50. Symptomatic treatment in infants and children (fever reducers and painkillers, anticonvulsants, mucolytics, medications affecting respiration and circulation).

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Antipyretics

See topic B33 in paeds 1.

Painkillers

In children, like in adults, the most frequently used analgesics are paracetamol and NSAIDs like ibuprofen or metamizole. Oral administration is preferred, but rectal or intranasal administration is a good option in children. If strong analgesics are required, opioids like morphine are required.

Anticonvulsants

First-choice anticonvulsants in childhood include valproate (20 – 40 mg/kg/day), levetiracetam (10 mg/kg/day), and carbamazepine. For treatment of status epilepticus, see topic 5.

Mucolytics

Acetylcysteine and bromhexine, administered orally or by inhalation, are the most frequently used mucolytic in case of thick mucus. Special mucolytics like nebulised DNase and nebulised hypertonic saline are useful in cystic fibrosis.

Medications affecting respiration and circulation

It’s difficult to know what they mean by “symptomatic medications affecting respiration and circulation”.

In case of hypotension or acute heart failure, inotropic or vasopressor drugs like noradrenaline, adrenaline, dobutamine and phenylephrine may be used.

In case of bronchial asthma, bronchodilators like salbutamol and ipratropium may be used.