Thursday, April 12, 2012

Tips from a Mom Pharmacist

This post may contain affiliate links.
Manon malade
photo credit: SpigooCreative Commons License
by Bethany Lynch

I love Babywise, and we have followed the principles with two children. I absolutely love being a mother, but I also have an occupation outside of our home. My job is a neonatal intensive care unit (NICU) clinical pharmacist. Basically, I round with the neonatologists and follow all of the medications very closely in those babies. I have done this for almost 7 years and love it! Without a doubt, one of the hardest challenges for me still is what to do when my children are sick. Do we stay on schedule? Do I hold them for hours? What should I give them? When should I give it? It's a lot harder when it is my own kids and I can't think as objectively, LOL!
I By no means do I have the answer to all of those questions, but I can give you some suggestions on what to use first for some common illnesses. Here are my top 5:
  1. Congestion. Most of the over-the-counter (OTC) products have been recently revised. Very few are recommended for use under age 2-6 years old. The reason for this is two-fold: overdoses and ineffectiveness. The very best treatment is usually saline drops. Many times, suctioning can actually make the congestion or stuffiness worse so 2-4 times a day is probably the maximum recommended amount of suctioning. Humidifiers are good and often helpful, but I would recommend spending the money to really get a good one that is also easy to clean. The harm in humidifiers is not cleaning it enough (as often as every 2-3 days) and growing water-loving bacteria...actually worsening respiratory infections.
  2. Reflux. This is probably a whole post in and of itself. Reflux looks different for lots of babies. The most common signs are crying with feeding (associated with acid burning), overfeeding (associated especially with breastmilk soothing the burning), slow growth, cough, congestion, wet burps, hiccups, and frequent wakings. Not all reflux needs medication. In fact, some literature suggests that increasing the pH of the infant's stomach for increased periods of time can actually be harmful. Spitting up is not always a sign, because silent reflux can be even more harmful if untreated (baby swallows acid back down, burning on the way up and on the way back down). I do believe there is a place for medication especially when baby is not feeding or growing well. Most insurance companies require that ranitidine (Zantac) be tried first. It is a histamine-2 (H2) blocker. It often needs to be weight-adjusted as the baby grows, and babies can develop tolerance in days up to months later. The next step is usually a proton pump inhibitor (PPI). These are quite effective, but more costly, take longer to work, and have different side effects. Babies, especially with dairy intolerance or other allergies, often have a hard time with some of the inactive ingredients of certain formulations. Most formulations need to be given 30 minutes before feeding, which is difficult at times with Babywise but doable. Know that they also need to be weight-adjusted as baby grows. They make the "spit-up" less acidic, but they will not keep babies from spitting up.
  3. Fever. This is tricky. Often I err on the side of "feed a cold, starve a fever." I think that fevers have a use in killing bacteria and viruses, but as a mom, there are times when it didn't matter if my child had a temperature of 99.9 or 102...they were uncomfortable and needed relief. Acetaminophen (Tylenol) is a great fever reducer, but it does not have much value for pain (even mild pain in my opinion). Ibuprofen (Motrin/Advil) is much, much better for pain and fever. Sometimes it is hard to distinguish whether the fever is associated with pain. If uncertain, I usually give ibuprofen. If my kids are still uncomfortable from the fever, I give acetaminophen usually 3 hours later. If the fever is more sudden and not associated with pain, I usually start with acetaminophen. These medications have 2 very different mechanisms, so in correct dosages, it is usually okay to alternate the two every 3 hours until you see relief. Ibuprofen needs to be given every 6 hours, but acetaminophen can be given as often as every 4 hours. Make sure that you read the label to give the appropriate dose as your child grows and gains weight. I prefer dye-free brands because they have less dye (duh!) and often another sugar source other than corn syrup.
  4. Antibiotics. The golden rule with antibiotics is to finish the entire course. I think doctors are really good at emphasizing it, but it is very tempting to wean them off or "save" some for later once your child bounces back. The problem is that not all of the bacteria may have been killed so they learn how to build back up stronger, better, and more resistant. Don't be too upset if your doctor does not prescribe antibiotics right away. Many childhood illnesses are viral and typically 5 days duration (range 3-7 days). Too many antibiotic courses can also build super bugs that end up requiring broad-spectrum antibiotics. Another problem with antibiotics is that they kill the good bacteria too (especially in the gut) so I am a huge proponent of probiotics to reestablish good gut flora. That being said, antibiotics are amazing drugs. In a true bacterial infection with the right antibiotic choice, you can expect your child to be feeling better in as little as 24 hours.
  5. Vitamins. I believe the best medicine is avoiding medicine. Start off with a healthy immune system. There is abundant evidence that most of the nation is deficient in Vitamin D. I believe that most children and adults benefit from a good quality multivitamin, but I think the evidence for vitamin D supplementation is overwhelming. In my own family, I saw a drastic reduction in colds this past winter after supplementing with vitamin D drops several months prior. I prefer vitamin D3 drops in coconut oil for the best absorption. Literature suggests that even breastfed babies are deficient so the vitamin D drops are perfect for dropping on your breast right before nursing. My favorite multivitamins are from "whole food" sources without added sugar or artificial flavoring.
One of the best things about using Babywise principles is that my kids seemed to be able to rebound from illness and getting off schedule very quickly. It is still hard to know how much to modify but hopefully this takes a little bit of the guess work out of where to start with some of the most common illnesses and medications. Makes sure to get in extra cuddles and snuggles no matter what you decide!

