Podcast: Busting myths about children’s pain and fever

Parents frequently purchase over-the-counter (OTC) medicines to manage childhood ailments. How can pharmacists help ensure they are administered correctly?

Pain and fever are common experiences in childhood,^1,2 but seeing their child in pain can be highly distressing for parents, particularly if it is their first child.^3,4 As such, parents frequently purchase OTC medicines to help manage childhood ailments;⁵ however, studies show that parents may be struggling to accurately measure and administer these medicines.^6,7 In this CPD-accredited podcast, listen to pharmacist Rebekah Moles tackle some common myths about managing children’s pain and fever alongside a real parent, providing a first-hand perspective on the parent mindset during these occasions and areas that pharmacists have an opportunity to address to optimise acute pain and fever management in children.

Parents often receive a lot of conflicting information about how to manage pain and fever from sources such as friends, other parents, self-help books and the internet.² This can create misconceptions such as attributing certain symptoms like fever and diarrhoea to teething, or considering fever to have dangerous consequences such as brain damage.^3,8,9 These misbeliefs can lead to delays in the diagnosis and management of serious conditions and contribute to inappropriate medication use.^6,7,9 Both undermanagement of pain and fever as well as overuse of OTC medicines can be problematic. Undermanaged pain can impact a child’s quality of life and memories of painful experiences can influence fear of pain and pain-coping behaviours into adulthood.^10,11 On the other hand, overuse of OTC medicines can lead to overdose which can also have serious consequences.^12-15 Given that the pharmacy is the most common place for purchasing children’s medicines,⁵ pharmacists have an excellent platform to address parental misconceptions and encourage appropriate use of children’s medicines.

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Transcript

Rebekah Moles 00:08
Hi, everyone, welcome to the Australian Pharmacist podcast. My name is Rebekah Moles, and I’m Professor of Pharmacy Practice and Research at the Sydney Pharmacy School, the University of Sydney. And I’m joined today by a mum of two Wafaa, who I’ll ask her to introduce herself to you all in a minute. I’d like to acknowledge that today Wafaa and I are meeting on Gadigal land in the mighty Eora nation. And I’d like to acknowledge that everywhere we walk in Australia, we walk on Aboriginal land. This CPD activity is sponsored by Reckitt, and all content is the true accurate and independent opinion of us as the speakers and the views expressed are entirely our own. In the discussion, we’ll be tackling some common myths around managing children’s pain and fever. And when it comes to dealing with kids’ pain and fever, sometimes or most of the time we’re not dealing directly with the patient but in fact, we’re dealing with the caregiver themselves. And of course, for all of those caregivers, it can be quite distressing to see their child, their loved one, in pain. And you know, parents want to do the right thing always. But they receive often a lot of conflicting information about how to manage their child’s pain and fever. And there are sometimes misconceptions. Pharmacy is the place where most commonly they’ll come to visit to get something to help with their child’s pain and fever. And so pharmacists are there and should be able to address these parental misconceptions, and encourage the appropriate use of medicines. So it’s great to actually have a mum with us in the audience today. Wafaa, so maybe I shouldn’t say audience or sorry, on the panel today, Wafaa. So, Wafaa, would you mind introducing yourself?

Wafaa Ezz 02:11
Yes, hello, Rebekah. Hello, everyone. My name is Wafaa. And I’m a mum of two. I’ve got an eight-year-old and a one-year-old. So two very different childhood stages.

Rebekah 02:22
Fantastic. Well, I think your opinions and what you’re doing will be great to share with everyone because, you know, it’s great to hear firsthand from a mum’s experience of what they’re doing. So, experiencing pain is part of growing up, whether it’s bumps and bruises. Today, we’re going to look specifically at tooth eruption, so teething, and we might also touch on fever a little bit later on. So maybe we’ll start with teething. Wafaa, could you describe what it was like when your child or children started teething?

