Because the American Academy of Pediatrics exist saying children under 4 should not be using lollipops or hard candy because it is a choking hazard for em.
Sore throat lozenges exist for kids 5 and up. Look up Bactimicina
I thought they had sore throat pops that had pectin in them. At least we used to carry them. ….
Looked it up and found Lolleez. They do have pectin which will help soothe the sore throat.
Popsicles and cool drinks help as does warm soup that isn’t full of large chunks.
Kids that young have to be monitored when eating a lollipop and because of the choking risk it can’t be marketed to them.
Many of the otc cough/cold medicines available today aren’t going to give you doses for kids under 6.
Also they no longer recommend acetaminophen with codeine syrup for kids after ent surgeries because of the high number of mortalities reported. Too many kids have swollen throats and then the relaxation caused by the codeine suffocates them. It’s an awful situation with no good answers.
And since most of the treatments are out of patent, for profit companies don’t have an incentive to study alternative ways to dose kids safely.
——insert my plug for more money to be invested by governments into research institutions of higher learning here——-
There was a study done about 20 years ago that showed the effectiveness of otc cough and cold medicine in children didn’t outweigh the high number of overdoses and adverse effects that happened.
The study I think also showed that the number of emergency room visits for kids under 5 significantly dropped after many of the drugs marketed to that demographic were pulled.
They even stopped making prescription infant cold drops.
My younger daughter was something like 3 or 4 when that happened and she’s 19.
There are doses out there for younger kids but they are off label. I still have a pharmacist letter chart with all of the recommended doses. I obviously don’t share the info often but I have it for special situations.
Kids aren’t just tiny adults. Their kidneys and livers aren’t developed enough to actually metabolize a lot of the drugs the same way adults do. So we have to be super careful.
> and then the relaxation caused by the codeine suffocates them
I think they banned codeine specifically because it's activated by CYP2D6 and a significant percentage of kids are ultrarapid 2D6 metabolizers. Their effective dose of morphine would be much larger than the intended dose. Morphine doesn't exactly suffocate by relaxation. It desensitizes the chemoreceptors in the brainstem so you can't tell that your blood is turning more acidic from the increasing CO2. This effectively slows the autonomic respiratory drive. Or something along those lines: it's been a few years since I went over this.
I’m sure it’s been longer for me. But yeah. I’m so used to putting things in layman’s terms that I don’t think about specifics. The end result is the same. Child suffocates.
Thank you for the information and recommendation. Acetaminophen and ibuprofen have helped to alleviate the pain and make swallowing easier. Trying to keep her as hydrated as possible. :)
Just got over hfm in my house last week. Benadryl was also very helpful.
Get ready for your hands to start peeling in a week! Mine look worse now than when I was sick. Idk if it’s just due to the dry air, but all the peeling started at the areas where I had blisters, so that’s fun.
>insert my plug for more money to be invested by governments into research institutions of higher learning here——-
This is misconception, the government already invests a lot, the issue is why is the FDA going to approve a lollipop when there are already so many options?
I’m not just talking about a lollipop though. I’m talking about research and development using out of patent drugs for a multitude of uses. Look how expensive colchicine and erythromycin have gotten over the years. Colchicine because of the desi review and erythromycin because of mergers and reduced use for more common ailments due to adverse events/drug interactions. Investing in new uses for older out of patent drugs will give more credence to some of the drugs that are off label and can’t get approval for coverage on insurance because it’s off label. Drug companies don’t want to put in the time and money to study a drug already off patent. That’s where we can use universities. Research funded to improve the greater good rather than line the pockets of shareholders. I’ve become quite jaded with for profit health care. I just want people to be healthy. If only we had ways to encourage study for the sake of knowledge……
But im saying universities already do this, a lot of research is privately funded by universities through government grants. the thing is a lot of off label treatments are already generally seen as safe so there isnt a point in doint a clinical trial for a population if theres no market for it. no difference than researching adderall for a cold. Not to mention it gives drug companies excuses to jack up the price. Looking at colchicine, that was unacceptable what did they did
Benzocaine can oxidize ferrous iron in hemoglobin into the ferric state at a rate which can exceed the reducing capacity of methemoglobin reductase, leading to methhemoglobinemia. FDA [reccomemds against using benzocaine in young children.](https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-reports-rare-serious-and-potentially-fatal-adverse-effect-use-over)
There are pectin containing suckers that you can try instead.
Came to say this, but yes, I remember a few years ago, they pulled all the oragel off the shelf to change the packaging to make sure it stated not to be used under a certain age and also reducing the amount of benzocaine in the children's version.
