“We are seeing either children are taking the medication in an inappropriate amount intentionally or accidentally ingesting it,” said Stephanie Felton, D.O., associate medical director for the emergency department at the medical center in Fort Worth. 

The trend mirrors a similar spike seen at Cook Children’s in 2020. During that year, patients reported getting the idea from TikTok videos claiming users could hallucinate by taking a dozen or more allergy pills. While that trend eventually faded through education and public awareness, a recent resurgence has prompted medical experts to issue a new alert for parents and caregivers.

“These are heartbreaking cases because these are usually normal, healthy, fully-functioning children that can have dire effects because of this choice,” said Dr. Felton.

She adds that these incidents often bring to light underlying issues, including bullying or psychiatric illnesses such as depression or anxiety.

The Power of Open Dialogue

Medical experts say open communication is the first line of defense in preventing an overdose. Dr. Felton acknowledges these can be difficult conversations, however, she emphasizes it can make a potentially life-saving difference.

“Be aware of what they're dealing with, their environments, what they're looking at, what they're watching,” explained Dr. Felton. “Ask them questions, direct questions.” 

Because Benadryl (diphenhydramine) is an over-the-counter medication, it is easily accessible to children and teens. Experts say it is important to communicate that consuming any medication improperly can be detrimental to a person's health in both the short and long term. 

“There is specific per age, per weight, how much you can take of a medication, if you go outside of that you can cause harm to your body,” said Dr. Felton.

Recognizing an overdose

While it may seem trivial because it is an over-the-counter medication, Dr. Felton explains that an overdose can have lifelong effects. This includes heart arrhythmias, electrolyte abnormalities, or urinary retention that can impact the kidneys. Hallucinations can also affect the brain.

Monitor for these symptoms of an overdose:

• Hot but not with a fever
• Pupillary size
• Heart arrhythmias
• Seizures
• Difficulty breathing
• Hallucination

Tips for Poison Prevention: 

Safe Medication Dosing 

• Follow the dosing directions listed on the medication by using the appropriate measuring items, such as a medicine cup or oral syringe.
• Double dosing is NOT twice as effective, and in many instances can cause internal damage.
• Adult medications may be too strong for children and should not be given in half doses. Only give medicine to your child that is intended for children.
• Print the medication schedule to keep the right dosage for your family. 

Safe Storage 

• Many people leave medications on bathroom and kitchen counters as well as bedroom nightstands as a visual reminder to take them. Avoid unintentional injury and store medication up high, locked, and out of reach.
• Hang purses and personal bags up high so children cannot reach prescriptions, vitamins, or other regularly used medications.
• Remember, when visiting friends and family, it is ok to have an open discussion about safe storage. 

Safe Disposal 

• DEA Drug Take Back Day is on April 25th from 10 a.m.-2 p.m.
• Visit a medication drop box at a local pharmacy. For more information on poison prevention, visit www.meddropbox.org.
• The best disposal option is to find a drug take-back location, which may be found in retail, hospital, pharmacies, and/or law enforcement facilities.
• Removing any unused or expired medication in the home can reduce the risk of access. 

 Related Stories:

• Spring Break with Allergies: Things to Be on the Lookout For This Season
• Cook Children's Experts Warn of Dangerous Social Media Challenges on 'The Doctors'
• TikTok Videos Encourage Viewers to Overdose on Benadryl

On this episode of Raising Joy, we’re joined by Callie Crow, founder of the nonprofit Drew's 27 Chains, in honor of her son who died of an opioid overdose in June 2020.  The organization provides free Narcan and training to law enforcement agencies and other first responders and is credited with saving more than 30 lives to date.

By Ashley Antle

There is a new clear and present danger for children and it’s coming to them through virtual street corners and hidden social media messages. It’s the highly potent synthetic opioid called fentanyl. Similar to morphine but 50 to 100 times more powerful, fentanyl is sometimes prescribed to control severe or chronic pain. Like many opioids, it’s also made and used illegally with deadly consequences.

