“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

The Centers for Disease Control and Prevention (CDC) found that nearly half of all people who enter an urgent care center, or walk-in clinic, with symptoms of a cold or flu leave with a prescription for an antibiotic.

The study found that 46 percent of urgent care patients were prescribed antibiotics for conditions, compared with 24 percent at emergency rooms and 17 percent at medical offices.

Educating families and staff on antibiotic overuse has become a focus of Parul Martin, M.D., medical director of Cook Children’s Urgent Care Centers. She joins the national movement on this topic to improve antibiotic stewardship and has highlighted this topic of concern in her presentations for the Urgent Care Association (UCA).  Additionally, the Cook Children’s Urgent Care Quality Improvement and Research Council is collaborating with the UCA to improve antibiotic prescribing practices nationally.

“Cook Children’s proudly supports a culture of clinical excellence,” Dr. Martin said. “Our practice standards are very high. We follow the American Academy of Pediatrics guidelines and we follow evidence-based medicine across the board, including our primary care offices, our specialties, our Emergency Department and our Urgent Care Centers. Everyone is held to those same high standards. We are continually educating our providers about antibiotics and the treatment of viral illnesses. But we also have to continue to educate the families we treat about the proper use of antibiotics.”

Many families don’t want to leave a doctor’s office without an antibiotic. But Dr. Martin said it’s important that doctors explain to families that too much antibiotic use can be harmful to a child. Education is the key to reaching a long term solution to the current crisis.

“We’re a little more proactive on this issue than some of the other Urgent Care Centers or walk-in clinics you may take your children to if they are sick,” Dr. Martin said. “We don’t have the same pressures that they do to stay in business based on volume. If families aren’t prescribed an antibiotic they may go somewhere else. That’s a tough position to be in because if those clinics don’t satisfy the families, they aren’t going to stay in business. That’s part of what has led us to this antibiotic crisis we are in right now. As caregivers, we have to be unified and responsible about only giving this medication when it’s absolutely necessary.”

For viruses that cause illnesses such as the common cold, also known as an upper respiratory tract infection, antibiotics aren’t effective. Antibiotics don’t stop viruses. They only kill bacteria.

The CDC estimates 47 million unnecessary antibiotic prescriptions are written in doctor’s offices, emergency rooms and hospital-based clinics each year. Furthermore, they estimate up to one-third to one-half of antibiotic use in humans is either unnecessary or inappropriate.

Using antibiotics the wrong way can cause bacteria to grow into superbugs and this could mean a problem for your child.

“Antibiotics are drugs used to treat bacterial infections,” said Marc Mazade, M.D., a pediatrician who specializes in Infectious Diseases at Cook Children’s. “Over prescribing or using antibiotics the wrong way can lead to antibiotic-resistant infections. This means the next time your child is sick, the next infection could be much harder to treat when he or she really needs an antibiotic.”

If you are unsure if you or your child needs an antibiotic, ask your health care provider these 5 questions:

1. “Do I really need an antibiotic?”

2. “Can I get better without this antibiotic?”

3. “What side effects or drug interactions can I expect?”

4. “What side effects should I report to you?”

5. “How do you know what kind of infection I have? I understand that antibiotics won’t work for viral infections.”

Each year in the United States, at least 2 million people get serious infections with bacteria that are resistant to one or more of the antibiotics designed to treat those infections. At least 23,000 people die each year as a direct result of these antibiotic infections, according to the CDC.

“I think what happens sometimes is that health care providers feel pressured to give antibiotics from their patients or in a child’s case, the patient’s family,” Dr. Mazade said. “The parents feel they are doing what is right for their child, but the reality is that they may be causing long-term harm to him or her. If they overuse antibiotics, the next time children need the drug to fight off an infection, antibiotic resistance may make the antibiotic useless.”

Antibiotic resistance happens when bacteria change in a way that reduces or eliminates the ability of antibiotics to kill the bacteria.

You do not need antibiotics for:

• Colds also known as upper respiratory tract infections (URI)
• Most coughs and bronchitis
• Sore throats not caused by strep bacteria
• Runny noses, stuffy noses and nasal congestion
• Seasonal Allergies
• Most earaches
• Bug bites by themselves
• Most Diarrhea
• Most Rashes
• Uncomplicated flu infection and RSV infections

Currently, I am the lone survivor of the war on Smith-Summertime-Flu-Like-Illness-2015.

You name the symptom and someone in my family has had it: fever, cough, runny nose, congestion, headache, sore throat, vomiting ... I could go on.

All of these symptoms are annoying. Running to grab the “puke bowl” when your 4 year old is “frowing up” is not my idea of a fun nor peaceful Wednesday evening. Trying to discern if his “headache” is really a headache, or fever or the early stages of some terrible bout with meningitis is not good for this pediatrician’s soul (nor his wife’s after she read this. It’s not meningitis, babe, I promise).

But the most annoying of all these symptoms for me is cough. When I have a cough, I generally try my best to keep it in for as long as I can, and let it go just before I feel like I’m going to drown in post-nasal drip. When my 6 year old has a cough, I’m pretty sure he feels like it is his duty to release that cough every five seconds. I think he does this just to remind me that he’s not feeling well and I haven’t given him anything to help.

Why don’t I give my kids cough medicines?

I don’t give cough medicine to my kids because they don’t work.

They really don’t.

Really.

The hard thing about this fact is that they were a staple of pediatric care for decades. Cough and cold medicines were first approved for use in children in 1976. There were no studies done to determine if they worked or what the appropriate dosing should be. I think the process back then went something like this:

“Why not give half the adult dose for children 5-12 and a quarter for the adult dose for children age 2-5?”

“Sounds good to me, let’s do this.” (Or maybe “Right on!” or “Groovy!” I don’t know, it was the 1970s.)

Since 1976 there have been several studies looking at the use of cough and cold medicines. The most recent review of the 25 best studies done stated this as a conclusion: “There is no good evidence for or against the effectiveness of OTC (over the counter) medicines for acute cough.”

I don’t give cough medicine to my kids because they can cause problems.

Side effects, even serious, even fatal ones, can occur as a result of giving kids (especially those under 6) cough medicines.

If you want to read some scary stories read these case reports from Pediatrics:

1. 3 year old ends up in ICU after becoming lethargic, having a slow heart rate, fast breathing and high blood pressure. Diagnosed with toxicity from Dimetapp (in this one we don’t know how much mom gave-could have been too much).

2. 3 year old being treated for pneumonia develops a fast heart rate, so fast that it start to interfere with the heart’s ability to work right. Parents were thinking they were giving Tylenol but ends up they were giving Tylenol Cold (acetaminophen, chlorpheniramine and dextromethorphan).

3. 9 month old boy is discharged from the ER with a diagnosis of pneumonia, doing well. Returns 12 hours later after being found cold, blue and not breathing. Unfortunately he dies after he is unable to be resuscitated. Toxicology on autopsy finds acetaminophen, pseudoephedrine, chlorpheniramine and dextromethorphan in the blood and heart tissue.

It is estimated that about 7.000 children are treated nationwide for toxicity related to cough and cold medicines and 64 percent of those are children under 6 years of age.

Everything in medicine is about weighing whether something works and if it could be harmful.

Cough medicines do not work and could cause harm, so my kids will pass.

P.S.

So will my patients because I don’t prescribe them either.