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A Simple Guide To Bandages

With so many different types of bandages available its easy to get confused with what bandage to use when. Bandages are generally used to cover wounds, to apply pressure to bleeding wounds and to support and immobilise sprains, strains and broken bones.

I have put together a list of the most common types of bandages and when to use them. As you will see most of them have interchangeable uses so its really a matter of preference and of course, cost.

There are three major types of bandages – roller bandages, triangular bandages and tubular bandages.

ROLLER BANDAGE

These are long single strips of breathable material. Depending on the thickness and elasticity, these bandages are the most versatile.

The different roller bandages are described below:

1. Conforming bandage
This bandage has a high degree of stretch so that it can conform to any shape. This bandage comes in a light, medium and heavy weight

Use:

  • Can be used to hold a dressing in place
  • Can be used with a dressing to apply pressure to control bleeding wounds
  • A thicker weight can be used to compress and support a sprain or strain

2. Crepe bandage
This is a thicker weight than conforming bandage.

Use:

  • Can be used to hold a dressing in place
  • Can be used with a dressing to apply pressure to control bleeding wounds
  • Can be used to compress and support a sprain or strain
  • Can be used to compress a limb in the event of a poisonous snake bite

Both conforming and crepe bandages are never applied directly onto open wounds. A dressing must be in place first.

3. First aid dressing
This is a roller bandage that has a dressing pad sewn into it. The bandage is usually lightweight with some elasticity.

Use:

  • The pad is applied directly onto an open wound and then the bandage is rolled to keep it in place. There is no need to apply a separate dressing first.

4. Elastic adhesive bandage
This roller bandage has a very sticky adhesive, which can be taped directly onto the skin. This bandage is thick weight. However, this is not my favourite bandage as it can be very painful to remove if there is a lot of hair on the skin and some people may have an allergy to the adhesive.

Use:

  • Can be applied onto a joint to compress and support a sprain or strain
  • Can be applied over a conforming or crepe bandage for additional pressure to control bleeding wounds. Great for amputations and arterial bleeding.
  • Can be applied onto a conforming or crepe bandage to secure it in place
  • Can also be used to hold ice packs in place on the injured area

5. Cohesive bandage
This is a thin lightweight breathable bandage that sticks to itself, without actually being sticky. There is no risk of pulling out any hairs when removing this bandage.

Use:

  • Most commonly used to compress and support sprains and strains

TRIANGULAR BANDAGE

This is the most versatile bandage. It is usually a single sheet of thick cotton or calico in the shape of a large triangle. It can be applied to areas of the body where it may be more difficult to apply a roller bandage such as the scalp.

Use:

  • These bandages are most commonly used to construct slings for soft tissue injuries, broken bones or dislocations. Some triangular bandages come with safety pins to help you construct the sling but most of the time you will not need them;
  • Can be used to secure splints;
  • Can be used as a pad on top of a dressing to apply extra pressure for a bleeding wound;
  • Can be folded down to form a strip of bandage and wrapped around a wound to hold a dressing in place and/or apply extra pressure to control bleeding;
  • Can be used to elevate a limb to reduce blood flow to the area if bleeding a lot from an open wound;
  • Can be used to elevate a limb to reduce blood flow and limit swelling; and/or
  • Can be used as a tourniquet in an emergency when the use of a tourniquet may be warranted.

TUBULAR BANDAGE

These bandages are not normally found in first aid kits. They can be medium to heavy weight.

Use:

  • The thicker weight bandages are used for compression, support and to reduce swelling for joint sprains and strains;
  • Can be used to protect the skin under a cast for a broken bone;
  • Can technically be used to keep a dressing in place and apply pressure to bleeding wounds but care needs to be taken when applying it so that the dressing does not shift when the tube is pulled over the injured area.

WHAT IS A DRESSING?

A dressing is something that is applied directly onto a wound to cover it. A bandage can then be applied over a dressing to keep it in place if the dressing is not adhesive.

WHAT IS A PLASTER?

