Pain relief medicines for children

A while ago I was contacted by Hannah who I’d met at the BritMums Live! conference back in June. She works for Nurofen for Children, who have recently launched a campaign to help parents use pain relief medicines more effectively to treat their child’s pain and fever symptoms. As part of this, they sponsored a small poll involving 500 mums (MumPoll, Mums Study, April 2012) which asked various questions about pain relief for children. Within the email that Hannah sent me were some results from this poll, and I was quite surprised by them, in that many mums did not seem to know as much about pain relief for children as I thought was general knowledge. I guess I take it for granted that my parents are pharmacists and therefore, along with working in their pharmacy myself as a teenager, I’ve grown up knowing quite a bit about medicines and how/when to take them (or not!)

So I thought I would do my bit in helping to dispel some of the myths surrounding pain relief medicines for children, by writing a blog post about how we use paracetamol and ibuprofen for Andrew (and will do for baby). First, I should say that I’m a firm believer in buying generic (pharmacy-own brand) medicines if they are cheaper than the brands like Calpol and Nurofen, because I don’t believe there is any difference in how they work, despite having heard, either directly or via Facebook or other such media, that various people’s little ones apparently had some kind of reaction (e.g. sickness, runny nappy) after they used own-brand medicine – we’ve never experienced such things with Andrew. I should also say that so far we’ve been very blessed with a child who has hardly ever been ill, had a raised temperature, or suffered much from teething pain. So our use of pain relief medicines has been quite rare, and we’ve only recently started on our second bottles of paracetamol and ibuprofen since he was born 21 months ago. I know this is not the case for all children, some of whom need pain relief more often than others, as is the case with us adults (I know I take paracetamol, and ibuprofen when I’m not pregnant, more often than Tom, for example).

We first used paracetamol when Andrew had his tongue tie snipped at 10 weeks. This was a one-off dose of 2.5ml, as he was still under 3 months old (but he was over 4kg and wasn’t premature – 2 things that need to be the case to give it to a less than 3-month old). He didn’t seem to be too affected by pain after the snip, and calmed down much faster with a feed than he did for his vaccinations, but I thought we’d give him a dose just in case. We didn’t give ibuprofen at this age, because it should only be used from 3 months in babies over 5kg. According to the MumPoll survey, over a quarter of the 500 mums didn’t realise that you can give ibuprofen even as young as 3 months, and I’d say that anecdotally amongst mums I know, this seems to be the case, with paracetamol (or rather ‘Calpol’) being the name that rolls off the tongue in conversation when talking about what they have in for pain relief in young babies.

I’d also say that in general amongst mums, of babies or toddlers, paracetamol is the medicine that I’ve heard mentioned most often when we’re talking about what their child has for pain relief and/or fever. This is supported by the results of the MumPoll survey, which showed that paracetamol is a preferred treatment among mums, with almost two thirds choosing it over ibuprofen to reduce a fever. Maybe it’s because that’s what we remember having as a child ourselves – I know I for one liked the taste of the paracetamol suspension I was given for pain relief, especially for all my bouts of tonsillitis before my tonsils were whipped out. But these days ibuprofen is also an option, and it’d be great if more parents knew about it and what it can do.

Since Andrew was 3 months old, we’ve used both paracetamol and ibuprofen for two main reasons: a raised temperature and teething pain. He’s never had en extremely high temperature, but the times that he has been at 37 or 38 degrees, one or two doses of both medicines (with the correct timing between doses) have helped to bring it down very quickly. That’s another thing that I’ve been surprised by: not everyone knows that doses of paracetamol and ibuprofen can be given at exactly the same time, because the two drugs work in different ways. (It’s the same for adults – taking the correct doses of paracetamol and ibuprofen at the same time is fine.)

The MumPoll survey showed that nearly 60% of mums chose paracetamol with the belief that it provides the fastest relief from fever, but in my experience, I’d say that both paracetamol and ibuprofen work at speeds that aren’t distinguishable from one another, and apparently (according to Nurofen for Children) there is evidence that ibuprofen works faster to reduce fever, in as little as 15 minutes (Pelen et al (1998) Treatment of fever. Monotherapy with ibuprofen. Ibuprofen paediatric suspension containing 100mg per 5ml, muliti-centre acceptability study conducted in hospital. Annales de Pediatrie 45(10):719-728. I don’t have access to this journal, so I can’t comment on their research, and the title doesn’t mention a comparison with paracetamol, but Nurofen’s claim seems to be based on something more than my anecdotal evidence that ibuprofen works pretty quickly!)