So far this year at Cook Children’s Medical Center, 15 children have been treated for fentanyl ingestion, some as a result of their own misuse of drugs and some as a result of exposure through someone else’s misuse. That’s up from zero in both 2019 and 2020, and 10 in all of 2021. 

This increase follows national trends. Fentanyl-related overdoses in the U.S. have exploded in recent years. For teens ages 14 to 18, death from fentanyl nearly doubled in 2020 and rose another 20% in 2021, according to researchers at the David Geffen School of Medicine at UCLA. It’s one tragic story after another of a child lost to the drug. A Los Angeles, California, teen dead and six others were hospitalized in September. Three teens from the same school in San Marcos, Texas, dead in August. Thirty-six Georgia teens dead in 2021, and the list goes on and on from coast to coast.

“What we're seeing in the littles is that they sometimes have exposure to fentanyl just because of their environment,” said Elizabeth Peeler, D.O., M.S., M.S.C.S. “They're at the mercy of their caregiver and it's kind of like a wrong place, wrong time situation. They're toddlers or babies, and so they toddle into drugs that are kept in the home. And that can be really scary because they're so small and fentanyl is so potent. It's so strong that just a little bit is enough to make a young child very sick.”

Dr. Peeler is a member of Cook Children’s Child Advocacy Resources and Evaluation (C.A.R.E.) Team. She and her fellow C.A.R.E. Team physicians specialize in examining and treating children who have suffered abuse, including from neglect and drug exposure. This year the team added fentanyl to their regular drug-testing panel due to a sharp increase in the number of fentanyl exposure cases they now encounter.

Drugs in Disguise

The clandestine nature of many fentanyl overdoses is what makes this battle a particularly difficult one.

When it comes to teens — and adults for that matter — it’s not that they are specifically buying fentanyl for a high, it’s that fentanyl is laced into other illicit or counterfeit drugs like Xanax, Percocet and Adderall, to name a few. These drugs don’t come with warning labels from their illegal dealers, so buyers have no idea their purchase may contain hidden fentanyl until it’s too late.

In the most recent fentanyl overdose cases at Cook Children’s, at least two were a result of marijuana laced with fentanyl and two from counterfeit Percocet pills containing fentanyl. The same is true in cases all across the country. According to the U.S. Drug Enforcement Agency (DEA), 42% of pills tested for fentanyl contained a potentially lethal dose of the drug. 

“There’s lots of different reasons why teenagers or adolescents may take a substance, whether it’s to have a good time because of peer pressure, whether it’s because they do suffer from depression or anxiety, whether it’s because they’re curious or because it was in the house and it was an accident,” said Artee Gandhi, M.D., Cook Children’s medical director for pain management and endowed chair for the Center for Pain Management and Integrative Health.

For dealers, adding a synthetic and highly addictive opioid that is cheap, easy to make, and keeps users coming back for more is easy money. However, get the dosage even slightly wrong and it’s deadly. Just two milligrams of fentanyl — the weight of a mosquito — can kill.

“Fentanyl is about 50 times stronger than heroin,” Dr. Peeler said. “Even a small amount can block the brain’s ability to remember to breathe. I want to remind all parents and children that substance misuse can have life-threatening consequences.”

A Mother’s Heartbreak

Callie Crow knows the devastation of fentanyl all too well. For years she watched her son, Drew, spiral into drug addiction, despite raising him in a home where alcohol and drugs were never a factor.

“He breaks that mold of what we sometimes think of as a stereotypical person that's addicted to drugs,” Crow said. “That's one of my biggest pushes is, you know, it's not even what I thought, because I've never done a drug in my life. I don't drink. I don't smoke. That's not something that my kids were exposed to in any way. And so in my mind, they were exempt and it wasn't going to happen to us.” 

Crow describes her son as having an old soul. He was articulate, even as a very young child, smart, funny and loved to learn. Drew was first offered cocaine by a trusted family friend at the age of 14. That eventually led to other drugs and pills and, by 17, he was addicted to opioids.