Depending which way you look at it, a plaster can either be an adhesive dressing or an adhesive bandage with an attached dressing. Plasters are more commonly known as adhesive dressings and Band-Aid is a brand of plasters.

Bandages are only helpful if used properly. It’s important to recognise the bandages you have in your first aid kit and to know which bandage you should use when and how to properly apply them.

First Aid Tips Every Mom Should Know

10 First Aid Tips Every Mom Should Know

I was recently asked by All4Women to put together my top 10 first aid tips for moms. I wanted to share these with all of you in this blog post. You can find more tips in my MiniKit Pocket Guide (https://www.oneaid.co.za/product/minikit/).

  1. Keep emergency numbers on speed dial: Every parent should know who to call in an emergency. You should also teach this to your children. Write the numbers down and stick them on your fridge or somewhere near the phone.
  2. Cuts and scrapes: Stop any bleeding by pressing firmly on the wound with a gauze or cloth. Then rinse the wound under cool running water before applying a dressing such as a plaster. Tap water is perfectly fine, you don’t need fancy antiseptic solutions.
  3. Burns: Rinse burns under cool running water for up to 20 minutes. This will prevent any further damage and reduce pain. Do not use freezing cold water or ice
  4. Bee stings: Remove the stinger if still attached and apply an ice pack to reduce swelling. Don’t use tweezers as this may squeeze out more poison. Rather scrape the stinger off with a flat-edged object such as a bankcard.
  5. Nosebleed: Lean your child forward so they don’t swallow any blood and pinch the nose closed just below the bony part. Blood can irritate the stomach and cause nausea and vomiting.
  6. Broken bones: If you suspect a broken bone don’t move the limb or apply any weight. Splint the injured limb to prevent any movement before going to the emergency room.
  7. Seizures: Never put anything into the mouth of a child who is having a seizure. This includes medicines for fever if your child is having a febrile convulsion. Roll your child onto his or her side and wait for the seizure to stop.
  8. Heat exhaustion: Get your child out of the heat and elevate his or her legs. Prevention is key so make sure your child drinks plenty of fluids before and during any activity in hot weather.
  9. Poisoning: If you suspect your child has swallowed a potentially harmful substance do not make them vomit or give them anything to eat or drink unless told to do so by emergency services. Here are 10 essential tips to prevent poisoning in your home (https://www.oneaid.co.za/10-essential-tips-to-prevent-poisoning-inyour-home/).
  10. Be prepared: Always have a well stocked first aid kit on hand so you can manage minor injuries without delay and reduce the risk of infection or severity of injury.

Be sure to follow me on Instagram @oneaidsa

A Bump To The Head: When Should You Worry?

I have attended to many children in the ER who have taken a tumble. In the US, falls account for around half the injury-related ER visits in children under 5 years of age. Most of these falls involve furniture such as changing mats, high chairs, baby walkers and beds.

Parents are almost always concerned about head injuries. Majority of head injuries from a fall are usually minor.

Children under one who fall are more likely to sustain head injuries regardless of the height from which they fall. Whereas older children are more prone to extremity fractures. This is because an infant’s head is much larger than the rest of their body. As a child grows, their head mass becomes more proportional and they develop upper body strength, which enables them to brace falls with their arms or legs.

WHEN TO SEE A DOCTOR

If your child is awake, alert and behaving normally after a bump to the head with no other signs and symptoms then he or she will most likely be fine and you don’t have to rush to hospital right away. It’s a good idea to observe your child for 1-2 days afterwards, since symptoms of a brain injury may present late.

Seek Medical Attention:

  • For any bump to the head in an infant;
  • If your child has lost consciousness, even if brief;
  • If your child has any signs and symptoms of a concussion (see below);
  • If your child is inconsolable;
  • If your child is vomiting;
  • If your child is difficult to wake;
  • If your child has a seizure; and/or
  • If you suspect a broken bone.

If your child has had a bad fall and you suspect a neck injury DO NOT move your child. Call an ambulance right away! Always trust your gut. If you are unsure rather head straight to your nearest emergency room.

