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“For the most part, parents do not want to give medicine to their children,” Dr. Stephen Turner said. But the most common agent used for its sedative effects is Benadryl, which also can prevent motion sickness.
“It is safe in pregnancy, so there is no reason to think it would not be safe in children. I think it is reasonable to use for a child older than 6 months for plane or long car trips, although I often suggest a ‘trial run’ as it may have the opposite effect and make children hyper,” said Dr. Turner, chief of the department of pediatrics at Long Island College Hospital in New York.
“Any other medicines are not indicated,” Dr. Turner said. “I am sure that the American Academy of Pediatrics would advise against using medicine for sedation for this reason. Their policy statement on cough suppressants is that they have never been shown to be effective in children.”
Others take more of a zero-tolerance position toward off-label sedation.
“Pediatricians are the advocates of children and should speak against a convenience-driven chemical silencing of the children,” Dr. Philippe Similon said in an interview.
“They must also educate the parents on the unexpected ‘paradoxical’ and harmful effects of antihistamines. Not uncommonly, parents do consider sedation of their young children prior to long airplane flights. Most of them, however, follow the advice of their pediatrician,” said Dr. Similon, a pediatrician in private practice in New York.
“The job of the pediatrician is to be responsive when the parent brings it up,” said Dr. Ellen Perrin, professor of pediatrics and chief of developmental and behavioral pediatrics at Tufts-New England Medical Center, Boston.
Like Dr. Similon, Dr. Perrin advocates that parents never sedate their children. “The medications have some side effects that can be problematic. For example, Benadryl will make the majority of children settle down or get sleepy. But it will make some others hyperactive. And combination products that contain an antihistamine can cause dry mouth and other effects.”
Dextromethorphan and pseudoephedrine are some active ingredients in children’s cough medicines associated with a higher risk of side effects. Parents’ administering too much, in some cases unknowingly combining different products with the same ingredients, has led to reports of morbidity and mortality with use of certain over-the-counter cough and cold remedies.
The Food and Drug Administration issued an advisory in August 2007 that parents should not use these medications in children under 2 years of age unless expressly told to do so by a physician*
Dr. Perrin suggested that parents employ age-appropriate strategies before travel to try to affect behavior. “First, inform children what is expected of them in a plane or car where they must sit constrained in a seatbelt. Also, provide incentives for the children.” Parents often know what type of rewards will work best for a particular child.
“As a general rule, rewards are more effective than punishment,” Dr. Turner said. “Parents also need to have reasonable expectations for what a child can handle.”
With young children, “the big issue is getting them to sit still,” Dr. Perrin said.
“For example, during takeoff and landing children, should know there are some activities they can and cannot do. They cannot run around but they can read a book or draw.”
Dr. Turner said, “Try distracting the child if possible with toys, games, a DVD, etc.”
A child should be well rested and well fed before a long trip, Dr. Similon said. “A favorite comfort object, a favorite book, or some favorite music can have a welcome calming effect.”
“Of course, young children do not always listen to reason and are occasionally subject to uncontrollable tantrums,” Dr. Similon said. The first priority for parents in this situation should always be safety, such as ensuring that seatbelts remain properly fastened, he said.
Tolerance from the other passengers and from the flight personnel should be the norm, he added.
“Parents who feel they are not able to deal calmly and comfortably with the tantrums of their young child may benefit from parenting classes,” Dr. Similon commented.
A behavioral consult might be warranted if the standard behavior management techniques parents can learn do not work, Dr. Perrin said.

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The incident came only days after former “American Idol” finalist Clay Aiken fell asleep on a Continental flight, his foot landing on the armrest of the passenger in front of him. The singer claims he was awakened by a quick hit to the chest by the annoyed passenger, prompting an argument and a call to the FBI, although no charges were filed.
Perhaps it’s not surprising that, with passengers packed like cattle into planes this summer and delays and even cancellations common, tempers were a bit frayed in the skies and taxiways. But major hassles can be avoided, travel and etiquette experts advise, if passengers simply pack their kindness and Sunday-best manners and leave hostile, I’m-so-important attitudes at home.
“Most people are not jerks who are out to get us,” said Barbara Pachter, etiquette expert and author of eight books. She advises not to think the worst about your fellow travelers. “Many people become preoccupied and have no idea how their behavior affects others. That’s true on planes. That’s true everywhere.”
It also helps to think ahead, Pachter said. If you plan to work on your laptop by setting it on your tray table, politely ask the person seated in front of you to warn you before he pushes his seat back.
That way, you will avoid hearing an awful crunch when that passenger suddenly pushes the seat back with the force of a defensive football tackle.
“You can’t ask them not to move back. That’s not your space,” Pachter added.