“We did detox. We did rehab. We did therapy. We did all of the things that, you know, are supposed to help,” Crow said. “And it just never, ever happened. I don't think he ever turned a corner from the time he was 17 on. It was really difficult watching that struggle.”

But there were moments of light. Drew got married and, at the time of his death at age 27, was studying political journalism at the University of North Texas. By then, his opioid use had morphed into a way to survive withdrawal, not necessarily to get high, Crow said, describing her son as a “functional addict.”

That’s what happened the night he died in June 2020. Crow says Drew purchased pills from someone in the town where he lived and took them to avoid withdrawal symptoms of nausea, vomiting, sweating and pain. The pill he took was unknowingly laced with fentanyl. Ten minutes after ingesting it, he was in cardiac arrest and died.

Four doses of Naloxone, also known as Narcan — the FDA-approved drug used to reverse the effects of fentanyl overdose — were within feet of Drew at the time of his overdose. Two on his bedside table that Drew’s wife did not know about and two on the police officer who initially responded to the 911 call placed by his wife. For reasons unknown to Crow, the officer did not administer the Naloxone he carried. Any one of the four doses in Drew’s presence at the time could have reversed the effects of the fentanyl and saved his life.

Since her son’s death, Crow, an EMT- paramedic, has made giving out Naloxone and teaching others how to administer it her life’s mission. She calls the organization she founded in her son’s honor Drew’s 27 Chains. The name is a reference to Drew’s love for disk golf. So far, 36 people have escaped a fentanyl-related overdose death as a result of Narcan handed out at a Drew’s 27 Chains event, and that’s just the ones Crow can track.

Like Crow, Dr. Gandhi is a proponent of keeping Narcan in your home and on your person.

“I think it is important for parents to know that there is a medication that's a nose spray that's available at any pharmacy and it does not require a prescription,” Dr. Gandhi said. “They can walk up to the counter and say, ‘Can I please have a dose of Naloxone?’”

Parental Interference Strongly Advised

“For the first time we are seeing an increase in overdose deaths in adolescents, and it’s predominantly due to the effect of fentanyl, which was not an intentional effect that the adolescent was going for,” Dr. Gandhi warned. “The number of overdose deaths itself has risen every year, but this is the first time that the adolescent population has actually had an increase.”

There are things parents can do to help protect their kids and teens. Running interference for your child against these dangers starts with a conversation. Not just one, but many.

“First and foremost, these conversations have got to happen all the time,” said Lisa Elliott, Ph.D., licensed psychologist and manager of Cook Children’s Behavioral Health Clinic in Denton. “There needs to be dinner conversations. There needs to be conversations in the car. They need to be constantly talking about it and making their kids very well aware of the reality and risks of drugs.”

Dr. Elliott says one way to talk to teens about these dangers is to frame the conversation as information they may need to help a friend. This takes the attention off your kid, she says, and they’re more likely to listen. These conversations should start early, as young children are at risk of fentanyl poisoning, too. Many dealers are disguising pills as candy, and there is always a risk of children ingesting a pill they’ve found on the ground.

Staying as involved as possible in your child’s life is the key to knowing if they are abusing drugs or participating in behaviors that could lead to addiction or overdose. This includes keeping a close eye on their online habits, social media accounts and text threads. A generation ago, keeping kids safe from drugs meant knowing their friends and steering them away from certain hangouts and street corners. Today, social media sites have brought an entire world of virtual street corners and strangers right into your child’s bedroom.

“Being vigilant about your kid’s social media use I think is important,” Dr. Gandhi said. “Your kids can have freedom on those devices but they still need monitoring.”

And for good reason. The prefrontal cortex of kids and adolescents is not fully developed until they are in their 20s. That’s the part of the brain that controls impulse, and that’s why young people have poor reasoning skills when it comes to risky behaviors.

“Kids and adolescents are basically a high-speed car going down a highway at a hundred miles an hour without any brakes,” Dr. Gandhi said. “They have no breaks. They have no self-regulation. They don't know the difference between what's real, what's not real, and what’s just something that you would think is a fluke. They don't understand the long-term implications or consequences of their actions. So don't fool yourself into thinking that your 15-year-old does. They don't. You've got to be involved in screening and monitoring and knowing what your children are having access to.”