CONCUSSION

A concussion is a brain injury caused by a blow to the head. The signs and symptoms may be vague and may even take a few days to develop. It’s important to know that not all concussions cause a loss of consciousness.

Concussions can be more difficult to diagnose in children, as they are not as vocal about their symptoms. Children older than 2 years will show more behavioural symptoms.

Signs & symptoms will therefore depend on age and include but are not limited to:

  • Irritable and fussy;
  • Unusually sleepy;
  • Crying more than usual;
  • Change in appetite;
  • Nausea and/or vomiting;
  • Lack of interest in play;
  • Headache;
  • Confusion;
  • Child is unsteady on his or her feet;
  • Sensitivity to light and noise;
  • Blurred or double vision;
  • Dizziness;
  • Unusual speech e.g.: slow or slurred;
  • Poor concentration and memory; and/or
  • Problems with co-ordination.

DIAGNOSING A CONCUSSION        

The doctor will do a thorough evaluation. A CT scan and MRI cannot diagnose a concussion. A CT scan will however, most likely be ordered to exclude a brain bleed or skull fracture depending on the mechanism of injury and presenting symptoms.

The majority of falls in children are caused by modifiable factors and are therefore preventable. It’s impossible to bubble wrap our kids and we shouldn’t have to. Falls and tumbles can teach our children valuable lessons, but we can spend time baby proofing our homes and being more cautious to prevent serious injury. Remember to always buckle your baby in their high chair and never leave him or her unattended on a changing mat, not even for a second – it takes seconds for an accident to happen.

RESOURCES

Burrows, P. et al. (2015) Head injury from falls in children younger than 6 years of age. Arch Dis Child, [online] 100 (11), pp. 1032-1037. Available from: https://0-www-ncbi-nlm-nih-gov.innopac.wits.ac.za/pmc/articles/PMC4680174/ [Accessed 3 October 2018].

CDC (2017) Traumatic Brain Injury & Concussion [online]. Available from: https://www.cdc.gov/traumaticbraininjury/symptoms.html [Accessed 3 october 2018].

Chaudhary, S. et al. (2018) Pediatric falls ages 0–4: understanding demographics, mechanisms, and injury severities. Inj Epidemiol, [online] 5 (suppl 1). Available from: https://0-www-ncbi-nlm-nih-gov.innopac.wits.ac.za/pmc/articles/PMC5893510/ [Accessed 3 October 2018].

Kendrick, D. et al. (2015) Risk and Protective Factors for Falls From Furniture in Young Children Multicenter Case-Control Study. JAMA Pediatr, [online] 169 (2), pp. 145-153. Available from: https://jamanetwork.com/journals/jamapediatrics/fullarticle/1939058 [Accessed 3 October 2018].

Samuel, N. et al. (2015) Falls in young children with minor head injury: A prospective analysis of injury mechanisms. Brain Injury, [online] 29 (7-8), pp. 946-950. Available from: https://0-www-tandfonline-com.innopac.wits.ac.za/doi/full/10.3109/02699052.2015.1017005 [Accessed 3 October 2018].

Does Your Child Need a Tetanus Shot or Not?

I’ve had parents often come into the emergency room after their child has taken a tumble asking for a Tetanus vaccine, which is why I felt the need to write a post explaining what Tetanus is and why we need to vaccinate our kids.

WHAT IS TETANUS?

Tetanus is a disease commonly known as lockjaw. It is caused by the bacteria, Clostridium tetani and can be fatal. The toxin from the bacteria affects the nervous system and causes severe painful muscle spasms, which can interfere with the ability to breathe. Currently there is no cure for Tetanus and treatment is mainly symptomatic until the effects of the toxin wear off. Complete recovery can take up to several months.

WHERE IS THE BACTERIA FOUND?

Clostridial spores can be found everywhere. They are found in soil, dust and animal faeces (including humans). Once the spores enter a wound they grow into mature bacteria, which produce the powerful toxin. Clostridium tetani is found worldwide.

