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Protocol for administering acetaminophen

PROTOCOL
FOR ADMINISTERING ACETAMINOPHEN
Acetaminophen is the generic name of the medication that is commercially available under the following brand names: Atasol, Tempra,
Tylenol and other house brand names.

Under the Educational Childcare Regulation, acetaminophen may be administered without medical authorization to a child receiving
childcare, provided it is administered in accordance with this Protocol and that a parent has given written consent.

A parent is not required to consent to the application of this Protocol. However, if a parent does not sign the authorization form, the
medication may not be administered to the child unless the parent and a member of the Collège des médecins du Québec give written
authorization.

BASIC RULES
2 liquid forms : drops or syrup. If children under 24 months of age are recei-ving childcare, it is recommended that drops be used instead of syrup. If the Within the framework of this Protocol, acetaminophen may be administered provider elects to use syrup for the other children, it is recommended only one solely to reduce fever. It may not be administered: The dosage must not under any circumstances exceed the dosage guidelines below or the dosage prescribed on the medication container.
for more than 48 consecutive hours (2 days); An adult tablet must never be cut up and administered to a child as
to children who have received medication containing acetaminophen in it could alter the dosage : an inadequate dose would not provide
the expected result, while an overdose could pose serious risks to
the child.

In those 4 cases, the Protocol does not apply and written authorizations from It is important to always check the concentration of acetaminophen and to fol- a physician and the parent are required to administer the medication.
low the dosage instructions on the container since new products of greater orlesser strength may appear on the market. It is also recommended to use only Childcare providers may have their own acetaminophen container, in which one concentration if the brand name selected is available in more than one case the brand name, the dosage form (drops, tablets, syrup) and the concen- tration must be indicated on the authorization form.
Any administration of acetaminophen must be recorded in the register of To avoid confusion, acetaminophen should be kept on hand in only one of its medications prescribed by the Regulation and the parent must be informed.
WHAT YOU SHOULD KNOW
Measurement Method
Normal Variation in Temperature
What is a normal temperature?
The normal temperature range will vary depending on the measurement method, used as illustrated in the table below.
WHAT IS FEVER?
take the rectal or tympanic temperature of children between 2 and 5 yearsof age. If the axillary temperature is taken, it is important to note that it is Fever is defined as a body temperature that is higher than normal. Normal temperature may vary somewhat depending on the child, the time of day, theoutdoor temperature and the level of activity. The cause of the fever is more take the oral temperature of children over 5 years of age; important than the temperature itself.
use the appropriate thermometer. Glass and mercury thermometers are notrecommended because of the risks of accidental exposure to that toxic It is generally considered that there is fever if the temperature is above the substance if they break. Fever strips are not recommended because they do normal temperature range where the rectal or tympanic temperature is above always use disposable plastic tips as they are more hygienic; otherwise, dis- The only sure way to measure fever is to take the child’s temperature. A child’s infect the thermometer properly before and after each use; temperature must be checked whenever the child’s general condition (franticcrying, loss of energy, change in general condition, loss of appetite, etc.) or if the child has just been physically active, wait approximately 15 minutes physical symptoms (flushed cheeks, excessively warm skin, sweating) could be as the child’s body temperature may be higher than normal if it is taken always comply with the time requirements for the thermometer being used The following measures are recommended:
since the time required may vary with the thermometer. A digital ther-mometer, which requires less time to take the temperature, is recom- take the rectal temperature of children under 2 years of age. At that age, to know if they have a fever, take the axillary temperature. If it is greaterthan 37,3 °C, the rectal temperature should be taken; WHAT YOU SHOULD DO
If a child under 2 months of age has a fever, that is, if the rectal tem-
notify the parent immediately, ask the parent to come and pick up the child and, in the meantime, apply the measures listed above; if the parent cannot come to pick up the child, call the persons designated by the parent as emergency contacts and if they cannot be reached, take have the child drink at more frequent intervals; the child to a medical service, to the local community service centre or to keep an eye on the child and take the child’s temperature again after a hospital emergency department; do not administer acetaminophen 60 minutes, or sooner if the child’s condition seems to be worsening; without a written medical authorization for the child.
