What You Should Have in Your Medicine Cabinet, According to a Pediatric Nurse

As a mom of two adult daughters and a pediatric nurse since 1981, I have seen A LOT of illnesses over the years. You may not want to listen to your own mother when it comes to parenting advice, but I'm not your mother, so you can listen to me: have some basic medications on hand before your child gets sick. When illness strikes in the middle of the night, you are not going to feel like visiting Walgreens at 3am. A little preparation goes a long way. Here's what I recommend all parents have on hand:

Fever reducer/pain relief

• Acetaminophen (also known as Tylenol) and Ibuprofen (also known as Advil or Motrin) are the most common medications used for fever and pain relief. Remember that you should never give aspirin to a child.
• Acetaminophen/Tylenol infant and children's liquid are sold in the same concentration so they are interchangeable, but the infant bottle comes with a nifty little measuring system and a spill proof bottle which is helpful for accurate dosing. Acetaminophen also comes as a suppository, which is useful for a child who is vomiting or resisting medication by mouth. Keep those in the fridge.
• Ibuprofen is also available in a more concentrated infant form. The infant and child dose are not the same. Make sure you give the correct dosage for your child’s age.

Antihistamines

• Antihistamines are given for general allergic reactions, itchy skin rashes, or insect bites.
• Benadryl will make most kids (and adults) very sleepy, it also can cause a few patients to be jittery. Benadryl usually comes with a warning not to use for children under 4 years old. In many offices, physicians are comfortable going off-label and using these medications for younger patients if indicated. I do not recommend giving it to a young child without speaking to your health care provider.
• Zyrtec has less likelihood of either sedation or the jitters.
• Claritin is an additional antihistamine choice. It also comes as a liquid. It is fine for sneezy allergies, but perhaps not quite as effective for itchy rashes.

Oral rehydration

• If your child is vomiting, you will be glad to have an oral rehydration solution in the house. Options include Pedialyte, Drip Drop, and Pediavance.
• Some of the oral rehydration solutions come in popsicle form, which is great for older kids. Most of the brands also come in convenient powder forms that you simply mix with water—great for travel.
• Breast milk is also great for a baby who is vomiting, but not everyone is lucky enough to always have it on hand.

Topical creams/ointments

• Please pay attention to this rather disgusting factoid: It is easy for tubes of ointments to get contaminated. Think about it. If the tip comes in contact with bacteria from a finger or directly from the body...there you go. Yuck! The best way to avoid this is to make sure that you don't directly touch the tip to anything. Try to keep it sterile. Squeeze the desired amount onto a spoon and then use whatever applicator you want (clean fingers are usually fine).
• Triple antibiotic ointment for cuts or scratches
• Anti-fungal cream for yeast rashes or fungal infections
• Hydrocortisone cream for mild itchy irritations. It comes in a variety of strengths. You can get the weakest ones over-the-counter.
• It is also worth having a basic barrier cream for **diaper rash.**
• Arnica is great for bumps and bruises
• Aloe is great for mild burns (moderate burns should be evaluated)

Basic first aid

• I particularly like the self adhesive gauze popular brands Coban or Coflex. They come in lots of colors and are pretty inexpensive. The advantage of these is that not only do they not hurt when you take them off, your child can’t pull them off without help. Also, your little one can’t eat the band-aid!
• Consider keeping a baggy with some gauze, Neosporin, and a roll of Coban in your diaper bag to take care of the little injuries that happen away from home.
• Ice packs/warm packs: Invest in a child friendly ice pack that you can keep in your freezer. There are loads of adorable ones on Amazon. Holding a soft little penguin or bunny against the boo-boo might elicit a bit more cooperation. Having a microwavable hot pack can also be useful. If you don’t want to buy one, you can fill an athletic sock with rice and that warms up nicely. Another option for a warm pack is to pour some water in a disposable diaper and heat it in the microwave for a few seconds at a time until it is a good temperature.

Equipment

• Have a working thermometer that you have tested for accuracy before someone actually has a fever. As long as your baby is over 2 months, I am not one who is going to focus too much on the exact degree of the fever, but we do want to get a sense of how high it is.
• Every family with a young child should have a nasal aspirator: The hospital will send you home with a bulb aspirator, but many people find those awkward. I really advise that every new parent have a Nose Frida. If the baby has a stuffy nose, or has secretions blocking their nasal passages, these snot suckers are a simple way to clear them.
• Infant nail clippers or scissors and file. Some babies are born with very long nails and can end up really scratching themselves if you don’t clip or file them.
• Have a syringe or dropper on hand for much more accurate measuring of medications.
• Pulse oximeters have gotten very inexpensive. If you or your child is congested, you can easily check the oxygen level.
• Have a good set of tweezers for removing splinters.
• I also suggest having a special tick removal tool.
• Artificial tears, an eye wash kit, gauze and first aid tape in case of eye injury.