WHAT ARE THE SIGNS AND SYMPTOMS OF TETANUS?

Signs and symptoms of tetanus can appear anytime from a few days to a few weeks from infection:

  • Spasms and stiffness of jaw muscles (hence the name lockjaw);
  • Spasms and stiffness of the neck muscles;
  • Difficulty swallowing;
  • Spasms and stiffness of other body muscles, commonly the abdominal muscles;
  • Other constitutional symptoms such as fever, sweating and palpitations.

TETANUS VACCINATION

I won’t go into too much detail regarding the various combination vaccines as there are many and every country has its own recommendations. A copy of the latest South African immunisation schedule can be downloaded from my resources page. The WHO recommends an initial 6-dose schedule to achieve tetanus immunity.

1. Primary vaccination

Three primary doses of the vaccine are recommended in childhood starting from 6 weeks.

2. Booster vaccination

Three booster doses are recommended prior to adolescence. Booster vaccines are then recommended every 10 years thereafter.

TETANUS-PRONE WOUND

  • This is any wound that has been contaminated with material that could contain tetanus spores;
  • This is any wound that is deep;
  • This is any wound that is dirty;
  • This is any wound that contains a foreign body.

Note: any wound can be tetanus-prone – cuts, scrapes, burns, animal (including human) and insect bites.

WHEN TO SEE A DOCTOR

It is recommended you see a doctor if:

  • Your child has a tetanus-prone wound and has not had a booster vaccine in the last 5 years;
  • Your child has a minor, clean wound and has not had a booster vaccine in the last 10 years;
  • Your child has a wound and you cannot remember when their last booster vaccine was.

RESOURCES

CDC (2018) Tetanus. [online]. Available from: https://www.cdc.gov/vaccines/pubs/pinkbook/tetanus.html#contraindications [Accessed 30 August 2018].

WHO (2018) Tetanus vaccines: WHO position paper, February 2017 – Recommendations. Vaccine. [online] 36 (25). Available from: http://dx.doi.org/10.1016/j.vaccine.2017.02.034 [Accessed 30 August 2018].

WHO (2018) Tetanus. [online]. http://www.who.int/ith/vaccines/tetanus/en/ [Accessed 30 August 2018].

Picking Scabs & Popping Blisters

I remember my mother telling me when I was a little girl that I shouldn’t pick my scabs because it would cause scarring. Now it is believed that the scabs themselves actually cause more scarring and the recommended treatment of skin wounds has moved away from dry healing towards moist healing.

What is dry healing?

This is when a wound is left open to dry out or it’s simply covered with a dressing. This method allows a hard scab to form over the wound on the outside. It was thought that the scab protected the damaged skin underneath and would eventually fall off once the skin defect had healed. The scab was also meant to protect the wound from infection.

What is moist healing?

This is when an ointment is applied to a wound and it is covered with a dressing. It has been proven that epithelialisation (formation of new skin) happens much faster in a moist environment when compared to dry one. Leaving a wound to dry out allows the new skin cells that are trying to grow and cover the skin defect to dry out and die resulting in more inflammation. This causes further pain, slows down the healing process and leads to more scarring. Previous beliefs that a moist dressing resulted in infection have not been proven.

When should you apply a moist dressing?

You should provide a moist, but not too wet, environment for cuts, scrapes and burns. Small cuts and scrapes that have already scabbed can be left open.

What is a blister?

A blister is a pocket of fluid collection within the superficial layers of the skin. They can develop when the skin is damaged by friction, extreme temperature (hot and cold) or certain chemicals that come in contact with the skin. The fluid acts as a barrier protecting the injured tissue underneath so it can heal.

How to treat a blister

Do not pop a blister! The blister protects the underlying skin from infection. The fluid within the blister also contains proteins that help promote healing. As the skin underneath heals the fluid in the blister disappears and the skin peels off. It is best to keep the blister covered with a dry dressing to avoid it getting scraped or torn open. If the blister does burst open, clean the wound gently without pulling off any skin, and apply a moist dressing.

