The Dangers of Acetaminophen for Children

CHOC Children's PharmacyAcetaminophen is a safe, popular pain reliever and fever reducer, but it can have devastating consequences for children if not taken properly, a CHOC Children’s pharmacist cautions.

Better known as Tylenol, acetaminophen is the medication most commonly given to American children, with 11 percent of children nationwide using the drug each week, says Ron Snyder, Pharm.D.

“It’s found in many over-the-counter prescription products, including cough and cold remedies and narcotic pain relievers,” Ron says. “The drug is generally considered safe, but can be toxic if taken in high doses or in certain situations.”

Acetaminophen can be toxic to the liver and is one of the most common causes of unintentional and intentional poisoning in the United States, he says.

Incidences of acetaminophen-related toxicity have increased over the past decade, Ron says. Each year, acetaminophen-associated overdoses account for approximately 56,000 emergency department visits, 26,000 hospitalizations and more than 450 deaths.

Here’s what parents can do to ensure their children use acetaminophen safely:

Read the product labels carefully.

Dosing can be confusing, so read labels carefully and ask for help in determining the correct dose. Parents should also limit the amount of acetaminophen taken per dose and limit the amount taken daily.

Be wary of acetaminophen availability from multiple sources.

If taking multiple medicines, be sure to check that child won’t “double dip” on acetaminophen. A big culprit behind overdoses is unknowingly taking acetaminophen from multiple sources, Ron says.

For example, someone with the flu may take Tylenol for a headache, as well as a cough medicine with acetaminophen. This can be extremely dangerous.

Double check what kind of concentrated liquid acetaminophen you have at home.

Liquid acetaminophen used to come in varying strengths for infants and children. The U.S. Food and Drug Administration found that confusion over these types led to overdoses that made infants seriously ill or die from liver failure.

Because of this, the industry has changed to one liquid strength of acetaminophen. However, older and stronger concentrations of acetaminophen once marketed for infants may still be available or in medicine cabinets. Again, read labels to know what you have and how much to give to a child.

Use the dosing device included with the medicine.

Kitchen spoons aren’t all the same, and a teaspoon and tablespoon used for cooking won’t measure the same amount as the dosing device. Rely on what’s included with the product to ensure proper dosing.

Early symptoms of acetaminophen overdose include vomiting, nausea, stomach pain, paleness and tiredness. If a parent suspects their child has overdosed on acetaminophen, call poison control immediately at 800-222-1222.

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Medication Safety FAQs Every Parent and Caregiver Should Know

To help keep your little ones safe from common medication mishaps, check out the answers to some of the most frequently asked questions about medications, medication safetyprovided by Shannon Bertagnoli, pharmacy safety coordinator at CHOC Children’s.

Why does my child’s medication look different?

A: If your child’s medication looks different in color, shape or size from the last time, make sure to review this with your pharmacist – you should have all your questions answered before going home. Sometimes there are multiple brands for the same medication that can look different, but it’s always good to double check. Some pharmacies are open 24 hours so if you get home and have additional questions, you should be able to reach someone even if it’s a different location where you filled your prescription.

Can I use a teaspoon or tablespoon to measure my child’s medication?

A: Never use a household teaspoon or tablespoon to measure the dose as these can vary in different households. When you are picking up a new prescription or over the counter medication read back the directions to the pharmacist. For example: I will give my child 10 mL of amoxicillin three times a day. If it is a liquid, demonstrate how you will use the dispensing device to your pharmacist. If you are unclear if your child’s medicine comes with a measuring device or a dosing cup, ask your pharmacist to recommend an oral syringe to use.

What should I ask my pharmacist when I pick up a new prescription?

A: Remember to tell your pharmacist if your child has any allergies even if you have already told your doctor. Ask your pharmacist what are the most common side effects of the medication, or if there is anything you should monitor for.

Is the bathroom medicine cabinet the best place to store my medications?

A: This is not the best place to store medications because the heat and humidity from the bathroom can break down the medicines and make them less effective. Instead, select a single and secure location in a cool, dry place that is up, away, and out of reach of children. Avoid storing in purses or drawers that children have access to.

Why does my child need to take multiple tablets to make up one dose?

A: It’s important to know that it’s uncommon to need more than two or three tablets, vials or syringes for a single dose of medication for a child. Before administering more than two or three of anything to your child, first verify with a pharmacist. Explain your concerns and have them double check the dose based on your child’s age and weight.

My youngest child is having symptoms similar to my older child. Is it ok to share medication if they have the same condition?

