There are many medicines available in stores over-the-counter (OTC) labeled specifically for infants and children. These medicines are advertised to treat minor issues like fever, pain, stomachaches, or allergies and are available for purchase without a prescription. However, just like any other type of medicine, these OTC medicines can be dangerous if taken incorrectly or stored improperly. Always follow the directions on the label and directions from your child’s pediatrician carefully before giving any medicines to your child. And always store all medications out of sight and out of reach of your children, preferably in a locked cabinet or container.

Here are some common types of OTC drugs for infants and children and how to safely use them:

Drug Facts Labels

In the US, the Food and Drug Administration (FDA) requires all OTC medications to have a drug facts label on the container. This label contains important information about the medicine including the type of medicine, what it’s used for, what’s in it, who can use it, and any applicable warnings. It also includes directions on how to take the medicine such as how much to take, how often, and how long it can be taken.

Before using:

1. Check the label – make sure the medicine is safe for your child’s age, as some products cannot be given to infants or young children.
2. Figure out the correct dose – use your child’s weight to ensure you’re giving them the correct dose. If you do not know your child’s weight, most labels have a dosage based on age as well. Always use the provided cup or syringe that was included with the medicine package when measuring liquid medicines.
3. Avoid combination medications – some medicines are advertised to treat multiple symptoms and combine different ingredients. Avoid using these to prevent double-dosing your child with the same ingredients.
4. Ask the pediatrician – always consult your child’s pediatrician before using OTC medications, especially if this is your first time giving that particular medicine to your child. If your child already takes other OTC or prescriptions medications, your pediatrician or pharmacist will let you know if there are any interactions between medications and which are safe to be taken together.

Common OTC Medications

Antihistamines

• Examples: Cetirizine, loratadine, fexofenadine, levocetirizine, diphenhydramine
• Used for: runny nose, itchy eyes, sneezing, itching, hives, or other allergic reactions
• What else to know: some of these products can make you drowsy and can be toxic if taken too much

Aspirin/Other Salicylate Products

• Examples: bismuth subsalicylate, oil of wintergreen, acetylsalicylic acid (ASA)
• Warnings: do not give aspirin or other salicylate-containing products to your child unless expressly told to by your pediatrician. This is because:
  • Salicylates are linked to Reye’s syndrome – a very serious condition in children with illnesses like flu and chickenpox.
  • Salicylates can be toxic if taken too much. The amount in a small bottle of oil of wintergreen can be fatal to young children. Just 1 teaspoon (or 5mL0 of pure oil of wintergreen contains about 6-7 grams of salicylate, which is equivalent to about 20-22 adult-strength (325mg) aspirin tablets.

Other Pain/Fever Medicines

• Examples: acetaminophen/paracetamol, ibuprofen, naproxen
• Used for: fever, headache, body aches, pain from injuries, soreness from a shot, menstrual cramps
• Warnings: use your child’s weight to give the correct dose and always use the included cup or syringe to administer the product.
  • Acetaminophen: use the AAP’s dose table and avoid giving more than 5 doses in 24 hours.
  • Ibuprofen: do not use in children under 6 months unless your doctor says you can.
  • Naproxen: this is only approved for children 12 years or older.

Cough/Cold Medicines

• Age Limit: NOT RECOMMENDED for children under 4 years of age unless advised by your pediatrician. DO NOT USE in children under 2 years of age.
• Examples: dextromethorphan, guaifenesin, brompheniramine, chlorpheniramine, diphenhydramine, phenylephrine, pseudoephedrine
• Used for: claims to help loosen mucus and calm cough. Combination cold medicines may claim to help runny nose, congestion, fever, and pain.
• What else to know: there is not much evidence to support the claim that cough medicines help with mucus. Ask your pediatrician if your child needs this type of medication and which one would be best. Also:
  • Always check the ingredients of the medicine before giving to your child. Many cold medicines mix ingredients into one product, such as antihistamine, decongestant, cough suppressant, and/or fever medicine. Make sure you are not giving your child fever or pain medicines twice.
  • If your child has asthma, do not give anti-cough OTC medications or any medications that contain anti-cough ingredients. This can worsen asthma in some children.

Decongestants (Oral liquid or pills)

• Examples: phenylephrine, pseudoephedrine
• Used for: nasal congestion or stuffy nose
• What else to know: as long as you child can eat and sleep well, there is no need to treat a stuffy nose. Some decongestants can even make your child fussy, nervous, or restless. Some may have other side effects, especially for children with existing heart problems, and may even affect their mood or behavior.

Decongestants (Nose drops or spray)

• Examples: oxymetazoline, phenylephrine, medication-free saline (saltwater) solutions
• Used for: stuffy nose and easier breathing
• Warnings: never use medicated decongestant drops or sprays on a baby. Medicated decongestant drops or sprays are not recommended for children at all unless advised by your pediatrician. These medications have side effects, especially for children with known heart problems, and can even affect their mood or behavior.
• What else to know:
  • If using these drops or sprays with an older child, do not use for more than 2 to 3 days consecutively. They work less the longer you take them and symptoms can return worse than before use (called rebound congestion or rhinitis medicamentosa).
  • Saline nose drops and sprays are the safer option if your child has trouble eating or sleeping due to congestion. Talk to your pediatrician before using saline drops and sprays, and always follow their instructions and/or the instructions on the package, especially for first time use.

Hydrocortisone

• Examples: hydrocortisone 0.5% or 1% cream and ointment
• Used for: insect bites, mild skin rashes, poison ivy, eczema
• Warnings: do not use these products for burns, infections, cuts, or broken skin or in or around the eyes, since hydrocortisone can increase the risk of developing cataracts. Ask your pediatrician how often you can use hydrocortisone on your child’s skin.

Stomach Medicine

• Used for: heartburn, gas, constipation, and diarrhea
• Warnings: always talk to your pediatrician before using these medications
  • Do not give your child stomach medications with salicylates
  • Do not use antidiarrheal medications if your child has infectious diarrhea as it is usually not helpful and can prolong illness.
• What else to know: which medicine to use depends on your child’s symptoms. Many stomach related symptoms go away on their own or can be helped by changing your child’s diet.

When to Call the Pediatrician or 911

Call immediately if your child has these symptoms after taking any medication:

• Trouble breathing
• Vomiting
• Face or mouth swelling
• Rash

Your child can be allergic to a medication, even if it is safe for their age and size. Always let your pediatrician know if you child has side effects from a medication.

More Information

• Using Over-the-Counter Medicines for Your Child
• How to Use Liquid Medicines for Children
• Caring for Kids With Colds & Flu: Simple Remedies to Ease Symptoms

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