Tylenol and Toddlers

If misused, Tylenol and other brands of acetaminophen have the potential for fatal injury to a toddler's liver.
My toddler attends a play group and one of the mothers there was talking about Tylenol being blamed for liver damage and deaths in children. Is this cause for alarm?
It is true that Tylenol and other brands of acetaminophen have the potential for fatal injury to the liver if misused. As you are aware, Tylenol and other brands of acetaminophen are readily available over-the-counter in pharmacies and supermarkets. This makes them easily accessible for everyone to use. It is very important for all medicines to be used as prescribed or as recommended on the container or by a health professional.

Many medications come in a variety of forms (e.g., infant drops, children's suspension, chewable pills), concentrations (the amount of medicine per unit dose), and are given based on age and weight. You can't just substitute one teaspoonful of the infant drops for one teaspoonful of the children's suspension (or vice versa). The amounts of medicine in each are very different--so if you are not careful, either overdosing or underdosing may happen. Medications should be somewhat pleasant tasting, easy to take, and hopefully not in large amounts or needed too often. Otherwise, kids won't take them, parents will struggle to get them in, and the health benefits will not be appreciated.

The Food and Drug Administration is aware of the importance of clear labeling for families, particularly with over-the-counter medicines. I personally never recommend giving acetaminophen for more than a couple of days in the recommended dose and frequency, without at least contacting a physician or reviewing the symptoms, to see if the use and the amount of the over-the-counter medicine is appropriate, and to determine whether the child needs to be seen. Most importantly, remind yourself that medications come in different concentrations, the recommended doses must not be exceeded, and dosing too frequently must be avoided. If there is ever a question about the proper dose or frequency, it would be important for you to speak with your child's health care provider.

Henry Bernstein, M.D., is currently the associate chief of the Division of General Pediatrics and director of Primary Care at Children's Hospital, Boston. He also has an academic appointment at Harvard Medical School.

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