How to clean a wound and apply a moist dressing

  1. Clean your hands thoroughly with soap and water or a hand disinfectant.
  2. Put on disposable gloves if available.
  3. If the wound is bleeding, stop bleeding by applying pressure with a clean gauze, bandage or cloth.
  4. Rinse the wound under running water for 10 minutes. Use a gauze pad or cloth soaked in water to gently wipe the wound and surrounding skin of any dirt and debris.
  5. Gently pat wound dry using a clean gauze or cloth. Do not use cotton wool as the fluff may stick to the wound.
  6. Apply a topical ointment such as petroleum jelly or equivalent. A thin layer of an antiseptic cream such as Cetrimide can also be used if the wound is at risk of infection.
  7. Cover the wound with a sterile dressing such as a non-adherent pad and bandage or a plaster.
  8. Clean the wound daily with running water and reapply a new moist dressing until the wound has healed.

Moist Healing plasters

Many brands have developed plasters that are designed to keep wounds moist without having to apply a topical ointment. These dressings provide a moist environment by absorbing and retaining fluid from the actual wound. Some of these plasters do not need to be changed daily. Make sure to read the directions on the box before applying your plaster.

As our little ones explore this world there is no doubt you will have to deal with many cuts and scrapes and even though wound healing is individualised most minor wounds will heal well with no complications if looked after from the very beginning.

RESOURCES

Elastoplast, (2018). 4 Reasons for Moist Wound Healing. [online] Available at: https://www.elastoplast.com.au/first-aid/wound-care/moist-wound-healing [Accessed 21 August 2018].

Field, C.K. & Kerstein, M.D. (1994). Overview of wound healing in a moist environment. The American Journal of Surgery, [online] 167 (1), pp. S2-S6. Available at: https://doi.org/10.1016/0002-9610(94)90002-7 [Accessed 21 August 2018].

Junker, J.P.E., Kamel, R.A., Caterson, E.J. & Eriksson, E. (2013). Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments. Adv Wound Care, [online] 2 (7), pp. 348-356. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3842869/ [Accessed 22 August 2018].

Emergency Numbers Every Parent Should Know

It occurred to me the day I went back to work after my maternity leave that I didn’t know any other emergency number besides 10111. Thankfully I have never had to use this but I couldn’t risk leaving my daughter at home with her caregiver without leaving a more comprehensive list of important numbers by the phone.

The last thing you want to do in an emergency is dial the wrong number. In the US, the UK and Europe there is only one toll-free number to call from any landline or mobile phone. In South Africa, things are not as simple. Unfortunately there isn’t one single number for an emergency.

I spent a really long time searching the web and making a couple of phone calls but I finally managed to put together this simple list. It is vital that you as parents and/or caregivers know what number to dial when and it is perhaps even more important that your little ones know this too.

USING YOUR CELL PHONE:

Any emergency nationwide – 112 (this number will still work even if you have no airtime)

USING YOUR LANDLINE OR CELL PHONE:

Police/Fire – 10111

Nationwide ambulance (public EMS) – 10177

Netcare 911 (private EMS) – 082 911

ER 24 (private EMS) – 084 124

Poison Information Centre – 0861 555 777

Remember, before making that emergency call, try to stay calm. You also need to have important information ready such as, the type of emergency, details of any injuries and the exact location of the emergency needing attention.

You can download a list of important emergency numbers here. It may be a good idea to stick this on your fridge or somewhere nearby the phone.

Child Immunisation Schedule SA

South Africa offers an extensive child immunisation program. All these vaccines are available at public clinics for free. Private clinics also offer an immunisation program, however, some fee may be involved, as not all medical aids pay for the vaccines. The private schedule offers more vaccines than state clinics and there may also be differences in schedules between private and public.

The following two tables below outline the different immunisation schedules.

