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A Warning About Children and Acetaminophen


The baby was teething. Fussing and crying, the 8-month-old was awake all hours of the night. Not even doses of the Tylenol for babies seemed to help.

So the child's worried father did what he thought was best: He gave his son a stronger dose--crushing adult Tylenol tablets and putting them in with the baby's bottle.

"The baby was crying much more than normal," said the Arleta man, who asked not to be identified. "The baby Tylenol had no effect."

Three days later, the child was comatose and near death from an accidental overdose that experts say happens several dozen times each year in the United States: Parents give their ill children too much of the pain-reliever acetaminophen.

In the past year, Dr. Sue McDiarmid, director of the Pediatric Liver Transplant Program at UCLA Medical Center, has performed two emergency liver transplants on local children because they were given too much acetaminophen for mild illness or fever. Last month, she also treated the 8-month-old baby, who recovered without the need for a liver transplant.

Although this type of overdose is rare, McDiarmid wants to get the message out loud and clear during this harsh flu season: Too much acetaminophen can result in liver failure and even death.

"This type of accident is totally preventable," she says. "Parents are giving too much, too often, over several days. It's a chronic poisoning."

These accidents have also led to suggestions that labels on acetaminophen--sold under the brand name Tylenol as well as many generic brands--should be changed to be more specific about the potential dangers.

But a spokesman for the manufacturer of Tylenol, McNeil Consumer Products Co., says: "These cases of acetaminophen toxicity are extremely rare, and invariably, are associated with misuse of the product. We feel our labeling is unequivocally clear. We do not see any need to change this label."


Acetaminophen is considered a safe drug when taken according to directions. It is commonly prescribed for fever, minor aches and pain, and irritation, and it is highly effective.

Perhaps because it so commonly prescribed, overdoses have become more common, says Dr. Ronald W. Busuttil, chief of liver transplant services at UCLA. But few people recognize the dangers of taking too much acetaminophen.

"The number of overdoses has probably gotten worse because so many medicines have acetaminophen in them nowadays," he says. "There needs to be an understanding that, although acetaminophen is a good drug, we have to be cautious. If we abuse it, the consequences are tragic."

Equally important, McDiarmid says, is that parents should buy the right product for the right age group and "follow the directions to the letter."

Medicines vary in strength according to the ages for which it is intended. Most products for adults do not give dosage levels for children under 12.

"Too many parents think, 'If we don't have the pediatric acetaminophen, we'll just give the adult acetaminophen, but we'll give less.' "

It is difficult to determine just how many children become seriously ill from this particular type of acetaminophen overdose, McDiarmid says. The National Poison Control Center reported 40,000 cases of acetaminophen overdoses in 1992, most of which were not serious. For example, in many cases the child was given--or took--one extra dose, which is not usually harmful.

But at least several dozen probably involved chronic poisoning. A doubling of the correct dose given every four hours for two days can cause toxic levels and destroy the liver, McDiarmid says.


Children's bodies have an enormous capacity to handle an overdose of acetaminophen without serious consequence--even more so than adult bodies, in part because children's livers are healthier. But what is so tragic about these rare cases, McDiarmid says, is that by the time the overdose is discovered, the child is often near death and needs a liver transplant to survive.

What usually happens is that the child recovers from a mild illness, such as influenza, and the parent stops giving the drug. But 24 to 72 hours later, the child gets sleepy and may even act bizarre or aggressive. Seizures and vomiting may occur.

"Because the child had seemed fine before, people have a false sense of security that it didn't involve the acetaminophen," McDiarmid says. "Parents and doctors can really get fooled."

This delay between the time the acetaminophen is stopped and the overdose symptoms appear is due to the long time required for the body to metabolize the drug, she says.

If the overdose is discovered before the symptoms set in, a medication can be given to prevent liver damage. But, she says, "this antidote has to be given within 16 hours of the overdose. So it's unlikely to be of much help. The horse is already out of the barn and down the road."

Once the poisoning is recognized, a liver transplant is usually required to save the child, she says. That means taking whatever liver is available, including one that might not be the best match.


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