are your toddler’s meds turning her into a tyrant?

Could medication turn your tot into a tyrant?

2015-01-01 - BY MARGOT BERTELSMANN

While it’s wonderful to have access to medicine that can relieve illness (not to mention lifesaving drugs, are we aware enough of the side effects that drugs can have on some children? We investigate the most frequently administered childhood meds – plus the effects you weren’t hoping for.

ANALGESICS AND ANTIPYRETICS

These very common drugs are used to relieve pain and bring down a fever. Most children’s pain meds contain mostly or exclusively paracetamol (AKA acetaminophen), in familiar brand names such as Panado, Calpol and Empaped. Paracetamol inhibits the production of painand inflammation-causing prostaglandins in the brain. It has no known side effects at regular doses but paracetamol is very dangerous in overdose (so always obey dosage instructions).

Some paracetamol-based children’s painkillers have codeine (as well as antihistamines) added to them (Stopayne and Stilpane). Codeine binds to opioid receptors in the brain and changes your perception of and attitude to pain. It also inhibits the cough reflex so it’s sometimes used at night for better sleep in a coughing child. “We gave our 18-month-old son Stopayne on the plane so we could fly in peace. He bounced all over the plane,” recalls mom Tania Roux – one of many parents with a Stopayne story. However, says paediatrician Dr Paul Sinclair, “bear in mind that hyperactivity related to drugs may be the active ingredients (like the antihistamine promethazine that is found in Stopayne), but equally it could be a reaction to the colourants or preservatives in the liquid, such as the big culprit sodium benzoate. Often sugar is blamed for behavioural changes when kids have eaten sweets, where the real baddie was the additives.”

The other big group of analgesics is made up of the nonsteroidal anti-inflammatory drugs (or NSAIDS). This umbrella term covers ibuprofen, diclofenac and mefenamic acid (Nurofen, Voltaren, Ponstan). NSAIDS affect prostaglandin production not only in the brain, as is the case with paracetamol, but all over the body. If the prostaglandins protecting the stomach lining have been affected, then NSAIDS can cause gastrointestinal distress, so a sore tummy is a known side effect. (While aspirin is also an NSAID, it is not listed here as it is unsafe for children. Never give aspirin to a child as it is linked to the dangerous Reye’s Syndrome.)

ANTIHISTAMINES

As the name suggests, these drugs act against histamine in the body in a variety of genius ways. Histamines are the bad guys who cause allergic reactions in your body, such as runny nose and eyes, itching, sneezing, inflammation, rashes, swelling and so on. Antihistamines come in syrups, or in topical form as eye drops or nasal sprays. Socalled first-generation antihistamines (such as Allergex) are known to have sedating effects, and can also cause a dry mouth or sore stomach. Many parents have also learnt to their detriment that they can affect their child’s mood. “Known as lipophilic antihistamines, they cross the blood-brain barrier easily and can cause drowsiness and personality changes,” says Dr Sinclair.

Phenergan and Vallergan are two examples of these older drugs, and they are the biggest culprit when it comes to turning Gandhi into Gaddafi in your house. In fact, says Dr Sinclair, “Vallergan is used as a sedative before medical procedures or during long travel trips – but it can have the reverse effect! It can also leave kids groggy and hung over. So try it out before your big trip, and use the lowest dose possible.”

The second-generation antihistamines have fewer side effects, but some children are still susceptible. “Antihistamines can make certain kids grumpy and aggressive, and though less likely, some children show similar side effects even on the more modern nonsedating antihistamines, from twitching to restless legs and behavioural changes,” says Dr Sinclair.

STEROIDS

The word probably makes you think of “anabolic steroids” – the things that build muscle and are banned in sports, and which are given to a mother to mature her foetus’ lungs if it has to be delivered early. But it’s corticosteroids that we are talking about here, such as cortisone and prednisone. These reduce inflammation and suppress the immune system, and so they are good treatments for asthma, eczema and allergies. Steroid meds come as a topical application (eczema cream, asthma pump) or syrup.

So what about side effects? “Cortisone (Aspelone) has made my son grumpy,” reports one parent. “It is usually at the third or fourth dose that he gets so grumpy, and it lasts all day.” Dr Sinclair says that steroids can affect behaviour, appetite and sleep. “And the higher the dose, the more likely it is to have an impact,” he says. “So a hungry, ratty, slightly obnoxious child on steroids is probably showing drug-related behaviour and should settle shortly after the treatment is completed.”