Special cases

• If your child is prone to constipation, Pedialax or glycerin suppositories are worth having on hand. If days have gone by without a poop and diet enough hasn't helped to get things moving, these are often the next step. If it is the wee hours of the morning and you have a miserable, grunting and straining kid, getting the poop out is a good strategy.
• If you have a colicky baby, the Simethicone products are safe and work quite well in my experience.
• If your child is prone to mouth sores, Glyoxide seems to help things heal up quickly. You can also make a "magic mouthwash" by mixing a teaspoon of Maalox and a teaspoon of Benadryl and apply topically.
• For eye issues, it is worth having Zaditor. It is an over-the-counter treatment for allergic conjunctivitis. It works quickly if allergies are the culprit. I also find that the homeopathic brand Similason is very soothing.
• For young babies, breastmilk in the eye can hasten recovery for a variety of issues.
• If eye irritation or discharge continues, It might be viral or bacterial. It is time to check in with your doctor. Gooey eyes can be a signal of an ear infection, so a visit is the best way to make sure you are getting the care you need.
• If your child has a history of wheezing, now is the time to make sure you have your asthma medications available. Please check the expiration date and see when they were opened. Many of them are light sensitive so you should always mark the package when you open them.
• If your child uses a nebulizer, the tubing should be replaced every 6 months.
• If you or your child use an inhaler, it should be rinsed out at least once a week. If it hasn't been used for more than a week it may need to be primed. Check the directions on your specific medication.
• Pro Air, which is one of the more popular inhalers, needs to have 3 extra puffs to prime it if it hasn't been used in 2 weeks. Flovent and Qvar are others that need to be primed if they haven’t been used recently.
• For basic congestion, it is worth owning a humidifier and making sure it is cleaned properly.

Pro tips

• With any of your medications, put a strip of masking tape on the side of the open bottle and sign and date your doses. This will avoid the common incident of parents double dosing their babies. This also will help you keep track for those times when you are sleep deprived and frankly can’t remember whether a dose was given or not. I get plenty of frantic calls from parents who have inadvertently overdosed their kids by giving the medications too often. If there is a concern your first call should be to your state’s poison control hotline.
• Make sure that all of your medications are stored in a safe, childproof location (a steamy bathroom is possibly not the best place). Don't underestimate the ability of a climbing child who knows where the gummy vitamins or yummy medicine is stashed. Even older kids can catch you by surprise at times. I recall a 7 year old patient with mystery tummy aches. He finally confessed to being in the habit of sneaking handfuls of gummy vitamins daily.
• Do a routine check for expiration dates. Even though I try to stay on top of this, I can be occasionally stunned by the old stuff that I find lurking in the back of my own medicine cabinet (it runs in my family).
• Please don't randomly toss expired medication down the drain or flush it in the toilet. Medicine can pollute the bay and ocean, or be accidentally misused or abused. Wastewater treatment plants are not designed to remove medications or other chemicals in waste-water; so, after traveling down your drain, medicine may affect our environment.

What does that expiration date mean anyway?

In 1979, the FDA required that manufacturers include an expiration date on prescription as well as OTC products. This is the date at which full potency and safety is guaranteed. Usually, that date is roughly 1 to 5 years from the time of manufacture.

The US military, which maintains large stockpiles of medications for both military and civilian populations for use during an emergency, became very interested in this issue following the 2001 anthrax scare. The cost implications were obvious. Throwing out large numbers of expensive drugs simply because they were past their expiration date was an enormous expense that could potentially be avoided if it was determined that the drugs were effective beyond that date.

To explore this, the FDA analyzed the potency of 122 common medications. The was called the The Shelf-Life Extension Program (SLEP). After vigorous testing of more than 3000 different lots of these drugs, almost 9 out of 10 lots were determined to have more than 90% potency at 1 year past the expiration date. The average extension of this degree of potency was 5 years.

So, while obviously if your child is ill, we don't want to take chances with medications that may be out of date, the bottom line is that in an emergency, expired medications are likely not dangerous. (Always double check the specific medication, there are some exceptions.) They may simply have lost a bit of their potency.

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