Department Of Health Extended Program Of Immunisation (EPI) Schedule:

AGE OF CHILD VACCINATION PROTECTS AGAINST
Birth BCG Bacillus Calmette Guerin Tuberculosis
OPV (0) Oral polio vaccine: OPV-Merieux/Polioral Polio
6 weeks OPV (1) Polio
RV (1) Rotavirus vaccine: Rotarix Rotavirus
DTaP-IPV-Hib-HBV (1) Hexavalent: Hexaxim Diphtheria, tetanus, acellular pertussis (whooping cough), polio, haemophilus influenzae type B, Hepatitis B
PCV 13 (1) Pneumococcal conjugate vaccine: Prevenar-13 Pneumococcal diseases
10 weeks DTaP-IPV-Hib-HBV (2) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, Hepatitis B
14 weeks RV (2) Rotavirus
DTaP-IPV-Hib-HBV (3) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, Hepatitis B
PCV 13 (2) Pneumococcal diseases
6 months Measles (1) MeasBio Measles
9 months PCV 13 (3) Pneumococcal diseases
12 months Measles (2) Measles
18 months DTaP-IPV-Hib-HBV (4) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, Hepatitis B
6 years Td (1) Diftavax Tetanus, Diptheria
9 years (girls only) HPV (1) (repeat 6 months later) Human papilloma Virus
HPV (2) Human papilloma Virus
12 years Td (2) Diftavax Tetanus, Diptheria

Private Practice Child Immunisation Schedule:

AGE OF CHILD VACCINATION PROTECTS AGAINST
Birth BCG Bacillus Calmette Guerin Tuberculosis
OPV (0) Oral polio vaccine: OPV-Merieux/Polioral Polio
6 weeks OPV (1) Polio
RV (1) Rotavirus vaccine: Rotarix/RotaTeq Rotavirus
DTaP-IPV-Hib-HBV (1) Hexavalent: Hexaxim/Infanrix-Hexa Diphtheria, tetanus, acellular pertussis (whooping cough), polio, haemophilus influenzae type B, Hepatitis B virus
PCV 13 (1) Pneumococcal conjugate vaccine: Prevenar-13/Synflorix Pneumococcal diseases
10 weeks RV (2) Rotavirus
DTaP-IPV-Hib-HBV (2) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, HBV
PCV 13 (2) Pneumococcal diseases
14 weeks RV (2) or (3) Rotavirus
DTaP-IPV-Hib-HBV (3) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, HBV
PCV (3) Pneumococcal diseases
6 months + Flu Influenza vaccine Influenza
9 months Measles (1) Rouvax

Or

MMR (1) Trimovax/Priorix

Measles

Measles, mumps, rubella

MCV (1) Meningococcal vaccine: Menactra Meningococcal diseases
12 -15 months MMR (1) or (2)

Or

MMRV (1) Priorix Tetra

Measles, mumps, rubella

Measles, mumps, rubella, chickenpox

Varicella (1) Varilrix Chicken pox
PCV (4) Pneumococcal disease
MCV (2) Meningococcal disease
HAV (1) Hepatitis A vaccine: Avaxim 80/Havrix Junior (repeat 6 months later) Hepatitis A virus
18 months DTaP-IPV-Hib-HBV (4) Diphtheria, tetanus, whooping cough, polio, haemophilus influenzae type B, HBV
18-21 months HAV (2) Avaxim 80/Havrix Junior Hepatitis A virus
5-6 years

 

MMR (2) or (3)

Or

MMRV (2)

Measles, mumps, rubella

Measles, mumps, rubella, chickenpox

Varicella (2) Chicken pox
DTaP Infanrix

Or

DTaP-IPV Quadrivalent: Adacel Quadra/Boostrix Tetra

Diptheria, tetanus, whooping cough

DTaP plus polio

9 years + (girls & boys; 13 years) HPV (1) Gardasil/Cervarix (girls only) (repeat 6 months later) Human papilloma Virus
HPV (2) Human papilloma Virus
12 years

 

TdaP-IPV Diphtheria, tetanus, whooping cough, polio

Download a copy of the South African Immunisation Schedule here.

RESOURCES

National Institute for Communicable Disease (2016) Vaccine Information for Parents and Caregivers. [Online] Available from: http://www.nicd.ac.za/assets/files/NICD_Vaccine_Booklet_D132_FINAL.pdf [Accessed 29 June 2018].