Know their friends, Dr. Gandhi says, and communicate with their friends’ parents. She also encourages parents to find activities that kids enjoy but also make them feel like they’re a part of a community.

If you suspect your child is using opioids or other substances, reach out to their school counselor, drug counselor, a mental health professional or their pediatrician for help. If you suspect your child has overdosed on fentanyl or any other drug, call 911.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

Event leaders will be collecting unused and expired medications in a drive-thru in the building’s parking lot, and distributing free medication lockboxes.

Stacey Vanvliet, M.D., an inpatient pediatric hospitalist at Cook Children’s, stresses the importance of locking medications up, even if they seem harmless. She said suicide attempts “have become part of my daily practice” and most are overdoses on a substance that’s “convenient for the children and teens to grab.” While most patients are in their teens, children as young as 8 or 9 are routinely admitted to Cook Children’s for attempting suicide with medication.

“Commonly, we see Tylenol, Motrin, aspirin, Benadryl—things that people just stock in their cabinets to have on hand,” she said. “We see teenagers take huge handfuls of them.”

Each year, Cook Children’s treats hundreds of children and teens for medication poisonings and overdoses. Sadly, the number of these patients continues to reach record levels year after year.

"It is a huge problem right now. We’re seeing more kids in the hospital for opioid overdoses than ever before," said Artee Gandhi, M.D., medical director of Pain Management at Cook Children’s. 

Dr. Gandhi also points out that a recent letter published in the American Medical Association reported a 20% increase in drug overdose deaths among 14 to 18 year olds from 2020. The 1,150 deaths is double the number reported in 2019.

“While teen drug use has remained relatively stable, the biggest problem is kids trying to get their hands on prescription opioids such as oxycodone or other medications such as Xanax and Adderall,” Dr. Gandhi said. “So often, counterfeit versions of these drugs are laced with deadly amounts of fentanyl. Therefore, it is paramount that parents, educators and health care providers argue against medication misuse or drug experimentation at all.”

**Dr. Artee Gandhi and DEA agents will be available for interviews at this event.

Over the last six months, Cook Children's has released 20 articles regarding mental health, suicide in youth and teens, and resources to help young people in crisis. Recently, we spoke with experts to learn more about what families can do to help reduce the risk of suicide attempts and learned that there are a few things that start at home. 

What do you do with expired and unused prescription drugs? Do you throw them in the trash? Do you continue to take them after expiration? Or do you simply let them sit in your home?

Experts at Cook Children’s Medical Center say it is more important now than ever to dispose of unused drugs because of the alarming statistics of young people overdosing. In July, Cook Children’s reported a record number of pediatric hospitalizations for drug overdoses in 2021 compared to previous years, particularly with opioids. 

"It is a huge problem right now. We’re seeing more kids in the hospital for opioid overdoses than ever before. The vast majority of them are intentional ingestions," said Artee Gandhi, M.D., medical director of Pain Management at Cook Children’s. 

“Teens and young adults are having ‘pill parties,’ where they are taking pills from their homes, and bringing them to a party with their friends. They then put them in one large bowl and grab handfuls,” Dr. Gandhi explained. “Not only is this unsafe, but different medications have potencies after their expiration dates and you can get sick from the medication being expired.”

Experts at Cook Children’s say the best thing to do is to safely dispose of any drugs that are expired or no longer being used for their intended purposes.

Savannah Panagopoulos, a child safety, and poison prevention specialist for the Center for Children’s Health led by Cook Children’s, says there are a plethora of take-back boxes in the area that allows people to dispose of drugs safely.

“These are permanent sites, where people in the community can come and drop off drugs, to get them out of the house. Taking medications that are no longer needed or expired out of the household could significantly reduce the chance of accidental poisoning or misuse that's intentional,” Savannah said.