A: Your child’s individual medical condition and tolerance to the medication may vary. Children’s medication dose also varies based on age and weight. You should never share your children’s medication. It’s important to consult your child’s doctor if you have any questions about this.

Who should you call if you have a question about a potential poisoning?

A: A great suggestion is to keep the Poison Center Hotline readily accessible: 1-800-222-1222. Poison centers provide immediate, expert advice, 24 hours a day, seven days a week. Seek immediate medical attention if advised by the Poison Center or if you have any concerns about your child’s safety.

What should I do if I drop a pill on the floor and cannot find it?

A: Stop and look everywhere until the pill is located. If you don’t find it, your child or pet is likely to. Depending on the medication, we know that even one pill can cause significant harm to a small child or pet.

For additional medication safety guidelines, visit

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Household Poisoning Hazards

Aufpassen: Baby will mit Putzmittel spielenPoison control centers across the country receive more than two million calls a year. Most of the calls involve children ages 5 and under who have been accidentally exposed to poisons in the home.

Considering the active and curious nature of young children, parents need to take extra precautions to prevent their little explorers from getting into dangerous household items.

Dr. Lilit Minasyan, who works in the Emergency Department at CHOC, offers the following tips to help prevent accidental household poisonings:

  • Store all vitamins, narcotics, over-the-counter medications, household cleaners, cosmetics and liquor in a locked or latched cabinet out of the reach of children.. Even items that may seem harmless, like iron-rich vitamins meant for adults, could be dangerous if kids ingest them in large quantities.
  • Never tell children that vitamins or medications are candy.
  • Always keep pills, household cleaners, liquids and other possibly toxic substances in their original containers. Don’t put them in soda bottles or food containers; your child might eat or drink from them.
  • Don’t keep cleaning supplies, including dishwasher detergent and dishwashing liquids, under the kitchen sink where kids can easily get to them.
  • Keep hazardous automotive products, locked and out of a child’s reach, in the garage.
  • While cleaning the house or using household chemicals, never leave the bottles unattended if a small child is present.
  • Memorize the national poison control center phone number – 1-800-222-1222 – and program it into your cellphone.

If you think your child has ingested a toxic substance, don’t induce vomiting, says Dr. Minasyan. A child could choke on the vomit or the vomit could travel into the lungs. Some cleaners and substances will cause internal burns in the mouth and throat, so it’s important to avoid further injury.

If your child is unconscious, not breathing, or having convulsions or seizures, call 911. If your child has mild or no symptoms, call the Poison Control Center at 1-800-222-1222.

To learn more about poison prevention in the home, please visit

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Medication Safety in the Home

Every 10 minutes in the United States, there’s a child under the age of 6 taken to an emergency department for medication poisoning. Most of the incidents occur in the home, a CHOC pharmacist tells CHOC Radio.

In podcast No. 23, Dr. Shannon Bertagnoli offers tips to help prevent children from getting into medications:

  • where to store medicine;
  • what to do with visitors; and
  • how to take medication

She also offers online resources for caregivers interested in learning more.


CHOC Radio theme music by Pat Jacobs.


How to Build a Basic First Aid Kit at Home

iStock_000054492154MediumMost parents are bound to face a small “medical emergency” at home with their child at some point, whether it’s a nasty scrape, nosebleed or bug bite. Knowing what to do and having some supplies handy can make minor injuries easier to care for when they occur.

“Everybody should have a first aid kit. They also should have a card in their kit with their pediatrician’s phone number on it in case someone else is watching the child and needs to know who to call if needed. They can also call 9-1-1 for a severe emergency,” says Dr. Mary Jane Piroutek, an emergency department physician at CHOC Children’s.
To build your basic first aid kit, Dr. Piroutek shares a list of supplies to include:

  • Gauze or dressing
  • Antibiotic ointment like Neosporin, for bites, cuts, stings and scrapes. This will help keep wounds lubricated and prevent infection.
  • Bandages
  • Antiseptic spray to help clean the wound.
  •  Tweezers to remove splinters. To remove a stinger that is still in a puncture wound, use something firm like a credit card to swipe it away.
  •  Non-latex gloves to keep hands clean.
  • Antihistamines for minor bites or allergic reactions (* talk to a medical professional for giving antihistamines to a child under the age of two)
  • Acetaminophen or ibuprofen – not aspirin – for pain.
  • A water bottle in case you are somewhere that lacks clean water and you need to wash a cut.

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