While it’s wonderful to have access to medicine that can relieve illness (not to mention lifesaving drugs), are we aware enough of the side effects that drugs can have on some children? We investigate the most frequently administered childhood meds – plus the effects you weren’t hoping for.

ANALGESICS AND ANTIPYRETICS

These very common drugs are used to relieve pain and bring down a fever. Most children’s pain meds contain mostly or exclusively paracetamol (AKA acetaminophen), in familiar brand names such as Panadol, Calpol, Disprol, Hedex, Medinol, and Empaped. Paracetamol inhibits the production of pain and inflammation-causing prostaglandins in the brain. It has no known side effects at regular doses but paracetamol is very dangerous in overdose (so always obey dosage instructions).

Some paracetamol-based children’s painkillers have codeine (as well as antihistamines) added to them (Stopayne and Stilpane). Codeine binds to opioid receptors in the brain and changes your perception of and attitude to pain. It also inhibits the cough reflex so it’s sometimes used at night for better sleep in a coughing child. “We gave our 18-month-old son Stopayne on the plane so we could fly in peace. He bounced all over the plane,” recalls mom Tania Roux – one of many parents with a Stopayne story. Bear in mind that hyperactivity related to drugs may be the active ingredients (like the antihistamine promethazine that is found in Stopayne), but equally it could be a reaction to the colorants or preservatives in the liquid, such as the big culprit sodium benzoate. Often sugar is blamed for behavioral changes when kids have eaten sweets, where the real baddie was the additives.

The other big group of analgesics is made up of nonsteroidal anti-inflammatory drugs (or NSAIDS). This umbrella term covers ibuprofen, diclofenac and mefenamic acid (Nurofen, Voltaren, Ponstan). NSAIDS affect prostaglandin production not only in the brain, as is the case with paracetamol, but all over the body. If the prostaglandins protecting the stomach lining have been affected, then NSAIDS can cause gastrointestinal distress, so a sore tummy is a known side effect. (While aspirin is also an NSAID, it is not listed here as it is unsafe for children. Never give aspirin to a child as it is linked to the dangerous Reye’s Syndrome.)

ANTIHISTAMINES

As the name suggests, these drugs act against histamine in the body in a variety of genius ways. Histamines are the bad guys who cause allergic reactions in your body, such as runny nose and eyes, itching, sneezing, inflammation, rashes, swelling, and so on.

Antihistamines come in syrups, or in topical form as eye drops or nasal sprays. So-called first-generation antihistamines (such as Allergex) are known to have sedating effects, and can also cause a dry mouth or sore stomach. Many parents have also learned to their detriment that they can affect their child’s mood. Known as lipophilic antihistamines, they cross the blood-brain barrier easily and can cause drowsiness and personality changes.

Phenergan and Vallergan are two examples of these older drugs, and they are the biggest culprit when it comes to turning Gandhi into Gaddafi in your house. Vallergan is used as a sedative before medical procedures or during long travel trips – but it can have the reverse effect! It can also leave kids groggy and hungover. So try it out before your big trip, and use the lowest dose possible.

Second-generation antihistamines have fewer side effects, but some children are still susceptible. Antihistamines can make certain kids grumpy and aggressive, and though less likely, some children show similar side effects even on the more modern nonsedating antihistamines, from twitching to restless legs and behavioral changes.

STEROIDS

The word probably makes you think of “anabolic steroids” – the things that build muscle and are banned in sports, and which are given to a mother to mature her fetus’ lungs if it has to be delivered early. But it’s corticosteroids that we are talking about here, such as cortisone and prednisone. These reduce inflammation and suppress the immune system, and so they are good treatments for asthma, eczema, and allergies. Steroid meds come as a topical application (eczema cream, asthma pump) or syrup.

So what about the side effects? “Cortisone (Aspelone) has made my son grumpy,” reports one parent. “It is usually at the third or fourth dose that he gets so grumpy, and it lasts all day.”

Steroids can affect behavior, appetite, and sleep. The higher the dose, the more likely it is to have an impact. So a hungry, ratty, slightly obnoxious child on steroids is probably showing drug-related behavior and should settle shortly after the treatment is completed.

LTRAS

Asthma is a battle fought on many fronts, and a drug called montelukast, a leukotriene receptor antagonist (LTRA), sold under trade names Singulair, Monte-air or Kulair, is the latest weapon for long-term treatment.

BRON­CHODILA­TORS

With 90 percent of patients having no side effects, but in a ‘select’ few it changes their personalities and/or gives them a very sore tummy – and cannot be used! These medicines make breathing easier by relaxing the muscles in the lungs and widening the airways. Long acting bronchodilators are used in conjunction with corticosteroids to treat asthma. They are usually nasal sprays or inhalers. But are their side effects worth it? “My daughter had her dose of asthma pump Foxair increased to four doses a day,” recalls a mother of a three-year-old. “She changed visibly into a moody pain. I decided to stop the pump, overnight her personality changed back to placid with a chance of tantrums. Foxair contains a low dose of inhaled steroid, which is unlikely to have any major systemic effects, but the b-2 agonist salmeterol it contains, like all the bronchodilators in high doses, can make kids shaky, anxious, feel as if their heart is racing, and make them cranky and jittery.

PSEUDOEPHEDRINE

Pseudoephedrine, and the less common phenylephrine, are both vasoconstrictors – they make the blood vessels in the nose smaller and reduce swelling so that less snot is able to be produced there. Decongestants are great when you need them, but they are known to have side effects including dizziness, anxiety, sleeplessness, and headaches. Saline solution is a great nasal washout as a first defense. But often a topical anticongestant like oxymetolazone (Iliadin, Drixine, or Otrivin) and/or a systemic decongestant containing pseudoephedrine or antihistamine, such as Demazin, Coryx, or Rinex, does help with sleep at night. Before giving your child any medicines, even over-the-counter ones, it is important to know the active ingredients in them so that you don’t accidentally give your child two different brands of drugs containing the same ingredient and accidentally overdose him or her. Follow your doctor’s advice for administering drugs strictly – and if you notice what you think is a side effect of the medication, go and chat with your doctor. You might just be surprised.

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