Once again, my take is different than that of most. About 70 percent of Americans measure their liquid medicines in kitchen spoons. But when smart college students were asked to pour a real teaspoon of liquid medicine into a kitchen spoon, they averaged either eight percent less or twelve percent more than the amount prescribed, depending on which kitchen spoon they used, according to a report in the January 5, 2010 Annals of Internal Medicine. This happened in a well-lit room, in the middle of the day, after having been shown the correct amount. Imagine how far off an exhausted parent might be in the middle of the night, distracted by a crying baby.

The obvious response to this data? Always use a dosing cup or dosing spoon instead of a kitchen spoon. One dose may not matter too much, but repeated several times it could quickly add up to danger or to an ineffective medicine.

My response?

1. When possible, choose medications where there is not a tight window between what works and what is dangerous. Cough syrup in children is one great example of this. A controlled study compared a DM cough syrup versus buckwheat honey. Children aged 2 to 5 years received ½ tsp, aged 6 to 11 years received 1 teaspoon, and 12 to 18 years received 2 teaspoons.  The honey worked better – at reducing the number of coughs, the severity of coughs, and the bother of coughs, and at increasing sleep for the children (and for the parents). Too much DM can cause diabetes, hallucinations, psychosis – even death. Too much honey? Not a big deal.
2. When the dose matters, don’t trust yourself to estimate accurately. Choose a dosing spoon, dropper or syringe. Acetaminophen is one place where correct dosing really matters. It’s easy to give too much. (And remember – fever is a friend – and kids often get better faster treating a fever only when it interferes with sleep or keeping down fluids).
3. Choose smaller spoons and plates for food and tall, slim cups for drinks. Overdosing food in children is an even bigger health problem in the US than overdosing medicines. Container size matters: In this experiment, those using the larger spoon poured 20 percent more liquid, even though they were confident they had poured the same amount. Container shape matters: The same authors found previously that even confident veteran bartenders pour 28 percent more alcohol into short, wide glasses than into tall, slender ones of exactly the same volume. Use smaller plates when you want your child to be happy eating less; use larger plates and bigger, wider cups when you want your child to automatically eat and drink more.

^{Wansink, B. and van Ittersum. K. “Spoons Systematically Bias Dosing of Liquid Medicine.” Annals of Internal Medicine, 5 Jan 2010, 152(1):66-67.}

^{Paul, I.M., Beiler, J., McMonagle, A., Shaffer, M.L., Duda, L., and Berlin, C.M. “Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and their Parents.” Archives of Pediatrics & Adolescent Medicine, 2007, 161(12):1140-1146.}

^{Wansink, B. and van Ittersum, K. “Shape of glass and amount of alcohol poured: comparative study of effect of practice and concentration.”  BMJ, 2005, 331:1512-4.}

^{Fisher, J.O., Rolls, R.J., and Birch L.L. “Children’s Bite Size and Intake of an Entrée Are Greater with Large Portions Than with Age-Appropriate or Self-Selected Portions.” American Journal of Clinical Nutrition, 2003, 77(5):1164-1170. [Discussed in Feeding Baby Green]}

Dr. Greene’s Answer:

How right you are! Cold and allergy symptoms are often very similar. When cold-like symptoms persist, allergies may be the reason. Many of the treatments for cold and allergy symptoms are the same.

Walking into a drugstore, you are confronted with an overwhelming display of brightly packaged allergy products, each promising greater allergy relief than its neighbors. Many of these products can actually harm your child and make the effects of allergies even worse. Included in this category are the myriad of cough suppressants that more and more doctors are recommending parents avoid. The right choices, however, used in the right ways, can dramatically improve your child’s springtime.

For years, the centerpieces of over-the-counter allergy therapy have been decongestants and antihistamines. Decongestants are caffeine-like compounds that work by constricting blood vessels throughout the body, including in the nose. By limiting blood flow to the nose, nasal congestion and swelling are somewhat decreased, providing a measure of relief.

Decongestants temporarily raise the blood pressure and make extra work for the heart. Since most kids have strong, healthy hearts this is usually not a problem. Rather, the tendency for kids on decongestants to experience irritability or sleeplessness is a more practical concern. Allergy preparations advertised as “non-drowsy” are typically decongestant preparations. Multi-symptom allergy or cold medicines usually contain a decongestant called phenylephrine, which has replaced pseudoephedrine. Topical decongestants (nose drops or nasal sprays) provide far greater relief with fewer side effects, but these powerful medicines should not be used for more than three days at a time (or they begin to work backwards and can also be habit-forming). These may be a great option for a night or two while another strategy is beginning to work, but are a poor choice for beating the effects of the allergy season.

