Scott Webb (Host): It can be a little daunting for parents to know what essential items we need at home and in our medicine cabinets to help and treat our kids when they're sick or injured. My guest today is here to help. I'm joined today by Dr. Nicole Dudaney.  She's a Pediatrician with Stanford Medicine Children's Health.

 This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb.

Doctor, it's nice to have you here today. We're going to talk about essential medicine cabinet items for children. And I was telling you, my kids are a little older, so I don't think about this as much, but my wife and I did think about what do we need to have, what you know, to be good parents, you know, to help our kiddos.

And I guess I just wonder like what are the top five, in your opinion, professional opinion, the top five essential items we should have in the medicine cabinet? You know, really, specifically tailored for children. Maybe are there any age specific items that should be included? Just based on the age group? Like as I was saying, you know, like younger kids need this, older kids maybe can have that, take us through that.

Nicole Dudaney, MD: Yeah, I think, this is a very important topic because there is a lot of misinformation out there and it's very easy for parents to feel overwhelmed in trying to navigate medications and first aid items for their children. But I think this is a really important topic to talk about and it's something that we can look at year round.

And me personally, myself, I'm actually pregnant with my first child right now, so this was great review for me to go over.

Host: by Congrats Congratulations. Yeah.

Nicole Dudaney, MD: Whenever I get asked this question in my clinic, I always tell parents to think about what is simple, safe, and age-appropriate for their child. So the five big things I recommend in general for all ages is a fever and pain reducer. A reliable digital thermometer, a proper dosing device, good first aid supplies, and then anti-allergy medications. So the first one being the fever pain reducer, that would be either Tylenol or acetaminophen.

And that's generally safe for all ages. And that can be given every four hours. And then you can also use Motrin known as ibuprofen. And that's safe starting at six months or older. And that can be given every six hours ideally with food. And so when the kids are beyond six months, parents can actually start alternating Tylenol and Motrin every three hours. So they can give Motrin at 3:00 PM for example, Tylenol at 6:00 PM, Motrin at 9:00 PM so on and so forth in order to really keep a fever down. So that's the first big item.

The second big item would be a reliable digital thermometer. So I think in the age of COVID, so the forehead, infrared thermometers, like those forehead guns got pretty popular. And a lot of that was due to hygiene purposes because you don't want to be sticking an oral thermometer in everyone's mouths when checking their temperature or screening people's temperatures. So, those got really popular, but unfortunately it seems like those have, remained really popular even in this day and age, even post pandemic.

And I see a lot of parents still using that to measure their children's temperatures. But, those are actually quite unreliable because they easily pick up the environment's temperature too, rather than the true temperature of the child. And that can actually miss a true fever, especially in our younger ones where their foreheads are so small and you want to know if they have a fever.

I strongly recommend to all my patients and my parents to stay with the old school digital stick thermometer. So that can be measured either axillary or rectally in infants. And then for older children, you can measure those orally. And then the third item I would recommend is an oral syringe or a proper dosing device for the medications.

So this sounds very basic, but actually dosing errors are one of the most common medication mistakes that I see. Many families tend to use kitchen spoons to kind of estimate the dosage, but these are not very accurate, and especially in our more little ones where every milliliter makes a difference, you want to make sure that you're getting a good accurate dose for them. So an oral syringe is very, very helpful for that.

The fourth item would be basic first aid supplies. So things like kid sized band-aids, gauze, tape and Vaseline are really essential for that. I know Neosporin has gained a lot of popularity. It's a topical antibiotic ointment, but, actually more recent studies show that Neosporin does have a high-risk of allergic reactions and contact dermatitis. And we find that most kids' wounds don't really need any neosporin or topical antibiotic. Vaseline just does the trick, and keeps the wounds nice and moist and then followed by putting a bandaid on top for any minor cuts or scrapes.

Host: Sure.

Nicole Dudaney, MD: And then the last crucial item I would recommend is any sort of antihistamine for minor allergic reactions. So our first-line now is Zyrtec or Claritin. And Benadryl was also kind of an old school of thought. It used to be the go-to anti-allergy medication, but we're moving away from that because it does have a lot of sedative effects on our kids, and those can be very unpredictable.

They can get easily over sedated, and then you miss like, you know, worsening symptoms that could be happening. Or it could even present itself as like a paradoxical reaction where instead of them getting sleepy, we see them getting very hyperactive and very irritable. I've seen many of those especially during my medical school training, so.

