Is over-the-counter medicine safe for kids?

If a medicine doesn't require a prescription, many parents assume it's safe for their child to take. That's not always the case. Nazima Zakhidova, M.D., Pediatrician at Children's Health℠ Primary Care McKinney, shares what you need to know before you grab over-the-counter medication for your child.

What are over-the-counter medicines?

Over-the-counter, or OTC, medicines are any medications you can buy at a drug or grocery store without a prescription. They include many common cold and cough medicines, pain relievers and allergy relief drugs.

Some OTC medications, including those for fever and pain, have been studied for safety, dosing and effectiveness in kids. Most haven't.

Common over-the-counter medications for kids

Parents often reach for over-the-counter medicines when their child has a fever, cold or upset stomach. While many of these medicines can provide relief, it’s important to know which are safe, when to use them and what risks to watch out for.

• Fever medications: Acetaminophen (Tylenol) and ibuprofen (Motrin or Advil) can help reduce fever (>100.4F) in children.

  • Do not give ibuprofen to babies under 6 months of age.

  • Never give aspirin to children under 18 years of age unless your doctor says it's okay. Aspirin in children has been linked to Reye’s syndrome, a rare but serious condition that can cause brain and liver damage.

• Pain relievers: Pain medicines can help with headache, sprains or other minor joint and muscle pain. They include:

  • Acetaminophen (Tylenol)

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Advil) and naproxen (Aleve)

• Allergy medications: Antihistamines provide relief from allergy symptoms and can also help with itching and rashes. Choose non-drowsy medications (Zyrtec or Claritin) rather than those that can affect a child's alertness (Benadryl).

• Anti-diarrhea medicines: Anti-diarrhea medicines are not recommended for children. Most episodes of diarrhea will get better in a few days, and the important thing is to keep your child well hydrated with electrolyte fluids (Pedialyte or Enfalyte).

  • Bismuth subsalicylate (Pepto-Bismol or Kaopectate) is not recommended in children because the subsalicylate in the medication is a form of aspirin. Aspirin is never recommended in children because of the risk for Reye’s syndrome, a rare but serious condition that can cause brain and liver damage.

  • Loperamide (Imodium A-D) is not recommended in children because it has a risk of causing heart problems, trouble breathing and worsening gut infections.

• Antifungal creams: Antifungal creams (Lotrimin, Mycostatin and Micatin) can help clear up ring worm, athlete’s foot and yeast diaper rashes. Barrier ointments made with zinc oxide (A&D) or petroleum jelly (Vaseline) can help prevent diaper rashes. Check with your doctor to see if your child might need an anti-fungal cream.

• Cold medicines: Always talk to your doctor before giving any OTC cold medication to your child – even if it's labeled for kids. Most cold medications are not recommended for children under 6 years of age, even if the label says it is ok for children 4 years and older. Cold medicines often contain several different kinds of drugs that can cause reactions in some kids. Many also contain acetaminophen, so you may be giving your child an extra dose if they are already taking Tylenol.

• Cough medicines: Cough medicines may break up mucus, suppress the urge to cough or soothe the throat. Options for kids older than 6 years old include:

  • Liquid cough medicines that include dextromethorphan (Children's Robitussin, Vick's Children's Cough Medicine and Children’s Delsym)

• Menthol throat lozenges (can be a choking hazard for young children)

• Decongestants: Decongestants help relieve a runny nose and stop postnasal drip. Ask your doctor before giving any decongestants to kids under 6. Options include:

  • Nasal sprays: oxymetazoline (Afrin Children's, limit to 3 days use) and fluticasone (Flonase)

  • Oral decongestants: pseudoephedrine or phenylephrine (Children's Sudafed and Children’s Mucinex)

• Sore throat relief: These can help soothe sore throat pain. Common treatments include:

  • Sprays to numb pain: Chloraseptic kids spray (not for use by kids under 6).

  • Lozenges: Sucking on throat lozenges sooth a sore throat but be careful due to the choking risk (Sucrets and Cepacol Cherry) (not for use by kids under 6).

Supplements and vitamins

Many OTC dietary supplements, including vitamins and herbal medicines, haven't been tested for safety or effectiveness in kids. Because children's bodies are still developing, they don't always metabolize supplements the way adults do. That can mean different side effects, especially in infants and younger children. The National Center for Complementary and Alternative Medicine (NCCAM) offers the following cautions:

• Supplements can interact with other medications your child is taking. A common example is that vitamin C slows down the body's ability to process acetaminophen (Tylenol).

• The hormone melatonin (a sleep aid) can alter the levels of other hormones in young children. Kids with medical conditions including diabetes, kidney or liver disease, cerebral palsy and other hormonal disorders shouldn't take melatonin.

• St. John's Wort is often given to kids for anxiety or depression, but it can have dangerous interactions with several medications.

• Though generally safe for gastrointestinal disorders, probiotics shouldn't be given to critically ill children.

• Parents should avoid giving multivitamins to healthy children who eat a varied diet. It's possible for kids to get too much Vitamins A and C, copper, folic acid, iron, selenium and zinc. A better choice is to supplement just those vitamins healthy kids don't get enough of such as vitamins D and E, as well as calcium.

Always check with your doctor if you're planning to give your child supplements for any condition.

A word of caution about over-the-counter medicines for kids

Over-the-counter medicines that are safe for adults aren’t always safe for children. Always read labels carefully before giving your child any medication. Many products share the same active ingredients, which means your child could accidentally get too much if they take more than one medicine at a time. Using extra caution – and asking your child’s doctor or pharmacist if you’re unsure – can help prevent serious side effects and keep your child safe.

Find care for your child

Children's Health Primary Care offers comprehensive health care for children from birth through young adulthood. Our pediatricians combine quality care with evidence-based practice to meet your child's medical needs.

Have questions about which over-the-counter medicines are safe for your child? Find a trusted pediatrician today to get personalized guidance.