LTRAS

Asthma is a battle fought on many fronts, and a drug called montelukast, a leukotriene receptor antagonist (LTRA), sold under trade names Singulair, Monte-air or Kulair, is the latest weapon for long term treatment. Some families, such as the Gouses from Pretoria, called it “revolutionary”: “It was a lifesaver for our son,” says mom Rina. “He turned from constantly sick to the healthier of the two brothers. At the same time, we grew used to him being rather moody. Years later he was placed back on Singulair in conjunction with his usual inhaler. It was as if a switch was thrown – the moodiness returned, big time!”

“Montekulast is a strange drug,”

2 USIDE LEG KICKS This move tones the outer and inner sides of the thighs, as well as the major glute and hip muscles that form part of your hip stabilising group. WHAT TO DO

Standing in waist or hip deep water, hold onto the side of the pool with one hand slightly in front of you.

Tighten your core, inhale and lift your leg to the side while taking eight counts to lift it slowly (as in the image to the right). Allow the buoyancy of your leg to act as resistance.

Exhale while lowering it back down again to its starting position, taking four counts to do so. Once again, use the resistance of the water to work your legs.

Repeat the process for ten repetitions and alternate legs.

LOOK OUT FOR

Be careful not to twist your hips to the side – your hip bones should face forward at all times.

Make sure that your foot is flexed and that your toes are pointed forward. Failure to do so means you will be developing an incorrect muscle strength ratio between the outer and inner thigh muscles of your legs.

Remember to keep your core contracted throughout this exercise, avoiding the temptation to rock your body as momentum or hike your hip up using your back. 3

TRICEP EXTENSIONS You may not realise at first how hard this move works your bicep and tricep muscles while still engaging your core and pelvic floor. WHAT TO DO

Grab hold of a pool noodle with both hands and stand in hip deep water with your back towards the pool wall, feet hip-width apart where the pool floor and wall meet.

Lean forward while pushing the pool noodle into the water with extended elbows (as in 3A). Keep your shoulders back and away from your ears. Slowly bend your elbows while bringing the pool noodle up with your arms (as in 3B). Bend your elbows to the point where you are still able to maintain control of your core and balance. Remember to engage your core at all times. Breathe by exhaling on the elbow extension and inhaling on the bent elbow position. Your goal is to complete two sets of ten of these extensions. Take four seconds to extend your elbows and eight seconds to bend them back to your starting position.

LOOK OUT FOR

Relax your shoulders and make sure your chin is slightly tucked in to avoid compressing and hurting your neck.

Keep your elbows pointing directly behind you – this goes a long way in achieving good muscle tone without straining your neck and shoulders.

Try not to arch your back, but keep your tail bone (coccyx) tucked in by pulling your navel to your spine.

you may not realise at first how hard this move works your bicep and tricep muscles while engaging your core and pelvic floor

This move strengthens your shoulder muscles and tones your upper back. This goes a long way to helping you carry that toddler.

WHAT TO DO

Move to where the water is deep enough to reach your shoulders and straddle your pool noodle.

Stretch your arms out to the side with your palms on the surface of the water (as in the image to the right). The way you hold your hands has an impact on the resistance levels of this exercise: Easy Fingers are splayed out. Moderate Fingers are held tight together. Hard Cut up a pool noodle into two pieces of about 15 to 20cm long to use as dumbbells. Keep your shoulders back and away from your ears and push your arms down to your sides. Remember how important it is to maintain your core, as this will help you balance. Come back to your starting point and repeat. Remember to breathe, exhaling on the down, inhale on the up. Aim to do two sets of 15 repetitions and apply the 4-second: 8-second ratio.

LOOK OUT FOR

It is very important to do this exercise while keeping your core contracted. Be aware of your lifting your shoulders up to your ears. If you are experiencing any discomfort in your neck this is the likely cause.

Another thing to consider is whether your weight is equally distributed on the pool noodle for balance purposes. 5

UABDOMINAL CRUNCHES A new take on the classic crunch, these will strengthen your abdominal muscles while maintaining your core.

WHAT TO DO

Position the pool noodle behind your back with each end tucked under your armpit. The depth of water is irrelevant in this case.

Lean back and lift your feet up while extending your legs, allowing the pool noodle to help you float (as in 5A).

While tightening your core, inhale and as you exhale bend your knees pulling them up to your chest (as in 5B). Use four seconds to bring your knees to your chest and eight seconds to straighten your legs.

Repeat the process for ten repetitions and do three sets.

LOOK OUT FOR

Do this exercise remembering to keep your core contracted. Relax your shoulders and concentrate on using your stomach to pull your legs up.

EXTRA

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