I would definitely steer away from Benadryl and stick more with the Zyrtec or Claritin they have found to work just as well for most allergic symptoms such as runny nose, itching or, like hives. But of course if there's concern for any impairment in breathing, or swelling around the mouth or any recurrent vomiting, you should use an EpiPen if you have one.

If your child has been prescribed one or take them to the nearest ER. And then for age specific add-ons that are worth mentioning. So for infants, I would highly recommend the use of saline drops or a saline spray as well as a nasal suction device. The reason being is because little infants, you know, they can't really blow their nose like older kids or adults can.

And then they have really small nasal passageways too. So when they do have a respiratory virus, this is a very bad combination because it makes it really hard to clear all of their mucus and boogers all in their nose. And that can potentially go into their lungs as well. So the saline helps to loosen the mucus, so giving them the saline drops or saline spray will loosen the mucus.

And then I tell them to try to tell parents to suction afterwards with either a bulb suction or one of those tube suction devices, such as the Nose Freedom. And that way it gets the most bang for their buck because their mucus is already nice and loose. So, it can easily get suctioned out. And then for infants too, I would also recommend having a diaper rash cream on board just in case you see any diaper rash pop up. The main ingredient that you want to make sure you have in your diaper rash cream is zinc oxide. Because that works as a very good barrier. So Desitin is one that's most commonly used for that. So that's more age specific for infants and then more age specific for like toddler age.

And even beyond that is to have a good electrolyte solution on board. So something like Pedialyte is great because it comes in both a drink form as well as it comes in a Popsicle form. Sometimes that's a little bit more fun for kids to take. And the reason I like to have an electrolyte solution on hand is really in the situations where they're having any GI illnesses or any stomach bugs and that causes a lot of vomiting and diarrhea and, you know, kids' body weight is only so big and so they can easily become dehydrated. So the sipping on an electrolyte solution or sucking on a little electrolyte popsicle in little bits throughout the day is very helpful to prevent the dehydration.

Host: For sure. Yeah. And just listening to you Doctor, it's like a trip down memory lane for me. Some of these things that I haven't thought about. You know, diaper creams and things. I haven't thought about this stuff in so long, just brought a big smile to my face and was always thankful that we had a lot of these things that you're mentioning.

And along those lines, when you think about OTC medications, just for your common childhood illnesses, your colds, fevers, mild allergies, let's talk through some of those. And is there a difference really between pediatric and adult formulations of the common over-the-counter stuff?

Nicole Dudaney, MD: Yeah. Those are all great questions. So for the common childhood illnesses, the main OTC medications to have on hand, would be the Tylenol and ibuprofen, for any fevers or pain. So the Tylenol as mentioned, is safe for all ages. Ibuprofen safe for six months and above. But really for any cold, supportive care is usually what works best.

So, the saline drops or spray to loosen the mucus, humidifiers, especially running overnight, will help to kind of keep all, everything nice and moist and then you can even turn on a hot shower. And even if the kid is not taking the shower, just bringing them into the bathroom, letting them breathe that steam for at least 10 to 15 minutes, and you can do that a few times a day.

Keeps everything nice and moist in there so the mucus isn't drying up. Having fluids on board, having honey for children over the age of one is really nice to kind of coat the back of the throat, especially for ones having a sore throat or, like a nasty cough. So those would be good really for colds.

Any other, like over-the-counter cold and cough medicines? I have a lot of parents using like DayQuil, NyQuil, a lot of over-the-counter cough ones to have a cough suppressant. I wouldn't recommend any of those for young children. They do have a number of side effects, a lot of them being cognitive related, a and then a lot of them just don't work very well either. I would steer clear of any of those ones besides the Tylenol and ibuprofen for pain or fever. And then for any allergies, the best over-the-counter medications are the Zyrtec or Claritin, for mild allergies. And then speaking about the differences between pediatric and adult formulations.

So the active ingredient may be the same in a pediatric and adult medication, such as with Tylenol, or with Motrin you might have the same active ingredient, but the concentrations are very, very different in pediatric medicines versus adult medicines. So in pediatric ones you have weight-based dosing and they usually come with the proper dosing devices, and you can usually see a table on the side of the medication box, which will provide a very good reference for the specific amount to provide to your child based on their specific weight. So if you are providing adult medications for these younger ones, that can very easily lead to accidental overdosing, or even double dosing. So my general advice is if the label does not clearly list pediatric dosing, or if it says to ask a doctor, that's a good sign to pause and check in with your pediatrician.

Host: Right. And as we know, pediatricians have all the answers, so, never a bad choice to reach out. Let's talk first aid supplies. You mentioned kid size bandaids and Vaseline earlier, but when we think about minor cuts, scrapes, insect bites, anything else?

