By Manisha Panchal, M.D.

In 2009, the Food and Drug Administration (FDA) issued new warnings about acetaminophen — which is sold under brand names like Tylenol or Excedrin.

What the FDA was concerned about was the high rate of acetaminophen overdoses in the United States. According to studies done between 1990 and 1998, acetaminophen-related overdoes caused 56,000 emergency room visits, 26,000 hospitalizations and 458 deaths each year.

Do parents need to be concerned about giving acetaminophen to their children?

No, not if they use acetaminophen correctly. Like all drugs, acetaminophen requires following dosing instructions carefully.

To minimize the risk of an overdose. Parents should be aware that currently liquid acetaminophen for children and infants is sold in two different strengths: one for infants and one for children.

Because infants cannot drink medicine from a dosing cup, like children can, they need a more concentrated formula that can be given with a medicine dropper. Therefore, the infant liquid acetaminophen is more than three-times the strength of the children's liquid acetaminophen.

Parents, however, may assume liquid acetaminophen for infants is weaker, not stronger, than liquid acetaminophen for children. As a result, they may give a child the infant strength liquid in a child dosing cup and thereby accidentally overdose their child.

The second possible problem highlighed by the FDA was multi-symptom remedies that contain acetaminophen and one or more other drugs. Sometimes people take these multi-symptom products to treat one problem, such as cough, and then add a second dose of acetaminophen for pain or fever, not realizing that the first medication already contained acetaminophen.

Whether taking a drug yourself or giving one to your child, always check what the active ingredients are and how many milligrams of those ingredients the medicine contains. In addition, if you or your child will be taking more than one drug at a time, ask your doctor or pharmacist first to make sure it is safe to combine the two medications.

What will an overdose of acetaminophen do to the body?

Acetaminophen overdoses can cause liver damage. In some cases, this damage can be so severe that the liver fails and the person's life may be threatened. According to the Centers for Disease Control (CDC), more than 400 people die each year from acetaminophen overdoses.

Should I stop using acetaminophen and buy a different pain reliever for my child, such as ibuprofen?

There is no need to stop using acetaminophen, especially when it is recommended by your child's doctor. However, the FDA warnings about acetaminophen are a good reminder that all drugs are potentially harmful and parents must take precautions to avoid overdoses. For all drugs, both those prescribed by your child's doctor and those you purchase without a prescription from the pharmacy, remember to always:

• Follow all dosing instructions exactly. If a medication does not seem to be relieving your child's symptoms, call your doctor or pharmacist. Do not simply give a second dose of the medication.



• Ask a doctor or pharmacist before giving your child more than one medication at a time.



• Keep all medications locked up. Many children's medications are sweetened, flavored and even colored to be attractive to kids, and some determined children can figure out how to get a "child-proof" cap off if left alone with the medicine.



• Make sure all caregivers know when and how much of a medication a child took. A well-meaning parent or other caregiver can easily give a child an overdose of a medicine if he or she doesn't know that someone else already gave the child the medicine. If necessary, put a set of post it notes in the medicine cabinet and write down the date and time of the last dose given on a note that you then stick on the medication bottle or another easily-visible place, such as the bathroom mirror.



• Never use an over-the-counter medication for something other than its intended purpose. For example, do not give a healthy child a cold medicine to help him or her sleep.

What should I do if I think my child received an overdose of acetaminophen?

Call Poison Control at 1-800-222-1222 right away to find out what to do. The signs or symptoms of liver damage may not be noticeable for hours or even days after taking acetaminophen. By the time you notice a change in your child, the liver damage could be severe.

Manisha Panchal, M.D., is a pediatrician at PAMF's Santa Clara Center .

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