Bethany blogs at TheGracefulMom.com

All material on this website is provided for your information only and may not be construed as medical advice or
instruction. No action or inaction should be taken based solely on the contents of this information; instead, readers should consult appropriate health professionals on any matter relating to their health and well-being.

20 comments:

Michael and Natalie said...

This was an EXCELLENT post! We just (hopefully) finished about a month of pretty rough illnesses with both our kids and I searched and searched for precisely the information you shared here!!! Thank you, thank you, thank you!!!

dani said...

thanks! I didn't even realize there was dye-free acetaminophen, I will look it up right now!

Sunshine stitches said...

I too am a pharmacist and mother of 2 babywise kids. Although I work with only adults (in a VA) in an emergency room. I really enjoyed your post. I appreciate the information regarding the vitamin D supplementation. I have read about possible antiviral activity so when my kids show any sign of illness I give them high dose vitamin D for 3 days and I have had great success. Based on you information, I may just start supplementing daily. Great to find another working mom that has found success with Baby Wise! Thanks for the great information!

Sarah said...

Thank you! Thank you! Wonderful information here.

liz22 said...

Thank you! What vitamins do you give your kids? I use Nutrilite -- they are made from organic, plant based material. Love them but am just curious what else is out there. Thanks!

Leigh Anne said...

I'm a pharmacist too, and I agree with all of your recommendations. I see overuse of antibiotics soooo much at my retail position. I have 3 littles (5yo, 3yo and 1yo) and have only taken the oldest 2 kids to the doctor once for sickness and never for the baby. Most often, good nutrition, symptom treatment (like you referred to, and some patience is all you need.

Bethany said...

Michael and Natalie--Thank you so much! I am very grateful that it was helpful. Hoping everyone stays well!!

Bethany said...

Dani--I usually get Target brand just because that's usually where I get household items. I think there are probably drugstore brands. Just double check the ingredients and look for the sugar source to be towards the end of the ingredients. Tylenol brand recalled some of their products so not sure if dye-free might have been one of them. Maybe Leigh Anne knows :)

Bethany said...

Sunshine stitches--THANKS! I think Vitamin D is another wonder drug. It honestly made a HUGE difference between last winter and this winter, and the only times my kids have gotten even a mild cold this year has been when I slacked off on giving it. So I do think there is something to be said for getting your levels up if you are deficient but I also think there is benefit in extra supplementation during illness.

Babywise is one of my saving graces as a working mom :) I seriously don't think I could work without the structure it provided.

Bethany said...

Sarah-Thanks!!! So glad it was helpful.

liz22--I use Nature's Plus Animal Parade. I've also used Rainbow Lite Nutristars but the last time I used Rainbow Lite my kids both had a weird reaction to them. I'm going to look into Nutrilite. They sound good!

Bethany said...

Hi, Leigh Anne!
Thank you for your input!! I think I can count on one hand the antibiotic courses for both kids (4 and 2). So grateful for their health!

Michael and Yvonne said...

Really interested in the vitamin D drops. What kind of vitamin D drops and does the dose vary? I have a 5, 3.5 and 5 month old. I have been tired this past winter with so many colds!! I thought it was because DD1 started preschool and was exposed to much but it's been every month! SO i'm all for how to avoid sickness the natural way. Beleive it or not they take 1 tsp emulsified orange cod liver oil daily...i started then when around age 3 and 1.5ish as i was tired of colds that winter....seemed to help but now this past winter. Thanks so much!

Bethany said...

My very favorite is Carlson vitamin D drops. It is vitamin D3 (the more active form) and the only other ingredient is coconut oil. The best part is that the dose is literally one drop. A bottle lasts forever. I usually give them the Baby D Drops (400 units). The adult is 2000 units. Sometimes I give them 2 drops to prevent illness. There are differences in opinions about the dose, but the AAP and CDC recommends 400 units for all infants and children.

Go Long! Go Green! said...

Awesome blog post! I, too, am a pharmacist and mom that tries my best to follow babywise! Great advice in terms people can follow. We use carlson vit d drops too! LOVE THEM!! I usually give my 3 yr old 2000/day! Her vit d levels are right on target!

Bethany said...

Wow, Val! You attract a lot of pharmacists :))

Go Long! Go Green!--very interesting about using the 2000 units/day. I have not had our levels tested but would like to do that. I know there is a lot of opinion about the "right" dose, and I think the evidence for higher doses is definitely increasing. Time to reorder our D drops :)

leelynch said...

Just wanted to leave an update from Baby Ddrops: "it is now only distributed by the manufacturer, Ddrops Company. Same natural product, preservative-free, dye-free, sugar-free, coconut oil, etc... except that it is now simply called Baby Ddrops. It is no longer available by the retailer that was mentioned in the article."

Bethany said...

Ha ha! Apparently my husband has a blogger account and was logged in first :) The above comment was from Bethany.

Marcella said...

Valerie, thank you for posting these information. In my working moms support group nyc, we don't have a member who's in the field of health. Most of the time, we only share practical things relating to health problems of our children.

Stew said...

Oh congratulations to you! You must be the happiest mom ever! Make sure you supplement yourself with vitamins to make your bonding time for meaningful. I've only used this one called biosil, which some friend recommended and so far so good, that's all I can say. Cheers!

Xander Lawson said...

Keeping a baby healthy is quite the adventure. It really helps to read through tips like this from experienced moms.

canadian vitamins

LinkWithin

Related Posts with Thumbnails