Wafaa 02:59
This is a very timely question for us at the moment because my youngest is currently teething, being one. And I could tell straight away because his temperament was different. It changed. He became more fussy, more irritable, not his usual happy self, less likely to eat. And I was a bit concerned when he wasn’t eating at first. But then I realised that that was because he was teething. So I wasn’t worried anymore. And generally speaking with my first, thinking back to a few years ago, when he was teething, I was generally more concerned when he changed when his temperament changed. But this time around when my youngest is teething, I remembered. Yes, this is because he’s going through the teething stage.

Rebekah 03:57
Yeah, there’s nothing like experience is there? It’s always so it’s a little bit easier with the second or more children. That first one I think, often parents are quite worried, concerned and often unnecessarily but you know, no one knows their child more than a parent. So it’s really always about monitoring that child and their symptoms. In fact, the symptoms that you just sort of described are so common. That gum irritation, sometimes there’s a bit of drooling, they often want to bite down or chew on everything and yes, sometimes there’s a bit of crying, bit of red cheeks, a little bit fussy, off their food. A lot of this teething pain is associated with actual inflammation and we get inflammatory mediators coming up as our gums swell as the tooth is erupting, and of course, that will stimulate our pain receptors. We call them the nociceptors. And so it’s very common that a child is experiencing a small amount of pain, but they all differ. And so watching your child and making sure they’re still eating, drinking and playing, yes, maybe eating a little bit less maybe a little bit grizzly. It’s really about monitoring. As I said, you’ll know, you’ll be the one who knows when there is a problem. From your experience, can you go over some of those symptoms, again, of what you have seen with your kids?

Wafaa 05:29
Yes. So general change of temperament as we mentioned. Sometimes it disrupts their sleep, their sleep patterns, the normal sleep patterns change. They’re more irritable, they’ve got gum pain, they want to chew on things. And I’ve also witnessed the change in their bowel movement, which I attributed to gastro, or could possibly be linked to the teething. It wasn’t clear to me but that was one of the changes that I witnessed in my child while he was teething.

Rebekah 06:05
Yeah. And it’s so interesting that you said that because you know, this time where teething starts. So it often starts anywhere between about four months and of course, goes on for quite a while until we develop all our teeth. And in particular, when it sort of starts around that six months sort of age is also when our children are undergoing a whole load of developmental changes, and lots of things start changing. They’re often starting daycare or becoming a little bit more social. And so sometimes it’s so tricky to associate whether the symptoms they’ve got are teething or there’s something else. So for example, you mentioned, the gastro, so the loose bowels or the diarrhea. And in fact, there’s some common thoughts with parents that, you know, diarrhea and fever, for example, are associated with teething. We actually think that they’re probably more associated just with that stage of development and children getting more infections, if you like, at that stage, but not actually directly linked with the teething. So it’s more about a developmental stage, rather than perhaps the teething itself causing diarrhea or a fever. So they’re more associated with an infection, probably not to do with the teeth. They just happen to coincide often at that time of a child’s development. So you know, I think that’s important too, for parents to understand. That doesn’t dismiss that if a child does have diarrhea, or they’ve got fever that might need to be looked after or sorted. But most importantly, if it’s just the teething on looking at the symptoms of the teething, then we might look at managing that complaint first. So when your baby was teething, or is, your current baby’s teething now, what has prompted you at any stage to intervene? And what have you done to help with bub’s pain?

Wafaa 08:08
As you said, I’ve always said that it’s hard being a baby because they’re going through a lot of changes rapidly, and it’s all new to them. But the first thing I do when I think they’re teething is look at their mouth, feel for any erupting teeth. And then indeed, I know it is the teething that’s causing causing them to be different or to feel upset. With my youngest, I didn’t feel like I needed to do much besides giving him things to bite on – soft, chewy toys. And I’ve also used some teething gel. Of course, it’s hard to tell whether that teething gel has helped him or not, or it’s just the teething that the difficult part of it passing on its own. But I only used it a handful of times, maybe just to make me feel better, that I’m doing something about it.