Nicole Dudaney, MD: It's always good to have a well stocked first aid kit, rather than anything too complicated. So, yeah, having band-aids in a few different sizes based on, you know, how big the scrape is. Having some gauze and medical tape on board and then the Vaseline as well as just soap and water. So I would recommend for the best wound care, clean the wound with soap and water initially. Put some plain petroleum jelly and that keeps the cuts nice and moist and it promotes really good healing. And then go ahead and put that bandaid on top to keep that moisture locked in there. And then if you'd like, you can also have a hydrocortisone 1% cream that's also available over-the-counter. That's more helpful for any itchy rashes or any insect bites.

And that helps to minimize the itch for that. And then maybe even having some cold packs for any swelling. Some tweezers if the kid steps on a splinter or, or a thorn or has a splinter in their finger. So those would be good things to have in a first aid kit. So most of these childhood injuries can be managed at home, but anything that does look very deep or very dirty or it's not healing as expected, that would be a good reason to check in with the pediatrician.

Host: Yeah. And just speaking for me and my family, we have a lot of ice packs in the fridge. In freezer. Yeah. We have small ones, we have big ones. You know, because then they'll use them and then they would forget to bring them back down. And then another kid, the other kid would need one. And so anyway.

Yeah. Good stuff. First aid kit. And you know, Doctor, the thing about emergencies or accidents is they're hard to plan for, but we can have some of the crucial things, right? That we can just sort of look into a crystal ball and say, these are things we might need as parents, since we have active kids who, you know, get injured, get sick, all of that.

So, how best in, your advice to prepare for these sort of unexpected health issues?

Nicole Dudaney, MD: Yeah, that is a great question. And in kids, I do like to mention , emergency situations just because in kids in particular, I've seen one too many times where they look okay for the first few minutes and then they can very rapidly worsen or rapidly deteriorate. So it's very important to keep that in mind, especially if you know that your kid is a little bit more on the high-risk side.

So parents should definitely, you know, prepare accordingly. So some crucial items to have on board, an EpiPen is great for children with severe allergies only if they've been prescribed an EpiPen because of their severity of allergies. And then for kids who have known respiratory issues such as asthma or any sort of compromise in their lungs, a pulse oximeter is also great to be able to monitor breathing and knowing that if it's below around the 92 level, they should be going and seeking immediate medical attention.

And then a reliable digital thermometer is great to track dangerously high fevers. It's also very helpful to have a list of emergency contacts that you can rely on, in case you need to take your kid to the ER. And if you have other older ones at home or younger ones at home, that need to be watched for, you have some emergency contacts that can come and watch them.

Your pediatrician's number also helpful to have. The poison control number is also helpful to have, and then the nearest urgent care or ER. Knowing where that is, having the number, all of that. And that should all be stored in an easily accessible place. But beyond supplies, truly like emergent preparation just means you should know the exact sign of a serious illness. So any difficulty breathing, persistent vomiting, severe allergic reactions, any unresponsiveness or seizures; those are all things that would require emergency services, either in immediate trip to the ER or dialing 911. And in general, it's also helpful for parents to actually have taken a basic infant or pediatric CPR class, especially if your child is more high-risk.

If they are known to have seizures or things like that. So that way if your child does become unresponsive or stops breathing, you can at least do basic medical care and medical CPR before emergency services comes to your home. Yeah, so having a game plan for each of these scenarios and then being able to review the use of proper devices such as an EpiPen injector, knowing how to use that beforehand, and then of course staying calm under pressure that can all make the huge difference in a true emergency.

Host: I just want to have you kind of go through the guidelines, you know, or the best practices to avoid accidental poisonings. Because it's something that, you know, I worried about a lot when my kids were little and thankfully we made it through, but help the rest of the parents out there.

Nicole Dudaney, MD: Yeah. Yeah. I'm glad that that was something that was on your mind when you were, when your were younger. Because we saw them so often in our ER and in our hospital where I was doing my residency training. And it's sadly way more common than we think. And that's with kids of all ages, not even the younger ones necessarily.

So, they are quite common, but they can be prevented with a few simple precautions. So first and foremost, storing all medications, vitamins and supplements out of their reach and out of sight from children completely. Ideally in locked cabinets, the medicines also should be kept in their original containers.