Antihistamines reduce allergy symptoms by blocking the action of the histamine released by mast cells in response to allergic triggers such as pollen. These can be very effective, but all of the over-the-counter antihistamines cause some change in kids’ levels of alertness. Most of the time, they produce drowsiness in children (which can be quite welcome — especially at night), but around 5% of kids act hyper instead.

Of far greater concern is the effect of antihistamines on thinking and learning. We know that kids who are experiencing allergy symptoms don’t think or learn or remember as well as kids who are feeling well (Annals of Allergy, Aug 1993). Careful studies have now been performed to determine whether this reduction in learning ability could be reversed by using over-the-counter antihistamines to relieve the allergy symptoms. The surprising results were that even though kids felt better on the antihistamines, their learning abilities were even worse than with no treatment (Annals of Allergy, Asthma, and Immunology, Mar 1996). When it comes to learning, children are better off congested than drugged. (Better yet is having the symptoms relieved in less problematic ways!)

Over-the-counter antihistamines are a reasonable choice for nighttime use, or for an occasional day or two when a child is home from school. I do not recommend them, however, as a long-term solution. Learning –even during play — is too important a part of childhood to blunt with drugs.

Antihistamines are found in almost all allergy preparations that are not specifically advertised as non-drowsy. Diphenhydramine is the most powerful, but it also makes kids the sleepiest (or most wired). Chlorpheniramine and brompheniramine both are a little less potent but have fewer side effects.

Nasalcrom (Cromolyn Sodium) is an exciting, over-the-counter allergy medicine that is more effective and far safer than either decongestants or antihistamines. Nasalcrom is a nasal spray that creates a protective barrier around the allergy cells in the nose so that pollen, mold, dust, and animal dander can’t stick to them. It stops the allergic response before it starts–without causing any drowsiness, irritability, or decreased learning. It doesn’t reverse allergy symptoms that are already present, but prevents new allergen exposures from causing symptoms. Unlike decongestant nasal sprays, this gentle medicine can be used for weeks or months at a time with no fear of rebound effects or addiction.

Many people think that Nasalcrom doesn’t work well, since when they give Nasalcrom a try, they experience no improvement in their allergy symptoms. Since Nasalcrom is a preventive medicine, though, it is only after using it 3 to 4 times a day for a week or so that the full benefits begin to appear. Nasalcrom is safer than decongestants and antihistamines and was a prescription medication for 14 years before it became over-the-counter (Mayo Clinic Proceedings, 77(4), April 2002).

Preventing exposure to airborne allergies is another powerful way to treat allergies at home. To this end, a HEPA filter can be an excellent investment. These High Efficiency Particulate Arresting filters, available at discount drug stores for about $60 – $100, can remove 99.97+% of the pollen, dust, and animal dander from the air. I highly recommend placing one in the room where a child with hayfever sleeps.

Some families also find that minimizing the amount of fabric in the home (i.e. curtains, rugs, carpets) or using nonporous mattress and pillow cases minimizes symptoms caused by indoor allergens.

When kids are playing outside during hay-fever season, pollen from grasses, weeds, and trees clings to their clothes and hair. Taking off the outside clothes as they enter the house, and perhaps rinsing the hair, can greatly reduce the pollen they are exposed to that night as they sleep. Every little bit of exposure reduction helps. If a child is allergic to pollen, dust, and cats, minimizing exposure to pollen and dust will make the cat allergies less severe by cooling down the allergic response.

The Old Farmer’s Almanac advises tying a bag of onions around the neck or around the bedpost as a good home remedy for allergies. My guess is that this works by stimulating tear production, which naturally washes pollen particles out of the eyes and nose. A less smelly way to accomplish the same thing is the liberal use of saline nose drops or saline eye drops (artificial tears). Saline drops are not the same as the eye drops that are advertised to “get the red out.” While “get the red out” drops do help to reduce the red appearance of irritated eyes, they are not a good choice for preventing or treating allergies.

The Almanac also suggests turning a piece of orange rind inside out and inserting it in the nose. We now know that some of the ingredients in citrus fruits (including vitamin C) block the histamine response in a safe and natural way. The most potent of these appears to be a vitamin-like compound called quercitin that is found in citrus fruits and buckwheat. Increasing these foods in the diet makes sense. Quercitin/vitamin C supplements are available in health food stores. We know that these reduce hay-fever symptoms in rats, but their effect in human children have not been established. They do appear to be safe and gentle, however, and many people report success with them.

Stinging nettle is the other natural remedy that shows a lot of promise. Also available in health food stores, this herbal supplement is now known to reduce the histamine response in test tube experiments. But again, although I have heard many testimonials, the scientific evidence in support of its effectiveness in humans is sparse.

The last remedy suggested by the Old Farmer’s Almanac is swallowing a spider. Yuck–the cure is worse than the disease! This can also be the case with oral decongestants, topical decongestants, and over-the-counter antihistamines — unless used carefully and with the right timing.