Rebekah 09:12
Yeah. And I think you know, teething gels are able to be used from four months of age, particularly those that have choline salicylate, but it’s always really important to have a look at the label on what the youngest age is that you can provide some of those teething gels. So for firstline treatment of pain, particularly associated with teething but all pain basically, we’ve got the ibuprofen and we’ve got paracetamol. Ibuprofen is indicated for pain and inflammation, and it’s known to inhibit cyclooxygenase and prostaglandin synthetase. And so it inhibits our inflammatory mediators and therefore it’s a good option when pain has an inflammatory component such as with teething. It can be given to babies over 3 months of age and dosing is every six to eight hours as needed, and doses should be limited to a maximum of 3 in 24 hours, with a dose of 5 to 10 milligram per kilogram.
Paracetamol’s mechanism of action is actually a little bit more unknown. We don’t know enough about it, which is ridiculous because we’ve had it on the market forever. But it is believed to inhibit the central prostaglandins, so doesn’t have as much of that peripheral anti-inflammatory effect, instead exhibiting an analgesic effect. Paracetamol can be given to babies over 1 month of age and dosing is every four to six hours as needed, and no more than 4 doses in 24 hours.
But regardless of the medicine chosen, it’s so important to stick to the dosing instructions, because both of them in excess can be harmful. Regardless of the medicine chosen, whether it’s a gel or whether it’s paracetamol or whether it’s ibuprofen, of course following strict dosing instructions. As a pharmacist, of course, we think that’s super important. But in fact, I think everyone should think that’s super important. I’m wondering if there’s ever a time where you’ve been tempted perhaps to deviate from the dose instructions on the label. So let’s just say it’s your youngest now, and you’ve perhaps used a bit of teething gel, when would you maybe give less or more?

Wafaa 11:34
I would never give more. I always tend to err on the side of caution. So if anything, I would possibly start with a lower dose than the recommended dose for bub’s age and weight. Because I know if I give more it would be an overdose. So if anything I would start off for, for example, if it’s 1 mL, I would give 0.9 mL or just a little bit less. And if they don’t ingest the whole amount, I don’t try to make up for it either, because it’s very hard to measure how much fell out of their mouth or how much they didn’t swallow.

Rebekah 12:16
Yeah. All right, so erring on the side of caution, which, you know, in most cases, you would think that’s a really good thing to do. And, I mean, I do think it is a good thing to do. But it’s tricky, because there’s a bit of a flip side as well. If we underdose them or give less, will we actually reach the therapeutic level that’s required? So in some of my own research with talking with lots of other mums and dads, there are some times I mean, 0.9 mL to 1 mL is very close, so I’m sure that that’s not making a big difference, but I’ve had many parents that will give half the dose and that also has some concerns because if we don’t treat a child’s pain adequately, we’re sort of giving them a medicine for no reason. So it’s a catch-22. On the other hand, I’ve also heard parents say, ‘oh, we’ll look I’ll just give a double dose, it’s over the counter, surely it must be safe,’ which it is absolutely not safe to be giving more than what’s recommended on the label.
So along with using these medicines for teething pain, of course, there’s always non-pharmacological things that can be used as well. In the pharmacy, most of us would be selling perhaps some of those teething rings, and they can be popped in the freezer, like they’ve got a gel in them, and that can be really quite soothing for bub’s gums. But if you know someone doesn’t want to pay money for one of those, they could also get a washer or a flannel, and wet that and put that in the freezer and bub can sort of chew on a cloth as well. So also some gentle massaging of the gums – doesn’t have to be with the teething gel – but just using the finger to use some gentle massaging on the gums. And distraction is always good for children’s pain relief. So anything that keeps them happy, could be some TV, some screen time, but also cuddles, playing with them. All of those things can often help soothe a child in pain.
So we might move on to fever now, which is a very common occurrence in children. In fact, children on average probably experience about three to six febrile illnesses over a year. So often these are, again, an infection that would have caused this fever. And we usually define fever when the body temperature is over 38 degrees, but different textbooks you’ll read will have different numbers, but consensus usually says fever is at about 38 degrees. So Wafaa for you, how would you define fever? And how would you go about, I guess, finding out if your child had a fever?

