Giving a cranky child cough medicine to put him or her to sleep may not seem like child abuse, but it can be dangerous or even deadly for the child.
Parental misuse of cough medicine nearly killed one Texas infant recently, according to Amitava Dasgupta, a toxicologist called in to consult on the case. The infant came into Children's Memorial Hermann "in bad shape" and was taken directly to the intensive care unit and put on a ventilator, he said.
The mother gave the infant one dose of "cough medicine in the afternoon and one in the evening to put the baby to sleep so it wouldn't disturb them," Dasgupta said.
He suspected it was an occasional trick used by the mother. It was unclear whether the infant got an adult or pediatric dose.
"The baby became unresponsive ... and almost died from an overdose of dextromethorphan, a common ingredient in cough medicine," he said. "In this case, it was not an intentional overdose, it was lack of information."
It is never recommended to give cough medicine or pain killers to children under age two without asking a physician, but many young parents are not aware of that, said Dasgupta, a professor of pathology and laboratory medicine at University of Texas-Houston Medical School.
Sometimes, however, observers believe exasperated parents sedate children with prescription medication or illicit drugs so they "don't have to deal with a crying child," Dasgupta said. He believes it is pure child abuse and a criminal offense.
Drugging Kids: a Hidden Form of Abuse?
The abusive use of drugs on children is an under-recognized issue, said Dr. Shan Yin, a toxicology fellow at the University of Colorado and the lead author on a new study on the topic.
Even when the caregiver is not intending to harm the child, it still constitutes child abuse, Yin said, and doctors need "to be aware of this kind of issue" just as they would be on alert for signs of physical or sexual abuse in a child.
The study, published today, examined cases of pharmaceutical abuse reported to the National Poison Data System between 2000 and 2008 and found that 14 percent of the cases resulted in moderate to major consequences, including the death of the child.
Over-the-Counter Turns Dangerous
Many parents, especially young parents, think that over-the counter equals "no big deal," Dasgupta said, but children under age 7 are especially susceptible to being harmed by the misuse of the medications, especially when they are used on an otherwise healthy child as a sedative.
"Because a child or infant's body is not an adult body, pharmaceuticals can be dangerous" when not given under a doctor's supervision, Dasgupta said. Even giving a pediatric dose to a child can be risky as some small children are more sensitive than others to sedatives or painkillers.
In Yin's study, nearly half of the abused children were exposed to at least one sedative and 17 out of 18 deaths during the study period were related to the use of a sedative.
The study did not determine the motivation behind giving the drugs, but pediatric experts say that it can range from punishing a child to providing temporary relief from parenting duties (when the child is asleep or sedated).
"If a child is very irritable and colicky, a parent may try to use cough and cold syrup to keep the child quiet, especially if the parent is overwhelmed and immature and thinks the child is doing this on purpose," said Dr. Lea DeFrancisci Lis, an associate clinical professor at New York University School of Medicine. Teenage mothers are at particular risk for making the mistake, she added.
Even when an overdose is not deadly, continual abuse of drugs in children "is likely to have cascading effects on the developing biology of children and even potentially long-term effects," said Alan Kazdin, a professor of psychology and child psychiatry at Yale University.
Mistake, Misuse, Maltreatment: When Is it Criminal?
Traditionally, child abuse is a blanket term for four types of maltreatment: sexual abuse, physical abuse, neglect and emotional abuse.
Yin argues, however, that malicious use of medication or drugs on children should be considered another form of child abuse, and many pediatricians agree.
"The practice guidelines should be changed to include malicious use of pharmaceuticals ... and questions to parents [on it should be included in] child abuse screenings," said DeFrancisci Lis.
But when is a parent's action malicious, and when is it just misinformed?
Clearly, when illicit drugs or adult prescription medications are used on infants and children, it constitutes child abuse, experts agree. But parents using over-the-counter medicine inappropriately may just be misinformed.
"Determining cause -- malicious vs. accidental -- is not easy," said Mark Riddle, professor of child and adolescent psychiatry at Johns Hopkins Children's Center.
"A little Tylenol can be helpful, too much Tylenol can be lethal. [Pediatricians should] look for a pattern of behavior, prior neglect or maltreatment" to help determine whether an overdose in a child is an honest mistake or a sign of abuse, he said.
Raising awareness on misusing drugs among parents, pediatricians, and other health care professionals working with children is the first step in cutting back on this kind of malicious or unintentional abuse, Dasgupta said.
"And parents should know that they can always ask a pharmacist which over-the-counter drugs are safe to give to their kids," he said. "They'll give you free advice."