Tylenol & Twenty Years As A Pediatrician

I’ve been thinking a lot about Tylenol lately.  In 2011, manufacturers made the strength of Infant Tylenol the same as Children’s Tylenol.  They made the change because dosing errors happened too often with confusion about the strength of their product.  Believe it or not, Infant Tylenol was actually MUCH more concentrated and stronger than Children’s Tylenol.   What the company failed to do, however, was to truly simplify their product presentation and marketing.    

Here’s what I want:  Tylenol Suspension (160 mg/5ml). One bottle.  With one calibrated dosing syringe. One dosing chart based on body weight (OK, you can put age on there, but only if the print is smaller so folks see it’s a second-best way to choose the dose.)  Problem solved.  Instead, we still have Infant’s Tylenol  and  Children’s Tylenol.  It’s the same stuff in both bottles.  There must be a business case for marketing the same liquid in two different boxes with accurate dosing syringes in some boxes but not in others.   

While Tylenol is an effective medication for pain and fever, we forget sometimes that EVERY drug comes with risks and benefits.  In the media of late, there have been several research studies calling attention to acetaminophen (AKA paracetamol) and its downsides.  Research has suggested that children who are given Tylenol following vaccines make lower levels of antibodies than kids who don’t get it. Read more  here  and  here  if you are interested in details.  This research made me ponder all the parents who were told to give a dose of Tylenol every four hours after my nurse gave vaccines, and I even used to send freebie-samples of Tylenol home as a gift. (I don’t any more.)  It cost almost nothing, and it felt good to give away those little boxes of Tylenol.  Now I wonder why I didn’t ask questions back when I was that newbie pediatrician and very much surprised by how much Tylenol parents gave their kids.  Somehow, without realizing it, I had become part of the process, and perhaps now…part of the problem.  

In May of 2013, NIH researchers published their findings on the rise in the incidence of autism.  It correlates with an increased use of acetaminophen. (   http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673819/  )  The NIH study did not say Tylenol causes autism. I bet you could show that increased consumption of colorful-dye number 72 in Happy Meals and KidCuisines  also correlates with a rise in autism and the use of acetaminophen.  This does NOT mean eating Dye #72 makes you take more Tylenol and subsequently develop autism. Correlation does not mean cause.  

It means pay attention.   A study published in the Journal of the American Medical Association, JAMAPediatrics, last week (February 24, 2014) suggests that there might be an association between how much acetaminophen a woman takes while pregnant and a later diagnosis of ADHD for her child. (You can read the abstract  here.)  Attention and focus problems are on the rise, at lease in the Danish study population cited by this medical journal.  The study correlates the how much Tylenol a pregnant woman takes with how likely her child is to have a diagnosis like ADHD.  Again, correlation does not equal cause.

One thing I learned is that the Tylenol molecule ( N -ace tyl – para -aminoph enol) is an endocrine disruptor.  Doctor’s have coined a buzz word for these molecules that interferes with the body’s hormone balance and metabolism.  There are lots of these molecules in our environment, and as you might guess, scientists don’t fully understand all this endocrine disruption yet.  If you are interested in the basic science research, you can read more about endocrine disruptors  here.  

Back to the fact that doctors have been recommending Tylenol for more than fifty years as safe and effective. We know parents want risk-free and painless, ‘safe and effective’ for our kids.  Emerging research on Tylenol might be another Wake-Up Call for parents and pediatricians though.  Nothing is risk-free.  We should always be asking if the benefit of anything a doctor recommends will truly outweigh the known risks.   ‘Safe and effective’ does have a price.  Sometimes we have to pay attention for a long time to see what that price tag might be. You’ve noticed, I’m sure, that my train of thought has been all over the place in this blog.  When I did the math, I was reassured to find that Tylenol hadn’t been in widespread use when my mother was having her babies.  I come by my short attention span honestly.

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