16 November 2006

Smaller dose of "children's" medication can stand in for the more expensive "infant" version

A big money-saver (one you'll appreciate if you've ever dropped several bucks on a miniscule bottle of Infant Motrin), from Jeff:

Okay, here's my hack.  But you gotta be extra careful because it deals with administering medications to infants.

The little guy got one of many colds so Mom sent me to the drug store for a decongestant.  We're big believers in not over-medicating, so an infant preparation with only the medicine needed was in order.  Except, they were out.  I talked with a pharmacist about alternatives and he suggested the "children's" version at half strength.

As it turns out, the "infant" version provides 5 mg per dose, the "children" version is 10mg per dose.  Simply half the children version for the same infant dose.  As it turns out, the child-sized bottle contains several more doses than the infant version for the same price.  When you figure twice as many doses, because you're halving the dose size for the infant, you make out double.  Big savings!

The cons are that you have to be really careful and make double sure your math is correct.  You also need some oral syringes (because the child size doesn't come with them) that have tiny doses marked. We figured a .4 ml dose for our little guy, not much at all.

We just happened to have plenty of oral syringes around because he's on a prescription for allergies anyway.

More: Best of Parent Hacks: Cold and flu season tips

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Sorry, I like saving money, but not enough to fiddle with medicine. I'll stick with the infant formulations.

We have the hardest time even finding infant formulations! My son had a cold, and I was told to get pedicare infant formula. I looked at like 5 different places and came up empty handed. The doc then told us to give him children's dymatap cold and allergy- just a quarter of the regular dose. He is 20lbs, and 8 months old.

He has reflux and is on adult prevacid (RX) as well- he just gets half a dose.

My recommendation would be just to give the doctor a call and ask about the dosage- most are more than willing to help you out!

I often use Dr. Sears' online medicine cabinet http://www.askdrsears.com/html/8/T089900.asp
to figure out doses when they're not indicated on the package (often not there for the under 2 set, even on the infant stuff) - but I'm willing to pay the extra $ to have less medicine to get into my son's mouth! I sent Asha my hack to remember the correct dose - use a Sharpie to write the dose on the outside of the bottle - great for forgetful parents and especially for sitters.

We just did this recently when the doctor said Infant Motrin for our 6month old's teething. Having a 2 and 4 year old running around, we have plenty of medicine in the cabinets...all children's size, none infant. Only after clearing with the doctor, and only because it was almost the little guy's bed time and I didn't have time to run to the store, we went with this approach.

I can see the logic of using it if you're going to have the children's version in the house anyway. One less thing to run out of and have to remember to stock up on. But to save money? Not sure I can see myself pitching that to the wife.

For things like plain Motrin or Tylenol it is probably safe for infant use if you first check with your pediatrician.
But many other types of childrens otc medicines have additional (and possibly unsafe) ingredients added to them such as decongestants and cough suppressants.

All I have to say is that the oral syringes are the absolute best way to give medicine.

Actually, our pediatrcian recommends the children's version of medications over the infant's versions. I wonder if parents could get information about the correct amounts to administer from their pediatricians, if they are unsure?
My pediatrican believes (and my MIL, an RN, confirms) that the risk for overdose with the concentrated is quite great. My MIL works in a hospital and she said that they often see infants who have had too much tylenol in the emergency room.

BE WARY & ASK A PRO although a good idea overall- some infant formulations are MORE concentrated than their children's counterparts.

An RN friend asked the pharmacist's advice about substituting because of the price advantage on Tylenol. The Pharmacist looked at the concentration of the children's product and told her how much MORE she would use for her infant than the dosage amount of the infant's product.

Even with the increased amount of product consumed, she had substantial savings buying the children's product.

The pharmacist told her that people sometimes get into trouble undermedicating their babies with children's medicines and over-medicating (to a dangerous degree) their children with infant medicines.

It's definitely worth a stroll over the pharmacist's counter to have the correct dosage and the savings.

