“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. 

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• TikTok Videos Encourage Viewers to Overdose on Benadryl

The FDA will require several changes to the labels of all prescription medicines containing these drugs:

• Codeine should not be used to treat pain or cough and tramadol should not be used to treat pain in children younger than 12 years.
• A label warning against its use in children younger than 18 years to treat pain after surgery to remove the tonsils and and/or adenoids.
• A recommendation against their use in adolescents between the ages of 12 and 18 years who are obese or have conditions such as obstructive sleep apnea or severe lung disease, which may increase the risk of serious breathing problems.
• Breastfeeding mothers should not take codeine or tramadol medicines due to the risk of serious adverse reactions in breastfed infants. These can include excessive sleepiness, difficulty breastfeeding, or serious breathing problems that could result in death.

“Opioid abuse has become a public health concern and should be addressed as such. The more awareness we have for providers and families the better the communication can be amongst the community,” said Artee Gandhi, M.D., medical director of the Pain Management Clinic at Cook Children’s.

Dr. Gandhi said tramadol has generally been considered a “safe” drug. However, the physicians in the pain clinic recognize it as an opioid with the same risks as medications such as codeine. In addition to the physiologic effects, there are the psychological concerns of addiction and overdose.

“Early exposure to opioids also increases the risk of misuse and abuse even if prescribed for medical reasons,” Dr. Gandhi said. “Adolescents do not have the cognitive ability to appraise the situation and deem the consequences of prolonged exposure. If prescribed by a physician they must be safe. It is the duty of health care providers to educate patients and families on the correct use of these medications.”

For more information

Cook Children's Pain Management improves the quality of life for our pediatric patients by providing a balance between medicine and therapy.