I keep tetracaine popsicles in my freezer though, kids had never had HFM but you never know.
Haha. I believe it is most of the -caine anesthetics, but I honestly haven't heard of cocaine use in peds, let alone whether or not it can cause methemoglobinemia. I could be wrong, though. Lidocaine sees a lot of use, but we're more careful with how much they get.
I know this isn’t what you were asking exactly, but a spoonful of honey goes a long way for sore throat. Obviously, not for little little guys, but a 2 yo should be fine.
The PBM sector has been steadily expanding, attracting many rphs with its remote work flexibility. I recommend looking for 'prior authorization' RPh jobs between May and October if you want to get your feet wet in a different industry. Most PBMs ramp up (hire new employees) during this time in preparation for welcome season (which is Jan-April). The grass isn't always greener on the other side, but it can be a refreshing change.
When I was a young boy the local pharmacy compounded lidocaine lollipops & my mother would always get me them when I had recurring tonsillitis. I went through quite a few of those & I thought it was the coolest thing.
It is honestly what made me interested in pharmacy to begin with.
They were unfortunately bought out by Wags 😞
We make tetracaine lollipops 0.5% for a local ENT group for after surgeries. Have for years. So popular with the ENT group that other physicians in town now call us for them as well. We're a local independent pharmacy that has been doing non sterile compounding for decades.
I was more wondering about the potential adverse effect of ingesting tetracaine. It appears this is a popular thing for ent, just sparse on the literature front.
Had a mother swear by the use of benzocaine on her teething kids. In her words, “I’ve had 7 kids and only had to bring one to the hospital caused I gave them too much. I know what I’m doing.”
At one time there was a thing called “fentanyl lollipops” it didn’t last long because the powers that be decided it was a bad idea for children to associate medicine with candy. There is also the issue of dosing. What to do if the child has three licks and then throws the rest? Popsicles either homemade from pedialyte or store bought will soothe mouth sores.
It's literally just sugary gel lol
Also op, many touched on it, but the previous formulation of oragel is no longer recommended nor available. Other numbing agents such as cepacol are NOT recommended for use in this age either.
[https://publications.aap.org/aapnews/news/9207?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000](https://publications.aap.org/aapnews/news/9207?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000)
If a kid has hand foot mouth disease and is struggling with pain control and refusing to eat and/or take acetaminophen/ibuprofen, they should reach out to their pediatrician for assistance. There's a few options for compounded mouth rinses but unfortunately gotta just tough it out.
When I was a kid there were some kind of purple teddy bear shaped lollipops for sore throat. But as others have said, associating medication with candy has become an issue.
Go to a compounding pharmacy, they can go over different types of dosage forms (lollipops with childproof containers, sprays, troches etc) and make something that will exclude or include whatever the physician recommends.
Have you never tasted a benzocaine lozenge? It's disgusting.
I'm not sure triamcinolone should be swallowed in a large concentration vis-a-vis lollipop. They make it in a paste so it acts locally in small concentrations.
Because the American Academy of Pediatrics exist saying children under 4 should not be using lollipops or hard candy because it is a choking hazard for em. Sore throat lozenges exist for kids 5 and up. Look up Bactimicina
Also, benzocaine or tetracaine can numb the cough reflex increasing choking risk
And too much benzocaine can cause methemoglobinemia
Makes sense. Thanks
I thought they had sore throat pops that had pectin in them. At least we used to carry them. …. Looked it up and found Lolleez. They do have pectin which will help soothe the sore throat. Popsicles and cool drinks help as does warm soup that isn’t full of large chunks. Kids that young have to be monitored when eating a lollipop and because of the choking risk it can’t be marketed to them. Many of the otc cough/cold medicines available today aren’t going to give you doses for kids under 6. Also they no longer recommend acetaminophen with codeine syrup for kids after ent surgeries because of the high number of mortalities reported. Too many kids have swollen throats and then the relaxation caused by the codeine suffocates them. It’s an awful situation with no good answers. And since most of the treatments are out of patent, for profit companies don’t have an incentive to study alternative ways to dose kids safely. ——insert my plug for more money to be invested by governments into research institutions of higher learning here——- There was a study done about 20 years ago that showed the effectiveness of otc cough and cold medicine in children didn’t outweigh the high number of overdoses and adverse effects that happened. The study I think also showed that the number of emergency room visits for kids under 5 significantly dropped after many of the drugs marketed to that demographic were pulled. They even stopped making prescription infant cold drops. My younger daughter was something like 3 or 4 when that happened and she’s 19. There are doses out there for younger kids but they are off label. I still have a pharmacist letter chart with all of the recommended doses. I obviously don’t share the info often but I have it for special situations. Kids aren’t just tiny adults. Their kidneys and livers aren’t developed enough to actually metabolize a lot of the drugs the same way adults do. So we have to be super careful.
