When a child develops fever or cough, parents often reach for a medicine that worked during an earlier illness. However, a team of researchers have warned that this seemingly harmless habit can sometimes lead to wrong treatment, incorrect dosing or delayed diagnosis.
In their review published in the International Journal of Pharmaceutical Sciences, they have highlighted several such instances while examining the growing practice of self-medication among children.
The review, “Self-Medication in the Paediatric Population: A Comprehensive Review”, has described paediatric self-medication as giving medicines based on a parent or carer's assessment of the child’s illness rather than professional medical advice.
The researchers, Tamanna, Rajesh Kumar, Ajeet Pal Singh, Amar Pal Singh and Pardeep Kaur of St Soldier Institute of Pharmacy, Lidhran Campus, Jalandhar, cautioned that children are particularly vulnerable to medication errors.
“Children are biologically distinct from adults,” the authors noted, pointing out that their developing bodies handle medicines differently and leave less room for dosing errors.
The review highlights the tendency among parents to repeat an earlier prescription when a child develops similar symptoms. But, the researchers point out, similar symptoms do not necessarily mean the same illness.
A fever medicine, for instance, may bring down the temperature without identifying its cause. Likewise, an antibiotic that was prescribed for an earlier bacterial infection may be inappropriate if the new illness is viral or has a different cause.
The authors warned that self-medication can hide symptoms of a serious disease and delay the diagnosis and treatment a child may need.
Dosing is another concern, said the researchers. Parents may estimate doses based on the child's age, a previous prescription or what was given to another child in the family. But paediatric doses are often calculated according to body weight.
A dose suitable for a 20-kg child may not be appropriate for a 10-kg child. Different syrups can also have different strengths.
The review cautioned that incorrect dosing can lead to treatment failure or toxicity. Using a household spoon rather than the measuring device supplied with the medicine can further increase the risk of error.
Also, combining medicines without checking their active ingredients is another potential problem, as two different products may contain the same drug.
The review lists adverse effects associated with inappropriate medication use, including headache, vomiting, dizziness, irritability and stomach pain. In more serious situations, drug misuse can contribute to organ injury.
The authors have also cited an Ahmedabad study in which adverse events reported among children included diarrhoea, skin rash and headache.
The review has also drawn attention to cases where children were exposed to medicines prescribed for other family members.
In one reported case, a six-year-old developed blurred vision and severe headache after using mydriatic eye drops prescribed for his grandmother following cataract surgery. Another reported case involved a 14-year-old who developed a skin rash after taking paracetamol and an antibiotic.
Such examples underline why a medicine prescribed for one family member should not automatically be given to a child.
The researchers have given particular attention to antibiotics, which parents may use when a child's symptoms resemble those of a previous infection.
But antibiotics do not work against viral illnesses such as most common colds. Unnecessary use can expose children to side effects while offering no benefit.
It can also contribute to antimicrobial resistance, making bacterial infections harder to treat, said the researchers.
Another habit highlighted by the researchers was keeping medicines from an earlier illness and using them again.
Even if symptoms appear similar, the new illness may have a different cause. An old prescription may also no longer be appropriate because the child's weight, other medicines or allergy history may have changed.
The review also pointed to the influence of online information. Parents may search for symptoms, compare medicines and decide on treatment without the clinical assessment a doctor would make.
The researchers acknowledged that self-medication is often driven by practical concerns. Parents may want quick relief, avoid waiting at a clinic, reduce consultation costs or rely on previous experience.
But this can be fatal for the children, the researchers warned, stressing the need for better health literacy and professional guidance to reduce unsafe self-medication in children.