Even severe allergy symptoms, however, can often be kept at bay by the proper use of Nasalcrom, HEPA filters and the other remedies we have discussed. If you are still having problems, make sure to check with your doctor about allergy testing or prescription medicines.

Dr. Greene’s Answer:

Preventing exposure to airborne allergies is another powerful way to treat allergies at home. To this end, a HEPA filter can be an excellent investment. These High Efficiency Particulate Arresting filters, available at discount drug stores for about $60 – $100, can remove 99.97+% of the pollen, dust, and animal dander from the air. I highly recommend placing one in the room where a child with hayfever sleeps.

When kids are playing outside during hayfever season, pollen from grasses, weeds, and trees clings to their clothes and hair. Taking off the outside clothes as they enter the house, and perhaps rinsing the hair, can greatly reduce the pollen they are exposed to that night as they sleep. Every little bit of exposure reduction helps. If a child is allergic to pollen, dust, and cats, minimizing exposure to pollen and dust will make the cat allergies less severe by cooling down the allergic response.

The Old Farmer’s Almanac advises tying a bag of onions around the neck or around the bedpost as a good home remedy for allergies. My guess is that this works by stimulating tear production, which naturally washes pollen particles out of the eyes and nose. A less smelly way to accomplish the same thing is the liberal use of saline nose drops or saline eye drops (artificial tears). Saline drops are not the same as the eye drops that are advertised to “get the red out.” While “get the red out” drops do help to reduce the red appearance of irritated eyes, they are not a good choice for preventing or treating allergies.

The Almanac also suggests turning a piece of orange rind inside out and inserting it in the nose. We now know that some of the ingredients in citrus fruits (including vitamin C) block the histamine response in a safe and natural way. The most potent of these appears to be a vitamin-like compound called quercitin that is found in citrus fruits and buckwheat. Increasing these foods in the diet makes sense. Quercitin/vitamin C supplements are available in health food stores. We know that these reduce hayfever symptoms in rats, but their effect in human children have not been established. They do appear to be safe and gentle, however, and many people report success with them.

Stinging nettle is the other natural remedy that shows a lot of promise. Also available in health food stores, this herbal supplement is now known to reduce the histamine response in test tube experiments. But again, although I have heard many testimonials, the scientific evidence in support of its effectiveness in humans is sparse.

The last remedy suggested by the Old Farmer’s Almanac is swallowing a spider. Yuck–the cure is worse than the disease!

Dr. Greene’s Answer:

Allergic triggers such as pollen prompt mast cells (frontline defenders of the body) to release a chemical called histamine that sets in motion a cascade of symptoms to repel the invaders. We call it ‘allergies’ when this response is triggered by something that would not otherwise be harmful for the body.

Antihistamines reduce allergy symptoms by blocking the action of the histamine. These can be very effective, but all of the over-the-counter antihistamines cause some change in kids’ levels of alertness. Most of the time, they produce drowsiness in children (which can be quite welcome — especially at night), but around 5% of kids act hyper instead.

Of far greater concern is the effect of over-the-counter antihistamines on thinking and learning. We know that kids who are experiencing allergy symptoms don’t think or learn or remember as well as kids who are feeling well (Annals of Allergy, Aug 1993). Careful studies have now been performed to determine whether this reduction in learning ability could be reversed by using over-the-counter antihistamines to relieve the allergy symptoms. The surprising results were that even though kids felt better on the antihistamines, their learning abilities were even worse than with no treatment (Annals of Allergy, Asthma, and Immunology, Mar 1996). They’re learning and mental agility is reduced whether or not they are drowsy. When it comes to learning, children are better off congested than drugged. (Better yet is relieving the symptoms in less problematic ways!)

Over-the-counter antihistamines are a reasonable choice for nighttime use, or for an occasional day or two when a child is home from school. I do not recommend them, however, as a long-term solution. Learning –even during play — is too important a part of childhood to blunt with drugs. Some of the prescription antihistamines do not decrease alertness or learning.

Antihistamines are found in almost all allergy preparations that are not specifically advertised as non-drowsy. Diphenhydramine is the most powerful, but it also makes kids the sleepiest (or most wired). Chlorpheniramine and brompheniramine both are a little less potent but have fewer side effects.

Nasalcrom (cromolyn sodium) is an over-the-counter allergy medicine that is more effective and far safer than either decongestants or antihistamines. Nasalcrom is a nasal spray that creates a protective barrier around the allergy cells in the nose so that pollen, mold, dust, and animal dander can’t stick to them. It stops the allergic response before it starts–without causing any drowsiness, irritability, or decreased learning. It doesn’t reverse allergy symptoms that are already present, but prevents new allergen exposures from causing symptoms. Unlike decongestant nasal sprays, this gentle medicine can be used for weeks or months at a time with no fear of rebound effects or addiction.