Savannah says “50% of potential drug and substance abuse cases start with a friend or family member giving it to someone in the home that it’s not intended for.”

She goes on to explain that only 4% are purchased from a stranger or a drug dealer.

“Not only does disposing of the drugs safely give you peace of mind, but it’s also important to dispose of them to keep our environment safe. Not flushing the drugs down the toilet, putting them in cat litter, etc.,” Dr. Gandhi said.

She also reminds families that flushing drugs down the toilet is dangerous because of the harm it can do to our water systems. Dr. Gandhi says Cook Children’s pharmacy has a take-back box, which is easy and convenient to use. The box is located inside the retail pharmacy at Cook Children's and accepts any medication, with the exception of liquids. 

“You don’t have to talk to anybody, you don’t have to see anyone. You put it in the disposable container and walk away,” she said. 

Cook Children’s also has a system in place that also texts families to remind them to take back their unused medications and to keep them out of the reach of children.

“We do this so families don’t run into a problem with children unintentionally or accidentally ingesting medication that is not safe for them,” Dr. Gandhi said.

Savannah says while most take-back locations are located in pharmacies, there are other locations, such as police stations, that are open 24 hours a day for safe disposal.

“A good rule of thumb is to take off all labels with any identifying information before you drop them off,” Savannah said. ”Although all drop-off locations are in secure areas that is something we tell people to practice for safety and privacy.”

The United States Drug Enforcement Administration (DEA) also hosts national take-back days across the country every year. In April, more than 4,000 law enforcement agencies participated, which resulted in nearly 900,000 drugs being taken out of homes and disposed of safely. The next National Take Back Day is Oct. 23, 2021. Information about national takeback days can be found here.

Both Cook Children’s experts want families to know and spread the word about this resource. It is important to know that you don’t have to wait for a medication to expire and if the medication is expired, you can drop it off before you go and get a fresh prescription.

Cook Children’s Center for Children’s Health has a page dedicated to poison prevention. The North Texas Poison Center is open 24/7 and can be reached at 1-800-222-1222. You can find information about drop-off locations in North Texas, pain management, and more.

It is important to note you cannot dispose of items such as needles, oxygen tanks, thermometers, and sharps when dropping off your medication.

Dr. Gandhi says the most important thing to remember is, if you are done taking medicine and have used it for the intended purpose, dispose of it like you would an antibiotic or anything else.

“This goes for over-the-counter medication such as Tylenol, Ibuprofen, Aleve, etc,” she said.

Statistics, no matter how alarming, sometimes blur into faceless numbers when parents hear them on TV or read them in a news story.

That’s until it’s your child in the emergency room, hooked to an IV while receiving treatment for ingesting too many pills—in this case, over-the-counter pain meds often used to relieve menstrual cramps—with the intent of harming herself.

And then suddenly, those numbers have a face. For Betty, a Tarrant County mom who asked not to be identified to protect her 14-year-old from any stigma attached to her attempted suicide, the face that came fully into focus was her own teenage daughter’s.

Betty’s daughter is among the many children and young adults across the country who’ve used excessive doses of common drugs, like pain relievers or allergy medications, with the intent of harming themselves. National studies have shown OTC meds as the No. 1 means used by youths in suicide attempts and the third-leading cause of youth suicide deaths.

“I really didn’t put those in the category of prescription medications, so I never put them away,” Betty said of the handful of OTC meds—a combination of Motrin and Midol—her daughter swallowed earlier this year. (Motrin contains ibuprofen, and Midol is a mixture of acetaminophen, caffeine and pyrilamine maleate, an antihistamine.) “I want other people to know, and to even have lockboxes for their medications, so that someone else doesn’t have to go through what we went through.”

Her daughter, who went to school but said it wasn’t the same because of COVID restrictions, had felt isolated and been sad because she missed her friends, she said. She faced the typical teenage stuff like low self-esteem, Betty said, but she had no idea her daughter was considering suicide.

“She’s seeking treatment now, but I want to be really clear, ‘Put all your medications away, not just your prescription medications,’” she said.

