Have you noticed that they don't put the dose anymore on the bottle of Tylenol for babies? If you have a child under 2, you're supposed to "ask your doctor".
So if my 18 month old has some pain from teething at midnight, I'm supposed to call the freaking doctor and ask them how much Tylenol to give???
Of course I'm not going to do that. I'm going to look up on the internet how much to give. Of course, there are different kinds of Tylenol, like concentrated or non-concentrated, so I have to stress over whether I got the right one.
Congratulations, Tylenol. You're really saving lives by not printing the freaking dose on the container.
I've noticed this a lot with baby products. Companies are so worried about liability issues that they've gone overboard.ReplyDelete
And it leads to underdosing, so we see a lot of kids in ER with fevers. Plus the fat kids with parents going off ages, and the ones not giving any at all, so we can see how high the fever is. Poor kids.ReplyDelete
So thankful for 24 hour pharmacies around here.ReplyDelete
The pharmacy in my neighborhood wouldn't give me dosing info about the Tylenol for my daughter either. They told me to "ask my doctor." Sooooo.... yeah. They were also pretty useless. Thank goodness for Up To Date.Delete
yeah, uptodate or lexicomp has all pediatric dosing on it. for anyone reading this who is now wondering: tylenol is 15 mg/kg/dose. ibuprofen 10 mg/kg/dose. no ibuprofen under 6 months.Delete
That's all fine and good, but the majority of people giving their kids Tylenol in the middle of the night are not doctors and don't have access to uptodate.Delete
As a pharmacist, I cannot tell you the dose of an OTC product if it is not labeled on the box. So yes, I have had to tell a patient to call their doctor (at 1030pm)because I need to protect both my license and the pharmacy's license.Delete
Patients will wine to me about it, but I am simply covering my butt. Pharmacists get sued, too.
I especially like it when the don't even know their own kid's weight because then I couldn't figure out dose anyway..... "they are 4, so that weight" 4 year olds can range from 30-50#! Big dose difference
I certainly wouldn't blame the pharmacist....Delete
I don't blame the pharmacist either, but that's because I didn't actually expect them to know. I just called because it takes 45 minutes on hold to talk to a live person at my pediatrician's practice, and I had a screaming two month old baby (5 hrs post first shots) on my hands and didn't think I could wait that long. I was hopeful my instinct would be wrong. Oh well.Delete
If they're not going to put the dose on the Tylenol box, then this is definitely something that the pediatrician needs to educate parents about. You're worried about parents doing a bad job at playing doctor on their babies? Then don't leave it to a parent to figure it out on their own at 2AM with a screaming infant on their hands.
OMDG- believe me, the pharmacists know. Why wouldn't you expect them to? Guess who Drs call to get dosing on pretty much everything, including Tylenol - pharmacists! I routinely have to call a Dr office to get an Rx changed because the Tylenol/ibuprofen/antibiotic dosing it too high or too low (yes, I get Rx for tylenol/ibuprofen so that it can be "free" due to Medicaid)Delete
Heck I will even get Rxs that say "pharmacy to dose" and I'm more than happy to, I just need the butt covering provided by that Rx.
Local peds give parents a sheet with the dose to take, but then they call in the evening wondering if they should follow that (duh!) and to clarify the sheet of paper they are holding (you are on the phone, I can't see it!)and if it is right (again, I can't see it, and you won't give me the info I need to check it for you, please bring it in and I will help you find right poduct and even mark syringe for you)
Ok fine, so they know. I still didn't expect them to be able to give me the information I needed, for liability reasons or whatever. Therefore I wasn't disappointed, and didn't "blame" them. It was still an annoying experience.Delete
My ped gave "report card" slips at each visit. Front- height, weight, etc were written in above standard "here's what's normal speech/motor/etc" around this age info. Included reminders like "your child may be pulling up soon- be careful with pot handles" and "read to your child.". Mostly stuff any idiot should figure out but..... On the back- Tylenol and Motrin dosing. THAT I found helpful at 2am a couple times.ReplyDelete
Anonymous, that sounds wonderful. And the Tylenol/Motrin dosing saves him or her calls at 2 a.m.ReplyDelete
They can't list it cause it isn't approved otc for that age.ReplyDelete
As a resident, we get mommy calls at all times of the night when we're on call. And frequently the question is "how much Tylenol/Motrin can I give my kid". So we have to calculate it out for them. I'm kind of glad for that stipulation on the box, though, because people often give Tylenol for non-febrile temps, so I get the opportunity to tell them that no, their kid doesn't need any Tylenol for a 99 degree temp. Also we see tons of folks who want to give it to their 3 week old baby rather than take them in for a sepsis workup, which is scary.ReplyDelete
Yet at the same time, one of my former pediatric practices charged a fee of $20 to talk to use the nurse help line during the night (a practice many on MiM defended).Delete
You seem pretty angry lately. Everythink ok?ReplyDelete
Oh my gosh, thank you for your anonymous concern. I can tell you're truly interested in my well-being by the fact that you left a one-line anonymous comment.Delete
No problem, so everything good?Delete