This Protocol was initially approved by a working group composed of representatives from the health and social services network and childcare services. The Protocol was reviewedby the Comité de prévention des infections dans les services de garde à l'enfance du Québec. The information it contains reflects the state of knowledge on the subject in 2006.
If a child 2 months of age or older has a fever, that is, if the rectal or
pour the medication (drops or syrup) into a medicine spoon calibrated in ml, then administer it to the child; never put a medicine dropper directlyinto a child’s mouth, unless it is a disposable dropper. The spoon must be apply the measures listed above for an increase in body temperature (dress the child comfortably, have the child drink and keep an eye on the child); inform the parent of the child’s condition; if administering a tablet, put it in a goblet then have the child take it. If the child wants to, he or she may drink a little water after taking the tablet; if the rectal temperature is above 38.5 °C, acetaminophen may beadministered to relieve the child, according to the dosage guidelines below wash your hands after administering the medication.
or the dosage instructions on the medication container, in accordance withthe rules in this Protocol. If necessary, acetaminophen may be given as soon as the temperature is 38.1 °C or higher; one hour after administering acetaminophen, take the child’s temperature again; if the temperature is still high, ask the parent to come and pick up the child. If the parent cannot be reached, call the persons designated by the parent as emergency contacts and if they cannot be reached, take the child to a medical service, to the local community service centre or to a When you administer acetaminophen:
always use simple words, appropriate to the child’s age, to explain to the child the relationship between his or her condition, the medication being wash your hands before handling the medication; check the concentration, dosage instructions and expiry date on the - The dosage unit may be repeated every 4 hours.
- Do not exceed 6 doses in a 24-hour period.
- The dosages shown in the chart above are based on a maximum dose of 10 to 15 mg/kg.
the dosage and frequency of administration are different for the2 medications; ACETAMINOPHEN IN RELATION TO IBUPROFEN AND OTHER it has been established that all NSAIDs may affect respiratory func- tions; that is why ibuprofen is contra-indicated in persons who have or IBUPROFEN:
a cross-sensitivity has been observed between salicylates and ibupro- A warning is needed since a clear distinction must be made between When applying this Protocol, care must be taken to never confuse ibupro- Although both medications have antipyretic (fever-reducing) properties, fen and acetaminophen or substitute one for the other.
they must not be confused because they belong to different classes ofmedications and work differently. Ibuprofen must not, under any circums- This Protocol may be applied as indicated even if a child has received tances, be substituted for acetaminophen for the following reasons: ibuprofen at home before arriving at the childcare service, regardless of thetime elapsed. There is no contra-indication to or danger in giving aceta- acetaminophen and ibuprofen belong to different classes of medica- minophen to a child who received ibuprofen earlier since the 2 medications ibuprofen is a non-steroidal anti-inflammatory drug (NSAID); OTHER MEDICATIONS:
in the 4 hours before arriving at the childcare service so the Protocol maybe applied safely, for the health and well-being of the child.
The availability of an increasing number of combination medications con-taining acetaminophen and another pharmaceutical product on the mar- If an educator or a person recognized as a home childcare provider notices ket calls for greater care in applying this Protocol. A number of cough fever in a child within 4 hours of the child’s arrival and has been made syrups, for example, contain acetaminophen.
aware that the child took syrup or other medication earlier, the educatoror provider may contact a pharmacist to obtain the necessary information Good communication between the parents and the person authorized to concerning the medication and apply the Protocol accordingly.
administer the medication is important. The person authorized toadminister the medication must know what medication the child received Authorization form for the administration of acetaminophen
A parent is not required to consent to the application of this Protocol. However, if a parent does not sign the authorization form, acetaminophen may not beadministered to the child unless the parent and a member of the Collège des médecins du Québec give written authorization. A parent may limit the period ofvalidity of the authorization by indicating the duration of the authorization in the space provided.
(name of childcare centre, day care centre, person recognized as a home childcare provider or person who assists the provider, as the case may be, or person desi-gnated under the section 81 of the Educational Childcare Regulation) to administer to my child, in accordance with this Protocol,acetaminophen sold under the following brand name: Brand name, form (drops, syrup or tablets) and concentration

Source: http://www.mfa.gouv.qc.ca/fr/publication/Documents/SG_protocole_acetaminophene_en.pdf

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