Betty is far from alone in facing this issue. Other parents across the nation also are grappling with children and teens who are intentionally overdosing with easily accessible OTC meds.

In a study published by The Journal of Pediatrics in May 2019, Nationwide Children’s Hospital and the Central Ohio Poison Center found that suspected suicide attempts by self-poisoning in children and young adults had doubled in the past decade. The research, which targeted ages 10 to 24 during 2000 to 2018, also showed suicide attempts using OTC meds had tripled among girls and young women.

The same researchers later expounded on the initial report, pointing out that the two most commonly used substances among all age groups were OTC pain relievers—such as acetaminophen, ibuprofen and aspirin—followed by antidepressants.

Last year, a study conducted by the Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children’s Hospital focused specifically on the use of OTC pain relievers in suicide attempts, showing a 57-percent hike in overall cases from 2000 to 2018. Children and young adults between 6 to 19-year-old made up half of the cases, and of those, 73 percent were female, the study showed.

Researchers analyzed 549,807 suicide-related calls made to poison control centers across the United States that involved OTC medications. The study, published in Pharmacoepidemiology and Drug Safety journal, also determined a 34-percent rise in the frequency of those cases during that time period, caused primarily by a jump among calls involving 6- to 19-year-old females, researchers said.

The results from the study showed the breakdown of OTC substances involved in the calls: 48 percent, acetaminophen alone; 33 percent, ibuprofen; and 19 percent, aspirin. Acetaminophen and aspirin accounted for 65 percent and 33 percent of deaths, respectively. Aspirin created the most serious medical outcomes for 36 percent of the cases and 68 percent of the cases with aspirin were admitted into a health care facility compared with other OTC pain relievers. Overall, while suicide-related cases using acetaminophen and ibuprofen climbed, the number involving aspirin decreased, researchers found.

Although local numbers on these types of cases are not yet readily available, physicians at Cook Children’s Medical Center are noticing a similar increase in intentional OTC medication overdoses.

Stacey Vanvliet, M.D., an inpatient pediatric hospitalist at Cook Children’s, said suicide attempts “have become part of my daily practice” and most are overdoses on a substance that’s “convenient for the children and teens to grab.” While it’s mostly older ones, children as young as 8 or 9 come in for attempting suicide, she said.

“Commonly, we see Tylenol, Motrin, aspirin, Benadryl—things that people just stock in their cabinets to have on hand,” she said. “We see teenagers take huge handfuls of them.”

Many people have a misconception of how dangerous these drugs can be when ingested over the recommended dosage, Dr. Vanvliet said. For example, high levels of acetaminophen (as in Tylenol) can cause liver damage or acute liver failure as well as other serious health issues.

“I think another misperception is that there’s a certain type of patient or type of teen that might try to overdose. Or that there’s a certain stressor or pattern, so to speak, that this happens and then the teen goes for pills or whatever it may be,” she said. “But in my experience, that’s not the case. We certainly have children who have undergone significant trauma and have mental health issues…but we also have children who haven’t shown a whole lot of warning signs and are very high achievers.”

When a child or teen attempts suicide, it’s usually an impulsive decision, Dr. Vanvliet said, which makes the accessibility to OTC meds more dangerous.

“You’d be amazed at some of the things that trigger them to make a serious attempt. It can be something as small as, ‘My mom took my phone away because I got a bad grade,’ or ‘My best friend is mad at me,’” she said. “It’s not necessarily anything that’s huge…but they make these snap decisions, and they go take a handful of pills, and it could be really damaging. It happens over and over, unfortunately.”

So, what can be done to keep children safe? Many health experts and researchers propose restricting the amount of OTC meds that can be purchased at one time and suggest unit-dose packaging, such as blister packs, as well as promoting safe storage for OTC and other medications.