In my (again, anecdotal) experience, it seems that a fairly common belief amongst parents of young children is that paracetamol is for reducing fever and ibuprofen is an anti-inflammatory and therefore is for relieving pain like teething and earache that might be accompanied by inflammation. Whilst it is true that ibuprofen is an anti-inflammatory, it also works to reduce a high temperature, similarly to (but not in the same way as) paracetamol. And the great thing is, as I said above, you can use them both at the same time! However, you should always read the label on the bottle and check that you’re giving the right dose of each for the child’s age and leaving enough time between doses.

Finally, there’s a handy (if slightly cheesy 😉 ) summary of paracetamol and ibuprofen use for pain relief and fever in children given by Dr Hilary Jones on youtube. I know I’m technically a ‘Dr’, but I guess you’re more likely to take on board what a medical doctor says about pain relief than what I’ve written here, which is based on our own experience. If you’re a parent of a young child, I hope you found this post useful and informative.

Disclaimer: All personal views expressed in this post are my own, based on my own experience. I was given no incentive for writing this.

Pregnancy diary: week 35 – birth plan

As yesterday was my last day at work (I’ll come back to that in a mo….), all of a sudden giving birth seems like a much more imminent event! So I thought it was about time that I write my ‘birth plan’. I thought I’d saved a copy of my birth plan for Andrew’s birth, but I have a feeling I didn’t back it up to the server (unusual for me, Little Miss Paranoid Doer of Back-ups) and annoyingly my laptop hard-drive died a few days after Andrew was born. The birth plan must be forever lost in an irretrievable gobble-ti-gook of 1s and 0s. But nevermind. I managed to find a great resource on the NHS choices website, which runs through the various points you might like to include in a birth plan. It even lets you save an online version of a birth plan that you create by ticking various multiple choice option boxes and then printing off a PDF, but I found this a little restrictive and preferred to write my own using ideas from the website.

Not much to say this week, other than it's a bump!

I’m not a massive fan of the word ‘plan’ in this context, because I don’t think labour and delivery are really things that you can ‘plan’ in the sense that I normally plan things (like what I’m doing next Monday morning at 10am, or when we will go on holiday next year, or what we’ll eat for dinner tonight, for example). Yes I have an image of what would be an ‘ideal’ birth, and actually I came pretty close to this with Andrew (lose the vomiting after the syntocinon injection and it would have been perfect), but I’m not so naive to think that there is no possibility of complications that might cause my ‘ideal’ birth to fly out the maternity hospital window. I’m optimistic that, given previous experience, the birth will go smoothly, but realistic that I have no control over the fact that it might not.

I remember when I came to write my birth plan for having Andrew that I didn’t know where to start. Although I had some ideas about what I wanted and didn’t want, I also had no idea how I would react to and cope with the pain once I was in labour, having never experienced anything like it before. So most of my points were couched in a ‘I’d like it to be as natural as possible but if I scream for drugs then please give them to me’ kind of tone. This time, of course, I know what it’s like, so I found it easier to write down what I hope for, complications and long duration notwithstanding.

This sets the scene for my birth plan, which I’ve set out below. I will print this out and keep it with my maternity notes, so that whichever midwife gets the job of helping us through labour will see it when she looks at my notes – this worked well last time, and she was keen to read what I’d written before doing much else with me. I’ve probably forgotten some important points, so if you think of anything I might like to mention, I’m all ears. Next week I have another midwife appointment, so I might have chance to go through it with her too, particularly as she’s coming to look at the flat in case of home birth necessity!

Ruth Cumming’s birth plan

This is not so much of a ‘plan’, because I’m not sure you can really ‘plan’ labour and birth, but rather it’s a list of things that I would like and not like to happen, if at all possible.

