Health & Well-Being - Fever pitch


Paracetamol brand Calpol is enduringly popular with parents and carers, but is it used too much? By Meredith Jones Russell

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For many children, the sweet pink liquid of Calpol is a comforting and restoring solution to feeling under the weather. But is it the best response to childhood ailments?

Calpol is consistently the most popular pain relief brand for children in the UK. It makes up 70 per cent of the market, with more than three times the sales of its closest rival, Nurofen, and 50 times those of the next most popular paracetamol brand, Parapaed.

Mahendra Patel, of the Royal Pharmaceutical Society, explains, ‘Even today, whenever a child is unwell, parents reach out for Calpol. It is almost a natural default reaction to just wanting to do something.’

However, the medicine, which can be used as analgesia (painkiller) or an antipyretic (fever prevention), has also been branded the ‘heroin of childhood’, with UK families buying around 5,220 litres a day.

Professor Patel warns, ‘For many generations, parents have been coming into pharmacies with prescriptions for Calpol with the belief that it could be used routinely, making it a household staple. Paracetamol is an everyday medicine but it can be dangerous if a child exceeds the recommended daily dose.’

PROPER DOSAGE

Although a child should not have more than four doses of paracetamol in 24 hours and must wait at least four hours between doses, Rohini Bajaj, consultant paediatrician and member of the Royal College of Paediatrics and Child Health, says there are issues with usage, such as:

  • over- or under-dosing (due to not following instructions or not taking strength into account)
  • accidental overdose (usually due to exceeding total daily dose)
  • giving Calpol when not required.

Dr Bajaj explains, ‘Calpol is a medication which is assumed to be harmless by many non-medical professionals. Actually, if used incorrectly, it can cause significant complications and therefore should be treated like any other medication and only given if really required.’

However, Damian Roland, honorary associate professor in paediatric emergency medicine at the University of Leicester and Leicester Hospitals, argues that parents cannot be entirely blamed for an over-reliance on Calpol.

‘If you watch the advertising, it is very clever,’ he says. ‘They don’t claim it is a magic medicine, but they do make people feel Calpol is the right thing to do. Parents are lulled into the sense that Calpol does what other brands can’t.

‘People talk about Calpol as if it’s a drug name, but it’s not. It’s paracetamol. There’s no reason to believe Calpol is any more effective than any other own brand.’

Johnson & Johnson, which owns Calpol, disputes the suggestion parents overuse the product. ‘Like all brands that make over-the-counter medicines, we are legally required to record all reported cases of misuse and report this data to the regulator,’ says a spokesperson. ‘We are not aware of any evidence to suggest that parents and carers are generally misusing or overusing Calpol. We always encourage parents to read the label carefully and ask a doctor or pharmacist for advice.’

FEVER PHOBIA

According to its packaging, Calpol is used for the relief of: fever (raised temperature), cold and flu symptoms, teething, headache, sore throat, earache, and other aches and pains. However, Dr Roland warns that fever can be misinterpreted by adults seeking to medicate children.

‘There is a big problem with fever-phobia,’ he says. ‘People are scared of the concept of fever itself. However, there is plenty of evidence to show that developing a fever is a natural biological process to fight infection. It is the side-effects that make us feel unwell, not the fever.

‘Of course, none of us wants a child to suffer, and if they feel miserable or are not themselves, they can certainly have some paracetamol to feel better. But we must treat the child, not the fever.’

An excessive willingness to medicate could even be more of a hindrance than a help, Dr Roland adds. ‘There have actually been studies recently suggesting fever is such an important part of the body’s response that taking paracetamol more regularly may even make a bug stay around for longer,’ he explains.

Dr Bajaj agrees. ‘As medical professionals, we are moving away from giving out paracetamol for temperatures unless clinically indicated. If a child is well, comfortable, and shows no signs of distress with a high temperature, then it is perfectly reasonable to monitor and follow other measures, such as removing layers to allow them to cool down naturally.’

Concern about a fever could lead adults to miss something else, adds Dr Roland, and advises monitoring:

  • fluid intake
  • behaviour
  • whether a child has passed a wet nappy in the last 12 hours
  • the possibility of a fit
  • responsiveness
  • whether there is any evidence of more serious infection.

These could all represent serious problems and require medical help immediately. If the child is less than six months old, or the fever has gone on for more than five days, carers should seek urgent medical advice.

For children at risk of developing seizures related to high temperatures, or febrile convulsions, Dr Bajaj is at pains to point out that Calpol is not a direct cure.

‘In these cases, we advise that the temperature is reduced by natural methods and medications such as Calpol or ibuprofen, often alternated to reduce the temperature and therefore the risk of seizure. Paracetamol itself has no direct impact on stopping a fit, but simply reduces the temperature in a child at risk of a febrile fit.’

TENDER LOVING CARE

Apart from these more serious conditions, Dr Roland says most of the time, ‘less is more’ when it comes to the use of Calpol or any other type of medicine for children.

‘Tender loving care from friends and family will help to resolve the majority of problems. Of course, it is distressing to see a child with a running nose or who can’t sleep, but there is very little that can make viruses go away any quicker. We really just have to sit it out.’

Dr Roland believes Calpol is a symptom of a bigger cultural trend for quick solutions to every problem. ‘We have a growing “click and collect” culture where we can do our travel, shopping, banking and even dating on our phones,’ he says. ‘We press a couple of buttons and the problem is fixed. Healthcare is not like that, and probably never will be. I understand we are all looking for a magic cure, but often TLC is all that is needed.’

CASE STUDY

If staff at one setting in Balham, south London, think Calpol should be administered, they ask parents to collect their child as soon as possible. ‘Should a child have a temperature, we will try to bring their temperature down by taking off shoes, socks and layers of clothes,’ says the manager.

‘It is at the manager’s discretion to administer Calpol while keeping in contact with the parent. We have done this ever since we got to the point when we had to send eight sick children home in a week. Calpol was helping to bring down their temperatures but wasn’t getting rid of the infection, which was spreading,’ the manager adds.

‘Parents use Calpol way too much. If I administer Calpol in the room, I will get a flock of other children wanting me to check their temperatures and give them some too.’

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