Netcare, (2016). Vaccine Schedules for South Africa for 2016. [Online] Available from: http://www.netcarehospitals.co.za/Portals/3/Images/Content-Images/PDF/latest-vaccine-schedule.pdf [Accessed 30 June 2018].

The National Department of Health, (2015). Vaccinator’s Manual “Immunisation That Works” Expanded Programme on Immunisation in South Africa (EPI-SA). [Online] Available from: https://www.westerncape.gov.za/assets/departments/health/vaccinators_manual_2016.pdf [Accessed 29 June 2018].

Medications for Pain & Fever In Children

There are a wide range of medicines on the market for pain and fever that make it confusing for parents to know which one to choose. All medicines are potentially dangerous so it is vital you know what you are buying.

There are two main groups of analgesics – opioids and non-opioids. I will not discuss opioids any further for now as these are usually reserved for severe pain and given the side effects of even the low efficacy opioids, such as codeine, I do not routinely recommend their use in children.

Non-opioids are further divided into three groups. There are a number of generics out there, so it’s important to read the product label carefully to know exactly what it is you are giving your child.

  1. Paracetamol (acetaminophen)
  • Indicated for mild-moderate pain and fever.
  • Has no anti-inflammatory properties.
  • Is non-sedating.
  • Includes but not limited to: Panado, Calpol and Empaped suppositories.
  1. NSAIDs (Non-steroidal anti-inflammatory drugs)
  • NSAIDS have anti-inflammatory, analgesic and antipyretic properties.
  • There are many NSAIDs available but most are not licensed for use in children or for pain and fever.
  • Is non-sedating.
  • Contraindications:
    • Children with asthma;
    • Children with dehydration;
    • Children with impaired renal function;
    • Children with impaired clotting or bleeding; and/or
    • A previous allergic reaction to any anti-inflammatory drug.
  • Includes but not limited to:
    • Nurofen (ibuprofen): >3 months and >5 kgs.
    • Ponstan (mefenamic acid): >6 months
    • Voltaren suppositories (diclofenac): > 2yrs.
  1. Aspirin (acetylsalicylic acid)
  • NOT RECOMMENDED for children and adolescents (<18 years) for routine analgesic and antipyretic use – AVOID!
  • Aspirin is associated with a rare, yet fatal disease known as Reyes syndrome.
  1. Combination preparations
  • These are usually a combination of Paracetamol with any one or more of the following; NSAID, codeine, caffeine, meprobamate, promethazine, dephenhydramine, doxylamine and/or other.
  • Indicated specifically for pain relief only.
  • These preparations are not superior to paracetamol alone for relief of fever.
  • These preparations can be sedating depending on the composition.
  • Includes but not limited to: Ibumol, Lentogesic, Lotem, Mybulen, Myprodol, Stilpane and Stopayne.

PARACETAMOL OR NSAID?

Now that you have a brief overview of what is out there, let’s discuss what to give your kids.

Keep it simple! Avoid combinations, as they are not any more effective than single preparations. Paracetamol is the first line drug for mild-moderate pain and fever. This is because of its high tolerability profile. Do not routinely use Paracetamol AND an NSAID together at the same time or alternatingly. I would recommend using Paracetamol first and if there is no response within an hour, try Ibuprofen.

From personal experience, Paracetamol works wonders and within 30-60 minutes your child will be running around like his/her normal self again.

Please use analgesics and antipyretics only if necessary and regardless of which one you choose, use it for the shortest time needed to control symptoms.  If you decide to use an NSAID DO NOT use more than one type at a time.

VOMITING

  • If your child vomits within 30 minutes of having ingested a dose of Paracetamol or NSAID it is safe to give that same dose again.
  • If your child vomits more than 30 minutes after having a dose of Paracetamol or NSAID DO NOT give another dose. Wait until the next normal dose.