Location

My preferred place of birth is in the Rosie Birth Centre, because I had my son at the former MLBU, and I liked the relaxed atmosphere and received excellent care from the midwives, who helped me but did not take over.

However, if baby comes even faster than my son did (which was pretty fast), I may decide that I’d rather stay at home, because I’d rather not risk being in advanced labour in the car – I’d rather have a ‘home birth’ than a ‘car birth’!

Of course if there are complications, I understand that going up to the delivery unit in the main Rosie hospital would be necessary.

My birth partner is Tom, my husband, and I would like him with me at all times during labour, no matter what happens.

Labour and delivery

I would like to be in a birth pool during active labour (another reason for choosing the Birth Centre); this helped me a lot for my first labour.

If possible I would like to deliver the baby in the water. Last time the midwife could tell that being in the water was relaxing me too much and she was concerned that I wasn’t pushing as hard as I could during the final stage in there, so she suggested I got out for delivery. She was right, because I gave birth within minutes of getting out, as I pushed much harder ‘on land’. If this happens again, I’m not against getting out of the water if necessary, but would rather have a water birth if possible.

Last time I used a birthing stool for the final pushes – this worked well and I would like it again if ‘on land’.

I am happy for baby’s heartbeat to be monitored like it was last time – with a detached probe device every now and then, i.e. I’m not constantly hooked up to a machine so I can move around freely.

I will move around during labour before the pool is ready, and get into positions that I find most comfortable at each point. This could include getting on all fours (possibly on the bed) and walking around. But I hope to spend most of the time in the pool.

I hope to deliver in the water, squatting or upright in some other way, or if I’m on land, squatting on a birthing stool worked well last time. I do not want to be on my back, lying down or completely horizontal in any way.

If I am in the water for delivery, I would like to pick baby up myself from the water, and sit there skin to skin for a while until I feel I’d like to get out.

If I am on land for delivery, baby should be delivered straight onto my tummy, without being cleaned, so that we can have skin to skin time. This worked well for my son, and he latched on for a breastfeed almost straight away. I would like this to happen again if possible.

I would like the midwife to cut the cord (Tom is not particularly keen to do this).

I do not mind if there are trainee midwives in the room.

Possible drugs/interventions

For pain relief, I would like to try and use just natural methodsbreathing, movements, and the water of the pool. This worked for my first labour and I didn’t need any drugs.

However, if labour goes on for a lot longer than my first labour, I may decide on other pain relief methods. Gas and air would be my first choice. I didn’t find a TENS machine helpful last time, so I won’t try it again.

I would prefer not to have an epidural, but I can see that if I’ve been in pain for several hours and I’m exhausted, that this would be something I would consider and would want to be given if I decided on having it.

I had a 2nd degree tear with my son, so I’m prepared that this might happen again. I’d rather not have an episiotomy if at all possible, but would consider it if the midwife thinks it is necessary if baby was in trouble.

I would rather not have an assisted delivery with forceps or ventuose. But if baby was in trouble and therefore it was advisable to have these interventions, I would consider them.

After my son was born I opted to have the syntocinon injection, but in a reaction to this drug I vomited several times and felt nauseous for about 6 hours after the birth. I would rather not have the syntocinon injection this time, but if the midwife thinks it is necessary because I am bleeding a lot (and I know I’ve had a slightly low platelet count that might not help the situation), I am prepared to have the injection. I would like Tom to be able to stay for as long as possible after the birth this time if I am feeling sick.

I would like my baby to have the vitamin K injection or oral drops.

Breastfeeding

I am going to breastfeed and this is extremely important to me. I struggled with breastfeeding my son in the early weeks, but eventually got on track with it and have continued to feed him until now – I plan to tandem breastfeed if he still wants to continue after the baby’s birth.

So I would like my baby to stay close to me at all times and not be swaddled – I would like to remain in skin to skin contact for several hours after the birth, so that baby can feed off and on whilst lying on me.

If complications arise and I need to be separated from him/her, I would like Tom to be able to have skin to skin with baby whilst I am out of action. I would like baby to be brought to me as soon as possible if we are separated, and have help with positioning baby on me for feeding if I am in pain from a difficult delivery (e.g. c-section).