Responding to that call, The Jordan Elizabeth Harris Foundation, a Fort Worth-based nonprofit group that targets suicide prevention, plans to launch Keep All Meds Secure (KAMS) public awareness initiative this summer. Christina Judge, the foundation’s executive director, said the initiative includes educating families and caregivers on the dangers of various medications, providing lockboxes for safe storage and advocating safe disposal of old medications. The foundation also offers free suicide prevention training to help parents to know what to look and listen for with a child who might be considering suicide.

The initiative began with a phone call that Judge received. A frantic mother, whose daughter had taken a handful of Tylenol and a handful of Advil, called the foundation seeking help in finding a bed at a mental health facility for her daughter.

“The pivotal moment was just hearing the anguish in the mother’s voice,” Judge said. “I asked her, ‘Did you know that these drugs in the hands of a suicidal child could be lethal?’ She said, ‘No. We just keep them in the cabinet above the sink.’”

“Well, that was enough for me,” Judge said, who researched the topic, presented a case for it and sought funding for the initiative.

Vanvliet believes programs such as KAMS will help with suicide prevention among children and teens.

“Education for parents and keeping those substances safe, I think, is a big part of preventing this from happening,” she said.

For Betty, what happened to her daughter has made her even more vigilant. She has always paid close attention to safety in her house. The family’s guns are always locked away in a safe, along with prescription medication. Now, she secures her OTC meds, too, she said.

She’s thankful her daughter, who’s getting ongoing treatment, didn’t suffer any long-term health effects from the incident. But Betty is highly aware that it all could have ended much differently that day her daughter tried to overdose.

“I think she got scared and came to me and told me. I’m so glad she did,” Betty said. “And I have to say if there were more pills in the bottles, we would have had a much different situation…it could have been much more harmful.”

“Like I said, we’d locked up everything else except for that. And if we had locked that up, maybe we would have avoided this,” she said.

Hospitalist nurse practitioner Amber Jewison and psychiatrist Kia Carter, M.D. were featured on the nationally-syndicated show “The Doctors” on Thursday, Nov. 5. The show highlighted a recent trend of TikTok videos that encourage viewers to take excessive amounts of the common allergy medicine diphenhydramine, aka Benadryl.

Cook Children’s first reported on these videos on Checkup Newsroom over the summer after three teens were admitted to the hospital for overdoses.

“We had three patients in a week who specifically told me they saw a video on TikTok that told them they could take Benadryl to get high, and it gave them a specific number (to take),” Amber said in an interview on "The Doctors." “When I viewed that video, I was pretty shocked.”

Patients who overdose on Benadryl can have abnormal electrocardiograms (EKGs) and may not be able to urinate. It’s even possible to suffer seizures. Amber has treated such patients and says parents are usually shocked to find out their child has overdosed.

“I try to tell parents that it’s really good to know what’s out there on social media and to be aware of what your kids may be doing,” she said.

And it’s not just shocking for parents. Medical professionals are also surprised to see healthy adolescents and teens taking part in these dangerous challenges.

“I was alarmed, I was extremely shocked that children are participating in something so lethal,” said Dr. Carter, who is also the medical director of Psychiatry at Cook Children’s. “Being a parent myself, it’s petrifying to think about the idea of my pre-adolescent daughter participating in this.”

So why do teens participate in dangerous viral challenges like the one involving Benadryl?

“I think people have to realize that children’s brains are not fully developed like an adult and judgement and executive function are a huge part in making decisions. When we see kids participating in these high-risk behaviors, we have to remember that their brains are not fully developed,” said Dr. Carter. “There’s some research also to show that social media and participating in these challenges is activating the reward center in the brain, which can cause kids to become further attached to participating in these challenges.”

Dr. Carter says it’s also important to realize the difference between a child participating in an online challenge, and one who is actively trying to harm themselves. She says kids who are taking part in challenges because they want to fit in are usually active and part of a social group. Kids who are taking medicines or over-the-counter substances to harm themselves are often excluded or bullied on social media.

Her advice for parents - be aware.

“Know what your children are doing on social media, participate and ask questions,” Dr. Carter said.

