Looking to the future

Despite the plethora of online information, when it comes to children’s health parents will often seek the trusted advice of their local pharmacist

Looking after a sick child or infant can be both frustrating and worrying. Thus it comes as little surprise that for many parents and carers of young children the local pharmacy is their first stop for treatment recommendation and reassurance.

Common cold and cough

Bridget Totterman, general pharmacy manager at White Retail Group, says it’s imperative for health professionals to understand how distressing it can be for parents who have a sick child.
In the case of a child with a cold, particularly if they are coughing, she says, “Understanding their distress, reassuring parents and presenting them with all the options we have available to us to get the child and parents through the cold are all a part of what pharmacists, as first line healthcare professionals, are about.

“Initially, various questions need to be asked to ascertain whether a referral to a medical practitioner is necessary. Certainly if the symptoms were persistent or if there was a prolonged fever this would warrant referral. We must also look at whether the symptoms are atypical of the common cold.”

She says treatment options for the common cold are mainly focused on keeping the child as comfortable as possible and might include the following:

  • paracetamol and/or ibuprofen to help manage fever and pain;
  • saline nasal spray or drops may help assist with nasal congestion;
  • increasing water intake and ensuring the child gets adequate rest;
  • elevating the head at night to assist in the post-nasal drip and help avoid throat irritation;
  • ensuring the child is able to eat and drink and is having regular wet nappies or going to the toilet regularly; and
  • giving the parents a list of what to look out for if it becomes more serious.

Given that cough and cold medications should not be given to children younger than six years of age and should only be given to children aged six to 11 years on the advice of a doctor, pharmacist or nurse practitioner, parents can be left feeling helpless.

Paediatrician Dr Deb Levy says, “In the instance of a child with a cough, the first approach is always to clarify the source of the cough. Once you’ve excluded causes such as asthma and reflux, for example, you can reiterate that many studies have shown that cough syrups have no benefit in children.”

“If it’s a post-nasal drip cough from a cold we can look at clearing up their nose. Lots of saline—in paediatric spray formula or drops—will help to thin the mucus so it doesn’t block the nose. I find spray formulas a better option, however children can resist these so it’s important for parents to be relaxed when they give it so that it’s more a matter of fact situation as opposed to a stressful event.

“There are also familiar nose sprays that dry up secretions but these are not recommended for long-term use. I recommend use for two days, three days at the absolute limit. I will usually only suggest these for a nighttime dose, to help the child sleep.

“Other ways to help with nasal secretion are positional. Get the child to lie on their tummy, either over the parent’s lap or the edge of a bed, with their head and chest angled down towards the floor.

“Keep the child there for about five minutes, as long as they’re not resisting. This helps move the mucus and when they sit up ask them to cough (older kids can blow their nose). This can be done before bed or during the day if it’s apparent the child has lots of mucus.

“To address symptoms affecting the throat and chest, based on the exclusion of asthma or pneumonia, older children can use throat lozenges. Any kind of lolly that produces a lot of saliva will do a similar job. It thins secretions in the back of the throat.”

She adds that once children reach an age where there are some OTC treatments available to them, pharmacists can alert parents to the risk of double dosing.

“Parents might not realise that OTC cough and cold preparations might contain paracetamol and this can lead to a doubling up of doses.

“It’s difficult when parents are faced with a child who’s miserable, coughing and they want to be able to do something for them.

“What’s really hard for parents is not knowing what to do or where to turn and this is where pharmacists are a wonderful source of information,” says Dr Levy.

Pain and fever in kids

“As pharmacists we tend to assume parents know how to assess and manage pain but, particularly when a child is in pain, this is often very difficult,” says Christine Onishko, senior pharmacist at Adelaide Women’s and Children’s Hospital.

She says that while tools, like the Faces Pain Scale, are useful—parents can be encouraged to take a more practical approach. “It might be as simple as asking: can the child sleep or is the pain waking them at night? Can the child eat even though they have a sore throat? Is their headache stopping them from sleeping or functioning?”