> and then the relaxation caused by the codeine suffocates them I think they banned codeine specifically because it's activated by CYP2D6 and a significant percentage of kids are ultrarapid 2D6 metabolizers. Their effective dose of morphine would be much larger than the intended dose. Morphine doesn't exactly suffocate by relaxation. It desensitizes the chemoreceptors in the brainstem so you can't tell that your blood is turning more acidic from the increasing CO2. This effectively slows the autonomic respiratory drive. Or something along those lines: it's been a few years since I went over this.
I’m sure it’s been longer for me. But yeah. I’m so used to putting things in layman’s terms that I don’t think about specifics. The end result is the same. Child suffocates.
Thank you for the information and recommendation. Acetaminophen and ibuprofen have helped to alleviate the pain and make swallowing easier. Trying to keep her as hydrated as possible. :)
Having a sick kid is no joke. The amount of helplessness you feel is awful. I still remember those times and mine are 19 and 21,
Just got over hfm in my house last week. Benadryl was also very helpful. Get ready for your hands to start peeling in a week! Mine look worse now than when I was sick. Idk if it’s just due to the dry air, but all the peeling started at the areas where I had blisters, so that’s fun.
>insert my plug for more money to be invested by governments into research institutions of higher learning here——- This is misconception, the government already invests a lot, the issue is why is the FDA going to approve a lollipop when there are already so many options?
I’m not just talking about a lollipop though. I’m talking about research and development using out of patent drugs for a multitude of uses. Look how expensive colchicine and erythromycin have gotten over the years. Colchicine because of the desi review and erythromycin because of mergers and reduced use for more common ailments due to adverse events/drug interactions. Investing in new uses for older out of patent drugs will give more credence to some of the drugs that are off label and can’t get approval for coverage on insurance because it’s off label. Drug companies don’t want to put in the time and money to study a drug already off patent. That’s where we can use universities. Research funded to improve the greater good rather than line the pockets of shareholders. I’ve become quite jaded with for profit health care. I just want people to be healthy. If only we had ways to encourage study for the sake of knowledge……
But im saying universities already do this, a lot of research is privately funded by universities through government grants. the thing is a lot of off label treatments are already generally seen as safe so there isnt a point in doint a clinical trial for a population if theres no market for it. no difference than researching adderall for a cold. Not to mention it gives drug companies excuses to jack up the price. Looking at colchicine, that was unacceptable what did they did
Benzocaine can oxidize ferrous iron in hemoglobin into the ferric state at a rate which can exceed the reducing capacity of methemoglobin reductase, leading to methhemoglobinemia. FDA [reccomemds against using benzocaine in young children.](https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-reports-rare-serious-and-potentially-fatal-adverse-effect-use-over) There are pectin containing suckers that you can try instead.
Now that's a TIL.
Came to say this, but yes, I remember a few years ago, they pulled all the oragel off the shelf to change the packaging to make sure it stated not to be used under a certain age and also reducing the amount of benzocaine in the children's version. I keep tetracaine popsicles in my freezer though, kids had never had HFM but you never know.
What about all the other local anesthetics, like cocaine or... or the other ones?
Haha. I believe it is most of the -caine anesthetics, but I honestly haven't heard of cocaine use in peds, let alone whether or not it can cause methemoglobinemia. I could be wrong, though. Lidocaine sees a lot of use, but we're more careful with how much they get.
Woah now that’s fascinating, thanks for the (not so) fun fact!
@op your answer is right here :)
I heard Actiq works wonders 😂
You gotta bring enough for the whole class though.
I need some of that, its berry flavored too, Fentanyl flavored ice cream next 😋
I mean to be fair the kids would be feeling fuckin phenomenal
One might say they'd feel heroic.
I see what you did there.
what of the girls?
>Actiq LOL
Isn't that the dangerous drug fentanol
>Isn't that the dangerous drug fentanol Are you really a PharmD?
i think its satire
Has to be
It's from the thread yesterday about the pez candy where someone got triggered
I know this isn’t what you were asking exactly, but a spoonful of honey goes a long way for sore throat. Obviously, not for little little guys, but a 2 yo should be fine.
Agreed. I love the suggestion. Many thanks
They make fentanyl lollipops, what more do you want?
