Despite the fact that most parents and pediatricians consider acetaminophen, you know- Tylenol, a totally safe drug, there has been a growing chorus of concern about this drug among researchers for many years. In today’s pedcast I am going to break those concerns down and give you some up to date knowledge on this subject. Stay tuned.
Photo by S. Buissinne @Pixabay Images
The History Behind Acetaminophen
Acetaminophen has been around for a long time, first being synthesized in 1800’s by various chemists. But it stayed on the shelves and was not used for medical purposes. It was just an interesting organic compound back then. But then in the 1950’s came Robert McNeil, an American chemist, who made acetaminophen into a liquid form and marketed it as a fever reducer/pain medicine for children, coining the name “Tylenol elixir”. Originally, a prescription medication and later becoming OTC. McNeil’s company was bought by J and J and brilliantly marketed, becoming the standard for pain and fever reduction for decades in both children and adults. When I trained, the only concern we had about Tylenol was overdose. With this concern in mind, the FDA limited bottle sizes and doctors, like myself, thought that Tylenol was flat out safe! Obstetricians even recommended it for pregnant and lactating moms and pediatricians gave it to very small infants. If that doesn’t speak to confidence of safety, I don’t know what does.
The Dark Side of Tylenol
But Tylenol had a darker side to its story. It was commonly being used as a suicide agent, particularly in England in the 1990’s. Just like with accidental overdoses, bottle sizes were again limited in size and this helped reduce the number of overdoses. Experts thought again, problem solved. But not so fast. Next came concerns, in 2008, that Tylenol use in children was increasing the rate of allergy and asthma that was occurring at the time. Multiple studies showed mixed results about this potential side effect but this concern still exists today. Then, in 2016, it was found that anti-pyretics like Tylenol, that are commonly given before or after childhood vaccines, are actually blunting the child’s immune response to the vaccine, sometimes to the point that it renders the vaccine ineffective. Oh no! Say it is not so. And now the latest blow to Tylenol’s reputation as safe- a report in JAMA Psychiatry has found an association between late pregnancy use of Tylenol and a babies chances of developing autism or ADHD. Now my, very savvy Doc Smo listeners, will know that associations don’t necessarily mean causation but this study is worrisome none the less and will get a lot more attention before the issue is resolved.
What Can we Learn From the Saga of Tylenol?
So what are parents to make of all this and how does this information help your parenting? I believe there are many valuable lessons that the Tylenol saga can teach us and that you can transcribe to other health decisions you will be making as your children grow.
First: With health issues in humans, it is very difficult to prove causation since there are so many variables. Proof that Tylenol is harmful, except in cases of overdose or drug interactions, is just not there yet, and in fact, may not exist. Time will tell us but like with all therapies, caution is the word of the day.
Second: Just because a drug is safe in some situations doesn’t mean it is safe in all situations. Older children may get all benefit from drugs like acetaminophen but babies before birth and infancy may have unique sensitivities due to their rapid growth and development. Safe for one use but possibly unsafe for another.
Third: Medications, by design, change your children to get the effects that they are designed to get. But while doing so, they often have unintended consequences. We call these side effects in the biz. All drugs have them and before using any medication, the risk of side-effects needs to be assessed, uncolored by the marketing hype of the manufacturer or the enthusiasm of the prescriber.
Fourth: Drug companies are very adept at accentuating the positive and minimizing the negatives of medications. Part of the mission of a pharmaceutical company is to market their drugs and create a positive impression of their medication in those that may want to use them and, I might add, to those physicians that may prescribe them. And I’m here to tell you that they are very good at marketing their products which, I believe, distorts the way we as consumers see these products. That’s not to say that medications are useless, but rather benefits and risks need to be objectively assessed.
Fifth: Since medications alter your child’s metabolism and physiology, even briefly, unless they being used to ameliorate a significant health problem, all medications should be avoided-especially in children. And since medications seem to have their most potent negative effects during periods of rapid change, they should be especially avoided during your pregnancy and your baby’s infancy.
Finally: There are situations when acetaminophen can and should be used in my opinion like if your child has severe pain from a broken bone or after a surgical procedure, or suffers from a very high fever and is extremely uncomfortable. You, along with the help of your child’s pediatrician, will need to think all that through and individualize the medicine’s need based on the situation. I’m afraid however, the days of giving Johnny or Janie Tylenol tonight and I will see you in the morning are gone along with alcohol baths for fever, syrup of ipecac for poisoning, and codeine for coughs. We evolve.
Well, that’s it for this installment of Portable Practical Pediatrics. If you think the information presented here is valuable, do me a few favors; hit the like button where you get your podcasts, tell a friend or relative about our podcast, and by all means, subscribe at my blog www.docsmo.com. By doing so, I promise I will make you one of the best informed parents in the room. This is Doc Smo, broadcasting from studio 1E, reminding you that before you reach for that med, pause and remember what we just said. Until next time.
Many thanks to Sonya Corina Williams for her help in the production of this pedcast.