Wafaa 15:07
So again, with little ones they can’t speak, so the first symptom is them seeming unwell, their temperament changing, they’re not their usual active self. So the first thing that I do is I put my hand on their forehead, the old hand on the forehead, and that’s my first indication. If it feels a little bit warm then I’ll move on to thermometer to check properly. And what we have at home here is a digital ear thermometer. And I like to check both ears just in case one of them wasn’t measured accurately, especially with little ones moving their head. And my threshold is a little bit lower than the standard 38 degrees. So again, I tend to err on the side of caution and would start giving paracetamol and ibuprofen at 37.8. So just a little bit lower. That’s my kind of cut off. And I think also my thermometer readings are a bit lower than standard and every thermometer is different. It’s not a scientifically calibrated thermometer, it’s just a home one. So that’s when I start giving medication at 37.8.

Rebekah 16:26
Okay, so I think let’s just unpack some of that. So the hand on the forehead, I bet you every single parent does it. And as you sort of said, it’s not very scientific, but I was pleased to see that you follow that up with an actual monitoring using a thermometer. I think the other thing that’s so important and you’ve also mentioned it is it’s about the symptoms the child has. So you know sometimes I think as first-time parents constantly sticking a thermometer under their arm. And you know, sometimes if they’re again if they’re eating, drinking, playing, and okay, they might have a little bit of a sniffily nose or whatever. I think if they’re okay with it there’s probably no need to do anything much about it. It’s really about those symptoms. So if you’ve got a child that’s just not their usual self, a little bit grizzly, a little bit snotty, you know, not quite themselves, that’s that sign that you would measure the temperature and by all means you’d stick your hand on their forehead and follow that up with a thermometer measure, you know, the 38, 37.8, 38 – they’re so close to each other. I’m not sure that that matters. And I think it’s about when you get to that stage of wanting to use analgesic agents like ibuprofen or paracetamol, it’s really about making sure that you’re treating the pain that’s associated with the fever. So not the number on the thermometer itself, but actually the child’s symptoms. We all know that when we get a bit sick that we don’t feel great. When we’re spiking a temperature, we don’t feel great, and we want to take some medicine. So it seems you know, absolutely appropriate to give a dose of medicine when your child doesn’t seem to feel like they usually do. You mentioned the thermometer that you use in the ear. Armpit thermometers, the digital ones, they’re pretty cheap from a pharmacy, they’re probably best when your child’s under three months. If your child’s over three months, a digital ear thermometer is fine. And the only reason that it’s a bit tricky if they’re younger than three months is just their ears are so little that the placement of those ear thermometers, so whilst we see them being used by the nurses in the hospital, they’ve probably got specific pediatric ones that they know how to use and they’re well trained on using it. We wouldn’t use a thermometer in a child’s mouth until they’re about five years of age. And I wouldn’t recommend using rectal thermometers at any stage. What are your biggest concerns when your child does have a fever, Wafaa?

Wafaa 19:13
For babies and small children in particular, when they have a fever, the first thing that I worry about is febrile convulsions. And that’s because I witnessed it firsthand with my friend’s baby. And it was a very scary experience. And we all had to rush to take their child to the emergency department. I actually drove them there. And just watching how quickly the child changed and the febrile convulsions episode, I don’t ever want to see it again. That’s something that I always want to try to avoid, when I see that one of my children has a fever.