The first comment made you sound condescending. But this comment just makes you sound like a prick.Delete
The new tylenol dosage makes me SO nervous. I always have to triple check what type of bottle I have and I'm still nervous I just overdosed the kid. I know they switched concentration levels because people were getting confused, but now I'm even MORE confused because I still have some of the older bottles in the house.ReplyDelete
I know! The concentration change is what made it impossible.Delete
as the infant concentration (100 mg/mL) still out there starts to expire/get used up, all we'll have is the children's (160 mg/5 mL). the disadvantage of the new concentration is that it is more dilute so you have to give a larger volume. but the advantage of it is that there will only be one concentration on the market, and it makes the dosing of tylenol and ibuprofen essentially identical. a kid who needs X mL of tylenol will also need X mL of ibuprofen. nice, right?Delete
I know the change in concentration will ultimately be a good thing, but right now it's still at a really confusing point. I'm pretty sure we're out of the old concentration, but I get really paranoid that I'm misreading the bottle/online dosage whenever I'm giving it. And I'm aware of the change and paying REALLY close attention, but I know there have to be parents out there that aren't informed about the change and are probably accidentally giving the new larger dose of the old concentration. The online dosage charts have a lot of warnings on them, but they are still hard to figure out for the average parent.Delete
Peds resident answer: Tylenol recently (within the last year or so) switched formulations. They used to have an "infant" concentration and a normal one. The infant one was 500 mg/tsp and the normal is 160 mg/tsp. Huge difference. Mixing those up could potentially be disastrous. This is something that *we* were in danger of potentially messing up in clinic, so I can understand why a drug manufacturer would be skittish.ReplyDelete
There's a lot of factors in play here that are basic knowledge to a second year nurse/med/pharmacy student but are genuinely confusing to normal people:
-Weight: No way average parents know dosing by kg. And that's *average* parents who could at least google metric-SI conversion. Conservatively, 10% of my patients' parents can't even do that. And no way I'd assume they know their infants' weights. If I'm on phones at night and I'm lucky, they'd just say they don't know. If I'm not, they'll give me a value from 3 months ago, or their birth weight, or a weight in kg that they then say is in pounds.
-Usage: Again, conservatively, 10% of my patients' parents "know" that if the box say give q4, they *really* mean q3 or whenever the baby doesn't look right. Temp of 99? As mentioned above, *plenty* of parents consider that a fever. Heck, I *frequently* have to tell parents that NSAIDs won't help with a cough. And if 15/kg is good then surely 20/kg is even *better*. Not to mention, heaven only knows what we're supposed to do if a baby spits the some of the stuff out. Give half again? All? None?
So yeah, I get why makers of tylenol are evasive about that sort of thing, especially in infants.
I actually was concerned, but I don't have an account with any of the options that allow you to leave a name/blog etc.. Sorry. I won't show anymore concern since its so offensive.ReplyDelete
So what did you think? That I was going to confide my problems to an anonymous person who wrote a seven word comment (one of those words being misspelled)??Delete
If you were *genuinely* concerned, which I highly doubt you really are, you could have at least taken the time to write a respectful email or something, and I would have given you a more respectful reply. The original comment you left was just insulting... I hope you can see that.
I am a different anonymous, but I did not see the original comment as insulting. I would not have sent an email, either...because I do not read email from strangers.Delete
I am relatively new to your blog, but it is good to know that you find concern from your readers to be offensive and insulting.
I just don't see the point of writing an anonymous comment saying "everythink ok?" How am I supposed to respond to that? If everything *wasn't* okay, am I expected to start gushing out my soul to this 7-word anonymous comment?Delete
Obviously not. Which leads me to believe that the person who wrote the comment didn't actually give a shit if I'm okay or not. Which makes the comment a little patronizing.
If you are genuinely concerned about another person, spend more than five seconds writing an anonymous comment to them. At least proofread the damn thing for typos.
I hope that ALL of the pharmacists you work with know the Tylenol peds dose! That's pretty basic. I do know that CVS is worried about litigation and will not allow pharmacists to recommend any cold products to children under 2. I am not a retail pharmacist, but my preceptors would help patients dose Tylenol for peds.ReplyDelete
It isn't because we don't know (that is basic pharmacy 101 stuff) it is because we can't give a dose for an OTC product that isn't listed on the box. I can't even tell an adult it is okay to take more ibuprofen than listed on the box, even though I fill higher dose prescriptions several times daily.Delete
Helpful Hint: Tylenol suppositories have dosing down to 6 months.
That's pretty bizarre. I know the dose (10-15 mg/kg) but is it really too much to put the lower end of the dose on the bottle?ReplyDelete
I think that Dr Cox form Scrubs made the Tylenol problem pretty easy:ReplyDelete