They should have child resistant caps on them so they're not easily accessing them. And then it's also important to never refer to medicine as candy as much as we would like to as parents. But that actually can encourage them to ingest it if they do find it. And then it's also important to avoid leaving any pills on any counters or nightstands or purses or bags, even if you think it's for a short time. Because you never know when they would be able to get access to it and accidentally ingest it. And then, you know, be extra careful too when you have visitors coming over or grandparents coming over having those medications because children may access those without supervision.

And then in general it's very important to have the poison control number on hand and saved in your phone. So that number actually is 1-800-222-1222. And that's those number specifically for the US Poison Control. So that way you can get immediate guidance if an exposure does occur. So for younger kids, supervision and secure storage is key.

And then for the older children, it's important to teach them that medicine is only for them and it's not to share with any friends. So hopefully with that we can prevent a little bit more of these accidental ingestions.

Host: Right. As you say that, they're more common probably than most of us would think. It makes me wonder, Doctor, like what are the recommendations like for how often we should sort of, you know, review and update the contents of our medicine cabinets?

Nicole Dudaney, MD: Yeah, that's a great question. That's not something that a lot of parents, think about very often, but reviewing the contents of your medicine cabinet should be treated, as part of your routine home safety. And I would recommend reviewing it at least every six months. Something that would be helpful is to have some sort of label on your medicine cabinet or medicine bag that says when you last reviewed it.

And then maybe when your next expected to review it and try to aim that for the six month mark. But that does mean checking expiration dates on all your medications, and that includes your over-the-counter medications and topical stuff that we talked about. And then safely discarding or replacing anything that's expired or no longer needed.

And then it's also a good time to review your child's age and your child's developmental stage and knowing as they're growing, what are their specific dosing needs now? Did they outgrow the dose that you currently have for certain medications? Are the medications still safe for them? And then what first aid supplies do we need as our child grows as well?

So for example, certain infant medications or infant formulas may no longer be appropriate as your child grows. And older children, you may want to add on things like, let's say cough drops, for example, if they're able to safely suck on a cough drop. So those are things that you would do in your routine review, And that way it ensures that your medicine cabinet is, very current and very safe and updated to your family's needs.

Host: Yeah, there are definitely times where I felt like I was a sort of an amateur pharmacist. Uh, when my kids are younger, I was like, I'm pretty good at this. Maybe I should have done this as a vocation or

Nicole Dudaney, MD: Right.

Scott Webb: Uh, Doctor, it's, it's great having you here. Nice to meet you and get your expertise and your advice on all this stuff. Like are there some reliable resources, guidelines that parents can refer to, just to stay informed, stay up-to-date about pediatric medications or anything else?

Nicole Dudaney, MD: There are several trusted evidence-based resources that parents can use. And this is much better than, you know, random internet searches or social media advice. Because these are written by and reviewed by pediatric specialists and pharmacists, which is very helpful.

So my favorite one is healthychildren.org. That is a website that's run by the American Academy of Pediatrics or the AAP. And that has extensive guidance on safe medication use in children. And that includes dosing tables, storage recommendations, and signs of when to call a doctor.

So that's usually my favorite resource, I give to parents and they have a plethora of other things too, other articles on, you know, all things that you may need for your child from like picky eating to how to use a nasal suction device, and how to treat wounds and scrapes. So, that website has definitely been a favorite for me.

And then there's other ones too that are equally as amazing, such as MedlinePlus, pediatricrx, kidsforcerx. Those have wonderful, easy to understand guides and dosing charts for our common pediatric medications, and safety considerations that have all been curated by pediatric pharmacists.

And then of course the last resource as mentioned, previously is having poison control center number, saved on your phone because that is the most expert guidance on any accidental ingestions or dosing concerns, and it's wonderful that they're available 24/7 as well.

Host: Yeah. 24/7. No doubt. Well, this is perfect. I really appreciate your time and your expertise. You know, it's not easy being a parent, but fortunately we have resources that, that you shared there, and also the resources of our doctors and nurses and you know, ED, if we need to, if it's that severe. So appreciate your time and all the advice today.

Thank you so much.

Nicole Dudaney, MD: Yeah. Thank you so much for having me. This is a great topic and really the key takeaway is making sure that you are having a very few well chosen, appropriate items on hand and knowing how to use them safely. And then consulting your pediatrician when in doubt. And that can make all the difference.

Host: Yeah. Awesome. Thanks again.

Nicole Dudaney, MD: All right. Thank you so much.

Host: And for more information, go to stanfordchildrens.org. And we hope you found this podcast to be helpful and informative. If you did, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Health Talks from Stanford Medicine Children's Health. I'm Scott Webb. Stay well, and we'll talk again next time.