Rebekah 20:03
And I could imagine how scary that would be to witness that. And yes, it’s interesting because these febrile convulsions will occur in about one in 20 to 30 children. So just less than 5% of children will have a febrile convulsion. The theory is that these convulsions occur when the temperature rises really rapidly. So it goes from being quite normal to that 38 or above very, very quickly and then a convulsion occurs. We don’t have any evidence that we can actually do anything to prevent a febrile convulsion. So while it seems likely that if you dosed the medicine and you’d brought down the temperature, you’d stop the febrile convulsion, we have no evidence for that. Because that temperature raises so quickly, we sort of can’t pick it up in time and we can’t do anything about it. Again, we think that there may be some genetic component to the febrile convulsion. So some children will have them and obviously 95% of children will not. 5% might, and 95% of children will not have them. So, you know, very, very tricky. Some other misconceptions around fever is brain damage. So I’ve heard many parents say, ‘oh, no, I had to treat the fever, I needed to get the temperature down. If the temperature kept going up, that child is going to end up with brain damage’. And basically, that’s not the case. We’re very lucky to be born with internal thermostats, if you like. And our body actually wants to raise the temperature when we have an infection because that’s how we kill the virus or bacteria or whatever pathogen is causing our infection. So it’s a thermostat. We want to raise our body temperature. And then when we lower it with medicine, once that medicine effect wears off, the thermostat goes straight back up there because it’s still trying to fight the infection. So it’s a normal physiological response. And, yeah, the only time we think that temperatures are dangerous, of course, is where temperatures would become over 42. That’s usually associated with a genetic disease, like Kawasaki’s disease or it could be hyperthermia where someone’s left their child in the car in the sun, so those are the times where temperature would raise. It’s not infection related. So, fevers usually are okay. Of course they can occur after immunisations. And most children in Australia need to receive about 15 vaccines between birth and the age of four. Did taking bub to get vaccinations at any stage worry you about fever, Wafaa?

Wafaa 22:51
Yes, actually, one of the things that I have been doing and he’s due for his vaccines now is give some paracetamol before on the day, about half an hour before he gets his immunisation as a prophylactic. And that was recommended by my GP, just before the vaccine, so in case they react and develop a fever.

Rebekah 23:20
Yeah, so look, as I said before, it’s quite common after a vaccine that you might get a little spike in temperature, and in fact, sort of a good thing. It doesn’t sound good, because as a mum, you don’t want your bub to be in pain or have a fever. But in fact, it is a good thing, because it’s showing that our body is hosting an immune response to the vaccine. So it’s actually showing that the vaccine is taking effect and doing what it’s meant to do. So the prophylactic treatment is interesting, because it used to be quite trendy. It was recommended often, to try and avoid that post vaccine spike in temperature. But really now the theory is that we probably shouldn’t use a prophylactic treatment prior to vaccinations, particularly the vaccinations from birth to four years of age where it’s not recommended. But it’s very safe to give a dose after the child has had the vaccine and hosted that response if they’re in any pain or fever. So I think the advice that you’ve received was certainly trendy, probably about 10-15 years ago, maybe a little bit longer ago. But the new evidence is that it’s actually better to allow the immune system to have that response, and to not interfere with the immune response to the vaccines.
There is an exception however for Meningococcal B vaccines, such as Bexsero immunisation, due to a higher risk of fever. The first dose of paracetamol, which should be based on 15 mg per kilogram per dose, is recommended within 30 minutes before receiving the vaccine, or as soon as possible after, and this is regardless of whether the child has a fever. This can be followed by 2 more doses of paracetamol given 6 hours apart, again regardless of whether the child has a fever.

Wafaa 25.12
Thank you for that. That’s really good to know.

Rebekah 25:15
So moving on to when you would use medicines Wafaa? When would you treat your child’s fever? I know you said that 37.8. What are you looking out for and how would you go about doing that?

Wafaa 25:28
I will give some medicine when I can see that bub is uncomfortable, or to help them sleep. So when they’re more irritable, or they can’t have their naps properly, or overnight sleep, I can give them a little bit of paracetamol to start with, to help bring down the temperature but also help them feel more comfortable and sleep better, which would in turn help them get better quicker. I usually start with paracetamol. And if that doesn’t work on its own, then I alternate between paracetamol and ibuprofen if the fever isn’t going down, or if they’re still feeling unwell. And the other thing that I also do to try to bring down their temperature naturally without medication is to dress them more with less clothing. So one less layer than what the temperature is or what they would normally wear during the time of year. And keep them comfortable. Keep the room cool and not turn the heater on if it’s winter to very high. Try to cool down the house by opening windows if it’s not too cold outside, so not rapidly dropping the temperature, the ambient temperature, but just keeping it slightly cooler than normal to help them naturally cool down.

