It was 3 a.m. The baby was crying (thank you, new lower right tooth) and my husband was holding her while I calculated the proper ibuprofen dose on my iPhone. As an ER doc, I’ve ordered ibuprofen for thousands of infants at work — but that was when I wasn’t half asleep, an infant wasn’t pulling my hair and I didn’t have to do arithmetic in my head. Suddenly, I understood how every year in the U.S. approximately 70,000 children are unintentionally given overdoses of over-the-counter pain relievers like ibuprofen and 30,000 children get overdoses of acetaminophen. Another is aspirin, which should never be given to a child unless specifically instructed by your doctor. 
How accidental overdose happens
For one, dosing meds for children can be tricky because the dose is based on their weight. That means that if the bottle doesn’t spell out the exact dose (and many don’t), it involves some calculating, leaving lots of room for error. (Quick: babies 24 to 35 pounds need 160 milligrams, but your baby weighs 18 pounds and that’s not in the directions, so you need to give how much? Oh, and your dropper is in milliliters.}
Secondly, some medications — like ibuprofen — have different concentrations for their infant and children’s formulation. That’s why it’s important not to mix them up and give an infant a pain reliever meant for older children.
What are signs of overdose?
It depends on the medication and how much the child received. Lower overdoses cause mild to moderate nausea, vomiting, abdominal pain and headache. Higher overdoses can be life threatening, so be sure to call your doctor if your infant or child shows signs of any of these symptoms.
One note: I don’t want anyone to interpret this as a cautionary tale to avoid either ibuprofen or acetaminophen altogether. They are both effective medications with great safety profiles and have been used for decades. As both a physician and a mom, I trust and recommend them for the treatment of fever, aches and pain. It’s just that we must always remember that, like any medication, they can be dangerous at doses higher than recommended. Please be careful and make sure you’re giving the right dose at the right time intervals.
Tips to avoid overdose
  • Be prepared. Many pediatricians have handouts on the proper dosages of ibuprofen and acetaminophen, based on your child’s weight. I advise my patients to post the guidelines in a place they’ll easily find – the fridge, inside the medicine cabinet -- when it’s 2 a.m. and you’re not wearing your contacts.
  • Pay attention when you buy. Be sure to choose the correct formulation for your child’s age. I find that labels can be misleading (for instance, one form is labeled “Infant Ibuprofen, for Children” and then only provides dosage instructions for ages 2 and up). Read the instructions to be sure that your child’s age and weight are listed. Still not sure you’re buying the right medication? Ask the pharmacist.
  • Follow the dosing instructions exactly. Don’t assume that different bottles can be measured in the same way. Even medications that are the same brand may have different concentrations.
  • Whenever you give your child medication, note the time. One of the top reasons for calls to the Poison Control Hotline is that parents inadvertently gave a second dose too soon. I’m always surprised how easily I can forget when I gave that last dose of Tylenol when my child is teething. Whether you call your doctor or the hotline, they’ll want to know the last time you gave your child the medication.
  • Have extra oral medication syringes or droppers on hand. Never use a regular household teaspoon, as those can vary drastically in size. You can buy plastic syringes and droppers at the drugstore. Be sure they are the same type that came with the medication.
  • Keep the number for the Poison Control Center handy (1-800-222-1222). If you think you gave your child too much, or just have a nagging concern, call. They’re available 24/7 and always happy to help.
  • Lock it up. It always bears repeating –- lock up all medications. Children love bottles, they love capsules and they love liquids. Shoot, the more dangerous it is, the more they seem to love it. Lock it up, out of sight, out of reach. Make sure that all family members (including grandma, when she comes to visit) do the same. Trust me, this one step alone will keep you out of the ER.