You can also ask for dosing charts from your doctor. Our doctor photocopies the dosing charts he gets from the manufacturers, which list the age/weight and dosage of each version, and include the specific concentration of each version.

The things even have pictures of the medication label, so even the clueless can figure out 'hey, that's not the same thing!' (barring major style changes on labels). We keep this copy tucked next to the bin of meds in the cabinet.

Do keep in mind that infant doses are often much more concentrated JUST so you don't have to force them to drink as much of it. They're going for volume, not just concentration. Older kids often reject meds based on taste, so those are thinned more with 'tasty stuff' to keep them from being spat out.

The problem with this is that Day Cares will not administer without a Doctor's note as the Children's OTC medications refer you to a Doc for Under 2 Years. Although at home, it is convenient and walking the thin line where your child's health is concerned, don't you think you should get the Infant's medications anyway--just in case someone else (sitter, aunt/uncle/g'parents) has to administer and you do not want to cause more confusion than necessary when your child is already sick.

If you're dumb enough to put a few cents ahead of the health of your child, this is great advice for you.

Bryan: Not helpful. The comments here suggest that there are a number of opinions on this issue, some of which point to children's medications actually being safer than the infant versions in terms of risk of overdose. Sounds like the wisest course of action is to check with your pediatrician on dosages.

If you can read the ingredients and do the math, and you're comfortable with it, do it. This actually addresses the issues of marketing and packaging more than anything else. Why do infant formulations come in these weenie sizes? You're paying a fortune for the packaging.

Also think about the fact that so many of these things list dosage by age - never mind the range of body sizes possible. So the 'precision' of the dosing is questionable.

We ran into this when our daughter (now 12) began to hate the artificial grape flavoring in so many of these products. When she really began to argue about it, I checked the dosage for her age and weight, and found, for example, that she was to get 200 mg of ibuprofen - which is exactly the adult single-pill dose. Offered her one of those instead - she was thrilled.

The one thing I miss about the liquids is the ability to split a dose. If your child is feverish, but it is a couple of hours before bedtime, with the liquid you can split the dose, and then give a full dose at bedtime. Our daughter was a complete crank if you woke her at midnight to give her medicine.

Neither of our children have taken liquid medications well since they started eating solid food, so we switched to the children's chewables (both OTC and perscription) long before they were two--with our pediatrician's blessing. He and our local pharmacist helped us figure out the dosing. Yes, sometimes I've cut pills in quarters (buy a pill cutter), but for us it was a practical issue--kids get better faster if you can actually get the medicines into them. But it is also cheaper since more OTC children's medicines come in generics than the infant stuff.

But the key there is, make sure you get the doctor or pharmacist to help you figure out the dosing, and then use Serena's hack--write in on the package in Sharpie! Dang, that's brilliant!

I think it is more than fine to base your infant or child's dosage on reading actual mg contents, not by blindly following "give 1 mL" instructions. That is not dangerous to me, it is actually more informed, IMO.

One other interesting point that my pediatrician explained to me. The volume of the additional ingredients is much lower in the infant formulations than the children's. They don't add a lot of flavoring or extra volume, so it is easier to get a smaller amount in carrying the same effective dose.

This can be an advantage if your child fights swallowing much of any medicine. However, the infant formulas usually taste a lot worse, due to the lack of flavoring. But, they may have extra stuff in there you may not like, like dyes and artificial flavorings.

More stuff to consider!

We figured this hack out when our son hit 24 lbs - the infant weight limit on the motrin by his first birthday. We'd had figured out how to up the dose beyond the weight range on the infant formula and were only getting 8 doses out of the bottles we had. We asked the pediatrician first who said to just use the weight guidelines on the children's formula. It turns out that now that he likes the flavor, it's no problem getting him to take it. I'll take better flavor over small volume any day. We figure out how many mg he needs by weight and then calculate that for the version he's taking. We use the syringes that came with the infant version, but figured once we had a few syringes, we didn't need to pay for more.

In my opinion, you should always figure medication dosages for children/infants by weight, not by age. It's a lot safer!

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