Rebekah 27:02
Cool. Sounds like some good things to do there. So I know we’ll let’s just start with some of that non-pharmacological cooldown methods. So, general rule of thumb, which it sounds like you’re doing is have a look at what you’re wearing, have a look at what bub’s wearing and make sure they’ve got sort of one layer less than you. So you know, if it’s summer, then singlets off. If it’s winter, then instead of jacket and top it’s just top without the jacket. So usually one layer less than you because what we don’t want to do exactly like you said, you don’t want to rapidly decrease their temperature.
I noted that you gave medicines when your child was, you know, perhaps not sleeping. And that seems perfectly reasonable. If your child is irritable, and not sleeping and in a little bit of pain, then giving a medicine it seems absolutely appropriate, just keeping in mind that these medicines do not cause drowsiness. I think a lot of parents think they do and sometimes revert to using these medicines just for sleep behaviour. They are not medicines that are sleeping medicines. I also heard you mention paracetamol being your starting point, but perhaps also sometimes using ibuprofen. And there’s a lot of people who alternate or give these medicines together. But in fact, the guidelines for fever are to use one medicine and stick to that medicine. And some of the reasons for that is of course they’ve got different dosing intervals, so they become really confusing. The other thing is that fever is your natural body’s response to an infection. So actually over treating the infection is not necessary, and we don’t want to hide any alarm symptoms. So you know, as I said, mums know bubs, and mums and dads know their babies the best. And what you want to do is make sure that you’re not sort of hiding any alarm symptoms by constantly dosing them with these medicines, and using two above one is not necessary for fever. Get mums and dads to choose one med and to stick to it and to make sure they know the dosing intervals. Ibuprofen and paracetamol, either of them are a choice for fever if the child’s miserable. Both of these agents have similar efficacy and tolerability. And so the choice really comes down to preference. So if there’s an inflammatory component, an anti-inflammatory might be appropriate. It could come down to the dosing interval. So ibuprofen is convenient in being dosed a little bit less often – six to eight hours between doses. It could come down to flavour – what the child prefers between these agents. Choose one, stick to it, but they both have similar efficacy and tolerability. What about the dosing? You said before I think earlier when we talked about teething or erring on the side of caution. How important do you think baby’s weight and age is when it comes to medicine dosing?

Wafaa 30:18
That’s a very good question. Because on the side of the box, there’s a table and it mentions the age and weight. My baby, for example, is small for his age. He weighs less than the average for his age. So I tend to err, I always use the weight requirement rather than the age dosage because I know that if I use the age, I would be overdosing and giving him too much for his weight. So that’s one of the things that I think might be slightly confusing if a baby or a child weighs less than what’s on the table is to use the age bracket, or sorry, the weight bracket rather than the age requirements..

Rebekah 31:12
Yeah, I think it can be very confusing and also confusing for caregivers who aren’t mum and dad who may not know baby’s weight. And that can be tricky as well. So but weight-based dosing is exactly what we want to do, not ages unless they’re obese or overweight is where we would go with their ideal body weight based on height. And as you said, your bub is a little bit smaller than his perhaps peers. And so it’s so important to go with your bub’s weight, not his age, which is really an important take-home. I guess the other thing that’s tricky with dosing is, you know, how do you actually go about measuring the dose? What devices or help do you use to pour out that medicine, Wafaa?

Wafaa 32:03
I usually use the syringe that comes with the medicine and once I draw out the correct amount, I aim it to the side of their mouth, towards their cheek and push it in really quick before they know what’s happened. And I know that that can cause some of it to fall out. But once I do that, and if I see a little bit fall that I don’t try to compensate for what’s falling out because it’s very hard to measure the amount that’s falling out and if I tried to compensate then that could very much lead to an overdose. So that’s what I tend to do with giving paracetamol or ibuprofen.

