OTC Dosing Guide
(And you thought math class was over!)

First, you MUST know your child's weight at least within a few pounds if she is over 25lbs. and within 1lb. if she is smaller than that. Weight to dose is everything in determining both a safe and effective dose of any med. Infants only gain 1 to 2 lbs per month in the first year so you can usually guess from the last month's visit but better to know exactly in the very young.

Most dosing is "per kilo", not per pound, due to the medical basis of the calculation and medicine's penchant for making things complicated - so get used to dividing your child's weight in half (that's close enough though not exact) to deal with dosing calculations. You might wonder why I don't tell you to follow the package instructions on dosing and that's because it's usually way off in accuracy, partly because they group kids by age, not weight, or the weight guidelines are a huge spread and for "safety" they aim at the lowest weight in the range they offer so that no one will take too much - of course this also means no one will take the right amount and so many will get insufficient medicine to make a beneficial difference - and what's the point of putting this stuff in your child's body in the first place if you're not going to see him feel better for it! In some cases this can even be quite dangerous, for instance when you are trying to control a very high fever and by following the package directions you keep giving too little acetaminophen (the active ingredient in Tylenol) and the fever just keeps on rising! Not smart! Many of us have complained to Tylenol about this but they just tell us we're right but that's our responsibility and they can't change the packaging without major FDA hassle. I for one find this very annoying and irresponsible. While I'm busy bashing let me also tell you to be very aware of the difference in strength between infant's Tylenol drops and children's Tylenol (this is also true of other meds with both infant and children preparations) - YOU CANNOT USE THE CHILDREN'S MED AS IF IT WERE THE INFANT'S, ONLY IN A BIGGER BOTTLE! - you will hurt your child if you do this and yet it happens all the time. The concentrations are totally different so don't stick the dropper you get with infants medicines into the children's bottle and draw up the same amount! If you understand the dosage difference you can of course use any dropper but you will be using a different quantity. Fortunately this error usually results in severe UNDER dosing instead of over dosing but that is still not what you want for your child. Also most instructions on OTC bottles are written for people with superior mega-vision and nothing but peace and time on their hands so know this - all suspensions (vs. Elixirs) MUST be shaken well or you will not be giving a dependable dose of medicine (but you sure may be giving a sugar jolt to Johnny!). Also note that some cold meds look like they are intended for your child's nose (see Pediacare infant drops packaging) when in fact it is meant to be taken by mouth (Pediacare finally put a very tiny warning on the front of the package next to the HUGE picture of a nose that says "for oral use".) Thank you for trying.

OK - to the business end of this "gift".
Tylenol or any acetaminophen product -15mg. per kilogram of weight to get a high fever down. READ the label to know what is in the bottle - typically Tylenol children's liquid form has 160mg per teaspoon of medicine-VITAL NEWSFLASH-one teaspoon means one medical teaspoon not one arbitrary kitchen teaspoon and one teaspoon equals 5cc (or 5ml depending on whether you get a measuring spoon of the British persuasion or the French - no matter - cc = ml). OK, back to Tylenol - Jenny weighs 40 lbs and that means roughly 20 kilos and 15x20=300mg which means Jenny needs almost 2 teaspoons (160 + 160 = 320) in order to get enough medicine. 2 teaspoons equals 10cc for those of you with a calibrated dropper or syringe and for the technical among you, you can exact the amount by giving 9cc instead of 10). Get it? 40lbs needs almost 2 tsp (I believe the box says 1 to 1&1/2 tsp for this weight - wrong!)

TYLENOL - 15mg/kg for high fever (12mg/kg for low grade fever but I don't use anything for low grade fevers anyway so I just ignore this). May be repeated as needed every 4 hours.

IBUPROFEN (Advil or Motrin) for Children - usually comes as 100mg per tsp. (Always check the label for the strength) - give 10mg per kilogram for high fever or pain due to inflammation (injury, teething, etc) and this can also be repeated as often as every 4 hours if needed although it usually lasts longer than Tylenol so you may not need to use it as often. I like this drug a lot.

BENADRYL (diphenhydramine) - usually used for allergic reactions or cold symptoms without worrying about agitating like ephedrine will do - sometimes misguidedly used to get the kid to sleep on the plane - it never works! Comes as 12.5 mg per tsp. Dose - 1mg per kilogram of weight so give your 25 pounder one tsp.

SUDAFED (pseudoephedrine) - used for congestion and colds but you should always be sure your child is well hydrated before using this or you can make symptoms worse - also know this tends to agitate so skip it at bedtime if your child tends to be high strung to start with. Comes as 15 mg per tsp. Dose is 1 mg per kilogram of weight so give your 60 pounder 2 tsp. 2 or 3 times per day (a day is 24 hours parents, so don't overuse this stuff).

IMODIUM ( loperamide HCl) - for diarrhea (check first with your doc if it's OK to use this in your child's particular situation) This one is easier - 1/2 tsp. for under 25 lbs. and 1 tsp. for 25-50 lbs and 2 tsp over 50 lbs and you may repeat this after each loose stool to a maximum of 6 doses in 24 hours. If it hasn't controlled things by then it isn't going to and you better consult your pediatrician again.

These are of course only some of the various OTC meds out there but they are the most common ones you call me about. Some of you are probably thinking "This is too complicated. Why don't I just call the pediatrician and she'll do all the figuring." You can, but just know, pediatricians like to sleep through the night sometimes too! Good luck and stay healthy - and if you must, use OTC meds in the correct dosage or not at all!

Happy calculating!
drpaula