Poison!

I had the interesting experience as a physician and father a few weeks ago of having those two competing interests at odds with each other. It caused me a significant amount of psychiatric grief, something I’m not much prone to.

It begins with me taking a 4 month old child to Maui. I wouldn’t normally chose to travel to such a far destination with my child, for one reason that’s how you get kids sick. My little Ruthie did end up with her first cold a few days after coming back. For another thing: children don’t care about time zones. Their body tells them when they should go to bed and when they should get up, we try to adjust that by “sleep training them” but time zones through things for loop.

So we took Ruth to Hawaii, it’s a 1.5 hour drive to Boise, a 1.5 hour flight to LA, then a 5-5.5 hour flight to Maui. Keep in mind that as recent has a month ago my daughter cried for upwards of 4 hours straight the last time we tried to drive longer then 30 minutes (1.5 hour drive to Hailey and then several hours of crying after trying to put her to bed). It seemed daunting. The start of the trip went off without a hitch.

The thing about Ruth is that she is a social-a-holic. She loves being out and seeing people, even at the expense usually of taking a nap. I’ve joked about it many times before that no one even believes we have a fussy baby. When she’s a church she’s a smiling angel, but the drive home will be continuous tears and then nap refusal and fussy afternoon because of being over tired. So flying on the plane, and transfer, airports was constant social stimulation for her longest stretch ever. We got to Maui 4:30 Maui time which is 8:30 PM here. She is now 2+ hours over her bed time. We loaded in the car over an hour later. We clicked her into the car seat and she cried for 45 minutes straight to the resort.

Now we come to the crux of the conflicting internal emotions. We had a plan in place to give the baby a tiny dose of Benadryl to sleep when we got to the resort the first night and hopefully help her “sleep in” and adjust time zones. The doctor in me has given that advice at times and knew it to be reasonable. The father of a doted upon, precious, darling, 4 month old little girl was crying out “Poison!!!”

Let’s look at this analytically. Benadryl is an allergy medication. It’s an anti-histamine. It’s not a sleeping medication, per se. It helps people sleep because the molecule diphenhydramine blocks histamine receptors and histamine receptors are involved in both allergy but also sleep. By blocking the H1 receptors in the skin and nose it reduces allergy, by blocking it in the brain it makes you tired. It also cross reacts with another category of receptors called the cholinergic receptors and medications that do that often make one drowsy also. It’s pretty safe from a medical perspective at the correct dosing. The side effect is “drowsiness” not “life threatening coma and death in infants”.

I rarely advise it to parents as a physician because over-dosing a child on it can be dangerous and there are deaths linked to doses much higher than appropriate (for example I found an article about a day care provider using 6x the dose I used on my 4 month old on a 3 month old and it dying). I rarely advise it because I can’t be there to assure that the parents understand concentrations and dosing of medications. For me it’s intuitive what 12.5 mg/5ml means and how much 5 ml is. My typical patient doesn’t even know what that sort of formula is or how to use it. I spend a lot of my day during cold and flu season explaining how to dose Tylenol (fortunately most parents UNDER dose that and their kids come to my office with a fever of a 102 on a half dose of anti-fever medication- so maybe it’s unfortunatly).

So again, the MD in me was pretty comfortable with our plan to give our baby one does of Benadryl. The father in me was shouting internally “Kids have died!” Keep in mind that this was only like 2 weeks after I really fell in love with my daughter on the walk from my last blog post. We went ahead with it, giving her a ½ teaspoon, she spit/coughed/gagged most of it out and we put her to bed. She woke up at 4 AM and I couldn’t help but think “maybe we should have given her a little more”….

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Published in: on October 30, 2010 at 2:47 pm  Leave a Comment  

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