Parents’ concern over addiction, side effects or dosing errors can lead them to use the lowest dose possible, rather than the correct dose. Onishko advises, “In general parents should use the recommended dose per milligram for their child’s age and weight. If the pain is infrequent, an analgesic can be administered every now and then when the pain is present. Parents should not wait until the pain gets really bad to give the child analgesic medicine.”

With regards to potential dosing errors she says, “The most important way to avoid this is to make sure the parents read the label properly. There are different strengths of analgesics so it’s no use for parents to remember what they gave their child last time, particularly if they’re using a different product. Pharmacists can remind parents to always read the label and choose the dose that’s applicable to that particular analgesic.”

Dianne Crellin, nurse practitioner and lecturer at The Royal Children’s Hospital Foundation in Melbourne, says, “Pharmacists are certainly part of a team that can promote a better understanding of what should and shouldn’t alarm parents when it comes to the health of their children.”

She says that although fever is a widespread complaint in children, many parents have an exaggerated fear of the symptom and this is something pharmacists can help address.

“Fever phobia is popular among parents, particularly those who have limited understanding of fever and its valuable role in diseases. For those who are particularly anxious about fever, concern over febrile convulsion is probably what’s underpinning their anxiety.

“Pharmacists can help alleviate some of these concerns by advising that only approximately 2% of kids experience febrile convulsion as a result of fever and it’s harmless, albeit scary for the family, and doesn’t have lasting ramifications.”

Aside from relaying what constitutes a fever—temperatures above 38°C—she says pharmacists can offer practical advice and tips to help dampen down fever hysteria.

Crellin advises, “Fever is a common symptom which, in most circumstances, goes hand in hand with a fairly benign illness.

“It’s not helpful to focus purely on the number (the temperature on the thermometer). The parent’s observation of their child, based on what they know about their child’s normal behaviour, is a much more meaningful piece of information than a temperature.

“The advice I believe pharmacists should be giving parents is to keep the child feeling comfortable.

Treat them in the same way you would if they didn’t have a temperature. If they feel quite warm take a layer of clothing off, this doesn’t mean stripping them. If they feel cool, add a layer.

“At the heart of fever management is parental education alongside comfort and fluids for the child. Children lose more fluids when they’re hot so make sure they’re well hydrated and comfortable.”

Strengthening pharmacy’s role

The accessible and trusted nature of community pharmacy makes it an ideal place for parents to discuss their child’s symptoms, gain clinical advice and seek reassurance.

Totterman says, “Our pharmacists come out from behind the counter and actively talk to parents about any health concerns they have about themselves and their children.

“Often mothers will come in to weigh their babies and within a few seconds one of our pharmacists will be approaching them and are able to open up a valuable conversation with them about any concerns they have about their child’s health.

“More often than not it is just reassurance they need, that they are doing a great job and their child is growing well. But there are those circumstances where we might be able to assist in correctly treating a case of nappy rash and preventing it from reaching the stage where it requires referral to a medical practitioner.

“The child health category is an opportunity for pharmacies to gain increased public recognition for the role we play as healthcare providers. Many parents ask me, ‘Is this something I need to take my child to the doctor for?’ ‘Is it safe to use this on my baby?’ All of these are questions pharmacists are more than qualified for when it comes to helping parents to take care of their child’s health.

“We are certainly able to reduce the anxiety that a lot of parents go through when they are just not sure and they feel they are over-reacting by going to the doctor. Even saying ‘I think we should have a general practitioner look at this,’ is often just the reassurance a parent needs in order to know they are not overreacting.

“In other cases we may be able to affirm that a condition is normal and we have a product in store that may help. Moreover, as pharmacists are at the forefront of the community, in some circumstances we may be able to talk about a health concern that a parent didn’t even know their child had.

“I had a mother who was coming to us each week to weigh her baby. On about the tenth week I saw a rash on the baby’s neck and chest that the mother hadn’t noticed. I advised that it appeared to look like eczema and suggested she talk to her GP about it. The mother came back the week later so thankful that it had been diagnosed early before it had gotten out of control.” 

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