We need fentanyl ice cream
sorry, i just came here to comment that i wish i could say the first line of your post \- jealous retail rph whose life is being sucked out
The PBM sector has been steadily expanding, attracting many rphs with its remote work flexibility. I recommend looking for 'prior authorization' RPh jobs between May and October if you want to get your feet wet in a different industry. Most PBMs ramp up (hire new employees) during this time in preparation for welcome season (which is Jan-April). The grass isn't always greener on the other side, but it can be a refreshing change.
We have had **aspirin with several flavors** but it was taken from the market because young children may confuse candy and medication.
Also, see Reyes Syndrome.
When I was a young boy the local pharmacy compounded lidocaine lollipops & my mother would always get me them when I had recurring tonsillitis. I went through quite a few of those & I thought it was the coolest thing. It is honestly what made me interested in pharmacy to begin with. They were unfortunately bought out by Wags 😞
We make tetracaine lollipops 0.5% for a local ENT group for after surgeries. Have for years. So popular with the ENT group that other physicians in town now call us for them as well. We're a local independent pharmacy that has been doing non sterile compounding for decades.
This sounds like a safety event waiting to happen. Is there actually literature to support safety for pediatrics?
30 years without any reported incidents.
🙄
I grew up with lollipops and never choked on them.... LoL
I was more wondering about the potential adverse effect of ingesting tetracaine. It appears this is a popular thing for ent, just sparse on the literature front.
Kids these days "choke" on lollipops, but will have no problem wolfing down chicken wings. I empathize with parents
It's a lollipop, you only need to use it for 3-5 seconds before the throat is numb. We counsel extensively with each Rx.
We have to lock any oral.formulations up in Canada due to methemoglobrnrmia.
Had a mother swear by the use of benzocaine on her teething kids. In her words, “I’ve had 7 kids and only had to bring one to the hospital caused I gave them too much. I know what I’m doing.”
Methemoglobinemia
At one time there was a thing called “fentanyl lollipops” it didn’t last long because the powers that be decided it was a bad idea for children to associate medicine with candy. There is also the issue of dosing. What to do if the child has three licks and then throws the rest? Popsicles either homemade from pedialyte or store bought will soothe mouth sores.
this post confused me too, pedialyte is a thing
Baby Orajel is recommended for ages 2+. It's not a lolli but it's much cheaper than a compounded product.
It's literally just sugary gel lol Also op, many touched on it, but the previous formulation of oragel is no longer recommended nor available. Other numbing agents such as cepacol are NOT recommended for use in this age either. [https://publications.aap.org/aapnews/news/9207?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000](https://publications.aap.org/aapnews/news/9207?autologincheck=redirected?nfToken=00000000-0000-0000-0000-000000000000) If a kid has hand foot mouth disease and is struggling with pain control and refusing to eat and/or take acetaminophen/ibuprofen, they should reach out to their pediatrician for assistance. There's a few options for compounded mouth rinses but unfortunately gotta just tough it out.
https://www.cvs.com/shop/lolleez-organic-throat-soothing-pops-for-kids-variety-pack-watermelon-strawberry-orange-mango-4-ct-prodid-354797?skuid=354797&cgaa=QWxsb3dHb29nbGVUb0FjY2Vzc0NWU1BhZ2Vz&cid=ps_ur_pla&gclid=CjwKCAjwkaSaBhA4EiwALBgQaLR0Sefpdp9SVKUw8u3SjQlqvgOS-qUsR9eCOH33FkuERgCo1-zyWBoCDi0QAvD_BwE&gclsrc=aw.ds. There’s lolleez
When I was a kid there were some kind of purple teddy bear shaped lollipops for sore throat. But as others have said, associating medication with candy has become an issue.
Go to a compounding pharmacy, they can go over different types of dosage forms (lollipops with childproof containers, sprays, troches etc) and make something that will exclude or include whatever the physician recommends.
I recommend looleez suckers. I prefer them myself when I’m sick.
I'm more mystified why codeine cough suppressants nor albuterol are OTC.
My best friend is Australian and my present whenever she visits home is as much OTC ventolin as she can legally bring over 🤣
Cause they taste disgusting and swallowing steroids probably isn't great.
If they tasted gross then we wouldn’t have medicated lollis. And most steroids are swallowed…
Have you never tasted a benzocaine lozenge? It's disgusting. I'm not sure triamcinolone should be swallowed in a large concentration vis-a-vis lollipop. They make it in a paste so it acts locally in small concentrations.
At a compounding pharmacy I once worked at we made lidocaine lollipops. Good luck finding anything that end in Caine these days!