Three teens were treated at Cook Children’s in May after overdosing on the common allergy medicine diphenhydramine aka Benadryl. Each of these patients said they got the idea from videos on TikTok that claimed users could get high and hallucinate if they took a dozen or more of the allergy pills.

One of the teens who ended up at Cook Children’s is a 14-year-old named Rebekah. She took 14 Benadryl pills in the middle of the night on Memorial Day.

“I got a call from mom and she was telling me I need to wake up,” said Katie, Rebekah’s mother. “I didn’t know what was happening.”

Katie was asleep when Rebekah appeared in her older sister’s bedroom, obviously intoxicated from the pills. The eldest sister called their grandmother for help, likely trying to avoid getting in trouble with their parents.

“It was scary. She had fractured sentences, hallucinations. Her resting heart rate was 199,” Katie explained. “We rushed her to the local ER and they decided to transport her to Cook Children’s.”

While at Cook Children’s, doctors performed an electrocardiogram (EKG) and they didn’t like the results. Rebekah was admitted to the hospital and observed overnight. Thankfully, her heart rate returned to normal the next day and she was able to go home.

“What struck me was that we had three teens come in for the same thing in one week,” said Amber Jewison, a hospitalist nurse practitioner at Cook Children’s Medical Center. “None of these patients were trying to harm themselves. They all said they saw videos on TikTok and were curious to try it.”

What these patients didn’t realize is that not only can a Benadryl overdose be harmful to your health, it can also be deadly.

“Too much diphenhydramine can cause a high heart rate and trigger arrhythmias,” said Jewison. “It can also cause hallucinations, seizures and require a catheter to drain urine from the bladder due to not being able to urinate.”

For Katie, the experience was eye opening. She said she never imagined her daughter would try such a thing and was completely shocked by the ordeal.

“As a parent, you worry about drugs and you know the signs for drug use. I never thought about having to lock up my allergy medicine,” she said. “I just want other parents to know about this because it’s dangerous and I had no idea. And I’m angry. These people are essentially prescribing medication without a medical degree and our kids are trusting them.”

Fortunately, Rebekah shouldn’t have any long-term health effects due to her overdose. Her mother hopes this incident will be a wakeup call for the teen and prevent her from putting herself in danger in the future.

In addition to the Benedryl videos, parents should also be aware of a popular TikTok challenge. It’s called the nutmeg challenge, in which TikTok users drink two to four tablespoons of nutmeg with milk or water and film their reactions. The objective is to get high from the large amount of the spice, but doing this can have detrimental effects on the body.

According to the American Association for Clinical Chemistry (AACC), one to four teaspoons of nutmeg can cause dry mouth, agitation, hypothermia, hallucinations, among others — and in some cases, coma and death.

So if your child or teen has a TikTok account, or spends any time online at all, it’s a good idea to monitor what they’re watching. Remember, they’re still developing the part of the brain that controls judgement and impulsivity. It may help to remind them that online challenges, even with things that may seem harmless, can have scary and serious consequences.

“Despite being a staple in pediatric care for decades, cough medicines don’t work,” said Justin Smith, M.D., a Cook Children’s pediatrician. “Since being first approved for use in children in 1976, they have failed to prove their effectiveness for acute cough.”

This message is echoed in a new video released by the American Chemical Society. In it, the narrator explains how antitussive drugs are supposed to block the body’s cough reflex. But most studies have found no evidence that over-the-counter medications actually work. Often, they proved no different than a placebo.

Not only do they not work, they can have serious side effects. Thousands of children are sent to the emergency room every year due to accidental overdoses on cough medicine. More than half of those are children under the age of six.

“I don’t give my children cough medicine and I don’t prescribe it for my patients,” said Dr. Smith. “Instead, parents need to know that keeping a child hydrated can help with a cough. By drinking plenty of fluids, kids are able to thin out any extra mucus triggering their cough.”

Dr. Smith says humidifiers are also helpful for children. You can place one in their bedroom while they’re sleeping to ease their breathing.

“In medicine, you have to weigh the risk with the reward. For cough medicines, there are numerous risks and possibly zero benefit.”

About the Source
Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.