Freddy started to move his legs and cry — signs that he had not suffered brain damage. Nicky says: 'The doctors could not believe it. He had been deprived of oxygen for 20 minutes. It was unheard of for him to be responding so well.'

Finally, at 4pm on Christmas Eve, the couple were able to hold their baby for the first time.

Nicky says: 'Tears were rolling down my face. He was still covered in wires and tubes but he was warm, his heart was beating.  'After what I had witnessed when he was born it felt like a true Christmas miracle. It was like he had been brought back to life.'

Freddy stayed in the special care baby unit that night but on Christmas Day nurses took him to Nicky and Daniel on the post-natal ward.  They had even dressed him in his red Christmas babygrow. Nicky recalls: 'It was the best present in the world. We were able to spend all Christmas afternoon cuddling him and holding him as a family.'

Now the parents cannot wait for Christmas 2013, as Freddy has finally been given the all-clear.  Nicky says: 'He is a miracle — and the midwives who refused to give up that day are true angels.'

Last year Nicky launched a campaign, Cool To Save A Life, to raise funds for cooling equipment in hospitals.


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