Tips from a Mom Pharmacist

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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.

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