SUPPOSITORIES

  • Oral administration of medicine is preferred since the rectal absorption of medicine is unpredictable, however, if your child is refusing to take medicine or vomiting, a suppository can initially be used.
  • Do not give an oral dose together with a suppository of the same drug at the same time.
  • Rectal administration of NSAIDs has fewer GUT side effects.

SIDE-EFFECTS*

Paracetamol:

  • Rarely causes any side effects if given at the correct dose.
  • Paracetamol overdose is VERY toxic to the liver and can cause liver failure and death.

NSAIDs:

  • Stomach pain, indigestion and/or heartburn;
  • Nausea and/or vomiting;
  • Diarrhoea;
  • Allergic reaction;
  • Bronchospasm;
  • Ringing in the ears; and/or
  • Kidney damage (little or no urine and/or blood in the urine).

*This is not a comprehensive list of all the side effects but rather a list of the more common and/or dangerous ones.

DOSAGE

When it comes to dosing, weight is more important than age, so please read the product label carefully and familiarize yourself with your child’s weight.

I suggest administering medicine using a syringe in order to measure up the dose correctly. Squirt the medicine into the space between the gum and cheek. This will reduce contact with the tongue and taste receptors making the medicine more palatable and having a higher chance of being swallowed.

Paracetamol:

  • 3 months: 15mg/kg/dose every 4-6 hours
  • < 3 months: 10mg/kg/dose every 4-6 hours
  • Max: 60mg/kg/day, up to 1000mg/dose or 4000mg/day, up to 4 doses/24 hrs.

Ibuprofen:

  • 5 mg/kg/dose every 6-8 hours
  • Max: 20mg/kg/day, up to 3 doses/24 hrs.
  • Administer Ibuprofen with food in order to reduce gastric side effects.

 

RESOURCES

de Martino, M. & Chiarugi, A. (2015) Recent Advances in Pediatric Use of Oral Paracetamol in Fever and Pain Management. Pain and Therapy. [Online] 4 (2), pp. 149-168. Available from: https://doi.org/10.1007/s40122-015-0040-z [Accessed 18 June 2018].

Gazarean, M. and Graudins, L.V. (2006) Safe use of NSAIDs in infants and children. Medicine Today, 7 (11), pp. 71-73.

Green, R., Jeena, P., Kotze, S., Lewis, H., Webb, D. and Wells, M. (2013) Management of acute fever in children: Guideline for community healthcare providers and pharmacists. S Afr Med J. [Online] 103 (12), pp. 948-954. Available from: doi:10.7196/SAMJ.7207 [Accessed 20 June 2018]

Jannin, V., Lemagnen, G., Gueroult, P., Larrouture, D. and Tuleu, C. (2014) Rectal route in the 21st Century to treat children. Advanced Drug Delivery Reviews. [Online] 73, pp. 34-49. Available from: doi: 10.1016/j.addr.2014.05.012 [Accessed 20 June 2018].

Marzuillo, P., Guarino, S. & Barbi, E. (2014) Paracetamol: a focus for the general pediatrician. European Journal Of Pediatrics. [Online] 173 (4), pp. 415-425. Available from: https://doi.org/10.1007/s00431-013-2239-5 [Accessed 18 June 2018].

Raffaeli, G., Orenti, A., Gambino, M., Peves Rios, W., Bosis, S., Bianchini, S., Tagliabue, C. and Esposito, S. (2016) Fever and Pain Management in Childhood: Healthcare Providers’ and Parents’ Adherence to Current Recommendations. Int. J. Environ. Res. Public Health. [Online] 13 (5), 499. Available from: https://doi.org/10.3390/ijerph13050499 [Accessed 18 June 2018].

Sharif, M.R., Rezaei, M.H., Aalinezhad, M., Sarami, G. and Rangraz, M. (2016) Rectal Diclofenac Versus Rectal Paracetamol: Comparison of Antipyretic Effectiveness in Children. Iranian Red Crescent Medical Journal. [Online] 18 (1): e27932. Available from: doi:10.5812/ircmj.27932 [Accessed 20 June 2018].

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