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.

But, does it help? Is it necessary?

I personally don’t think so…and here are 4 reasons why:

1. I don’t treat numbers, neither temperatures nor times.

When your child has fever, sometimes it’s not such a bad idea to let it be. If the child isn’t too uncomfortable and they are drinking well, it’s reasonable not to treat even if their temperature is high. If you’d like more information, read this great post from Dr. Paul Offit called, “The Case for Letting Fever Run It’s Course.” The bottom line is that treating fever may in fact cause the symptoms to last longer and the child to be contagious longer than just letting it run it’s course.

Bottom line: If treating the thermometer is not the best idea, should we be treating a child every three hours, around the clock, just in case? Maybe not.

2. It might keep the temperature lower, but it doesn’t make kids feel better.

There have been a few studies that suggest treating fever on a scheduled basis might keep the child’s temperature lower. So, it probably does work to do that. The interesting thing with those studies is that when you ask the parent how well they thought the fever was controlled, both groups reported that their fever control was adequate.

Bottom line: Even if the temperature was lower, the parents couldn’t tell the difference in how the child felt.

3. It increases the risk of extra doses.

When your child is sick, you are tired and stressed, things are complicated enough. The risk of extra doses is significantly higher when you are alternating medications. While the risk of an extra dose here and there probably isn’t high, if there is little to no benefit, I choose not to risk it.

Bottom line: If you are going to do alternating doses, write them down somewhere to keep track.

4. I’m lazy and it’s too much trouble for me.

This is not one of those issues that I’m willing pick a big fight with another doctor or patient over…but given the three points above combined with my desire to keep everything as simple as possible, I don’t personally alternate fever reducers for my kids and I don’t routinely recommend it for my patients.

Well, it is not from teething but it could be from the treatment you are using for it.

Fever, congestion, diarrhea, fussiness, putting things in their mouth, not sleeping well, you name it and someone has attributed it to teething.

So how do you treat the pain associated with teething?

There are lots of products available most of which are not helpful and can be potentially harmful.

Avoid products with benzocaine and lidocaine (oragel and other gels). These have been known to cause a problem in babies called methemoglobinemia where your child will turn BLUE. I mean smurf crazy blue and is obviously a medical emergency. Also, avoid products with belladonna (teething tabs) as this has known to be poisonous and doesn’t have studies proving that it decreases pain anyway.

This quote comes from the healthychildren.org article on teething (click to see full article):

“To ease your baby’s discomfort, try gently rubbing or massaging the gums with one of your fingers. Teething rings are helpful, too, but they should be made of firm rubber. The teethers that you freeze tend to get too hard and can cause more harm than good.) Pain relievers and medications that you rub on the gums are not necessary or useful since they wash out of the baby’s mouth within minutes. Some medication you rub on your child’s gums can even be harmful if too much is used and the child swallows an excessive amount.”

So what symptoms really do come up before babies cut their teeth? When can we expect teeth to erupt? What can we do for our children when they are teething?

The best study I have found about teething was done in 2000 and included lots of kids and 475 tooth eruptions. Click here to see the study.

The symptoms that they found to be associated with teething were the following:

• Biting
• Drooling
• Gum-rubbing
• Sucking
• Irritability
• Wakefulness
• Ear-rubbing
• Facial rash
• Decreased appetite for solid foods
• Mild temperature elevation

The following symptoms were NOT associated with teething:

• Congestion
• sleep disturbance
• stool looseness or increased stool number
• Decreased appetite for liquids
• Cough
• Rashes other than facial rashes
• Fever over 102 degrees F
• Vomiting

I have seen some studies that will include congestion in the symptom list for teething. I think one of the main misconceptions is about fever. I commonly have parents ask if 102-103 temp could be caused by teething and the studies are pretty clear that if the fever is that high, it probably isn’t just teething.

If our children are particularly fussy from teething, we will occasionally use Tylenol^® and if more than 6 months old Motrin^® according to weight appropriate dosing sporadically for a day or 2 until symptoms subside.

The main thing is that you have to be flexible with your child and allow them a little extra grace for changes in sleep and feeding habits. Teething is normal and should be consider a normal developmental stage. It can be disruptive to schedules and the extra fussiness can make things stressful. Hang in there, this phase is temporary.

Related article:

4 teething myths every parent should know