Rebekah 32:49
Fantastic. And yeah, I think syringes are ideal. They’re really the most accurate dosing device that we have. It can be a bit tricky because a lot of the products will come with a measuring cup, particularly once they get past those infants or the one-to-five range, and they come with a medicine cup. And whilst the medicine cups, you know, do come with the package, and if you can measure accurately great, but sometimes I just find it so much more accurate with the syringe, particularly if you’ve got like a colour-free liquid and then you’ve got a dosing cup and that the 10 mL, the 11 mL, the 12 mL all so close to each other, that it’s so hard to see. So I think that’s really important. And I love the way that you don’t redose if the child spits it out. We just don’t know how much they’ve taken in. So you’re much better at that stage to wait until it’s time for the next dose. I think that’s very good techniques and processes that you’re using there Wafaa. What about foods? You know, there’s a lot of people that think they must give the medicine in relationship with food, empty stomach or full stomach? Do you have any thoughts there with that, Wafaa?

Wafaa 34:04
I tend to give them medication when it’s needed and just follow the normal eating or feeding schedule or so I don’t actually give it to them with or without food, it just happens naturally. I don’t particularly consider it. So sometimes they might have an empty stomach or sometimes it might be after they’ve eaten, that I don’t do it purposefully, or avoid it purposefully.

Rebekah 34:34
Yeah, that’s fantastic. And, you know, I know so many people out there who say ibuprofen must be given on a full stomach or after or with food. But that’s actually not the case. So it’s much more important that you give it when the child is in pain, and not associated with anything else. And so it doesn’t matter with regard to food. What is more important, of course, is the dosing interval. And they’re different. For paracetamol, four to six hours between doses. For ibuprofen, six to eight hours between doses. So that is way more important, there is no need to worry about regard to food. So again, very good practices, by you Wafaa. I think that really summarises pain and fever management today. It was fantastic to have you with us and you give us your valuable insights. So just think finishing up with some key takeaways. Look, it’s clear that parents need some guidance and some reassurance when it comes to understanding and appropriately managing pain and fever in children, especially since children are not always able to articulate the pain that they have. And they can be really vulnerable also to the harms of these medicines. So either they’re getting underdosed and it’s not working, or they’re getting overdosed and that’s a massive issue with paracetamol and hepatic failure. So liver damage, ibuprofen, dehydration, kidney issues – we just don’t want to overdose these children.
So key areas, we need to make sure we include counselling on as pharmacist is what to expect, when the medicine should or shouldn’t be given, appropriate dosing, how do they measure that dose, weight-based dosing and using a syringe and thinking about food – it’s not necessary to worry about food along with that administration. The recommendation of paracetamol versus ibuprofen should be tailored to the symptoms the child has. If it’s more inflammatory, perhaps you should go with an anti-inflammatory. If it’s just simple pain, then you know, it doesn’t matter on the choice. But it’s not about using them both together or swapping between them, alternating them. It’s choosing one and sticking to it because we know that lots of mistakes are made with dosing so there is no need to make it more complicated. Choose one, give the great advice that goes with that one. And finally, parents need to know if their child is really sick, and they’re worried – lethargic, not eating, not drinking, not playing – that is the time where they need to be referred to a medical practitioner. Thank you for listening, everyone. To earn CPD points from this podcast, go to psa-ph.osky.dev and complete the questions.

References:

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Our speakers

Dr Rebekah Moles (she/her) B.Pharm, DipHosp, Pharm, PhD, GradCertEdStud (Higher Ed) is a pharmacist and Professor at The Sydney Pharmacy School of The University of Sydney. Her research focus is on medicine safety, where she has a particular interest in the paediatric population. She has published a number of papers about the management of common ailments in children including pain and fever management.

Wafaa Ezz (she/her) is a mother of two young children.

CONFLICT OF INTEREST DECLARATIONS:
Dr Moles is director of a company called SetDose that has filed a patent on a medical device to assist caregivers in dosing liquid medicines. This device is not mentioned during the presentation.

Ms Ezz has no conflicts of interest to declare.