Airlines such as AirTran that offer free headsets for satellite radio also introduce the potential for tension.
Say, for example, that your seatmate’s arm is covering the plug and channel indicator. Kindly ask her to please move her arm, just for a moment, so you can change the channel. Don’t say, “Move your lousy arm so I can change the channel,” Pachter advises. That won’t work, she said.
Of course, there’s always the risk of sitting next to the chatty traveler. Kathleen Ameche, author of “The Woman Road Warrior,” tries to avoid the issue by using headphones, a book and sunglasses to discourage a lot of conversation.
If talking can’t be avoided, Pachter advises that you give your fellow passenger a reason for wanting to end a conversation. “At some point you need to say, ‘I’m really tired. I need to get some sleep.’ Or, ‘I’m really pressed for time. I have to prepare for a meeting.’ ”
Children can create thorny problems. You don’t want to come off as a mean-spirited adult (many passengers in the Continental ExpressJet incident sided with the mom), but parents need to be aware that an enclosed plane is not simply another playpen.
If a child seated behind you starts kicking your seat, Pachter said, “You put up with it for a little bit. But if the kicking continues, turn around and say to the child, You’re kicking my seat. Will you please stop it?’ If that doesn’t work, ask the child’s parent to intervene,” Pachter said.
Parents can help, too, by making sure they have things for their children to do. Pauline Frommer, creator of the new Pauline Frommer Travel Guides, has traveled with her two daughters since they were infants and always brought pipe cleaners along to amuse them.
“They are an amazing invention. Unlike games, they can keep them busy for a long time,” she said. “You can make hats. You can make one into a loop, one into an arrow. You can do sculptures.”
Travelers can help out parents with children, Frommer said.
“If you see a mom in trouble, trying to keep her child quiet, start making faces at the kid. Start clowning around with them.”
Then there’s the dreaded middle seat in a row of three. If you find yourself stuck there, remember rule No. 1: Do not hog the armrests just because you have less room.
“It’s big enough to share,” Ameche said, adding that you can even make a small joke out of it. “I say, I’ll take the back, you take the front. Are you OK with that?’ Lay those ground rules. Use of humor is very important.”
Boarding and deplaning can be stressful, too.
Alert passengers who keep their belongings organized help keep things running smoothly so that a plane departs and arrives on time; travelers who are tying their tennis shoes in the aisle after the plane has landed are in the way.
Once you board, “Get into your seat as quickly as possible,” Pachter said. If the plane is late and you’re stranded and forced to sleep overnight in an airport, move away from snoring passengers or an aisle near the bathroom where there’s always a lot of traffic.

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In an multicenter investigation dubbed the Trial of Infant Response to Diphenhydramine, or the TIRED study, Dr. Dan Merenstein and his associates assessed 44 babies aged 615 months who slept in their own cribs; had difficulty falling asleep; and awoke two or more times per night, needing parental assistance to fall back to sleep. They hypothesized that babies treated for 1 week with diphenhydramine would be more likely to fall asleep without their parents and to put themselves back to sleep when they awakened during the night, compared with babies treated with placebo.
The investigators further hypothesized that during treatment, babies who received diphenhydramine would soon associate their cribs with sleep, and that this effect would carry over after treatment ended. They predicted the treated babies would demonstrate better sleeping habits at 2- and a-week follow-up than those who had received placebo (Arch. Ped. Adolesc. Med. 2006;160:707-12).
After a 1-week run-in period, half the babies were randomly assigned to receive the most commonly recommended dose of diphenhydramine (1 mg/kg) 30 minutes before bedtime every day for 1 week, and the other half to receive a placebo of purified water colored and flavored to match the drug. Parents tracked the babies’ sleep habits in a daily diary, and also rated their own happiness with their babies’ sleep. Clinicians assessed outcomes at 2, 4, and 6 weeks after enrollment.
All of the researchers’ hypotheses proved to be incorrect. The study was halted before full enrollment was completed because an interim analysis showed that diphenhydramine was ineffective.
Immediately after treatment ended, there was no significant difference in sleep improvement (number of nighttime awakenings and length of time before falling asleep) between the two groups. Only three babies in the placebo group (14%) and one in the active treatment group (5%) showed improvement.
However, by final follow-up, a small but statistically significant improvement was noted in babies who received the placebo. Five babies in the placebo group (23%) showed sleep improvement, compared with one (5%) baby in the active treatment group.
The parents’ reports of their happiness with their babies’ sleep throughout the study “were nearly identical for the two groups,” reported Dr. Merenstein of Johns Hopkins University, Baltimore, and his associates. “Many in the medical and lay community accept diphenhydramine as effective treatment for sleep problems. Unfortunately, this attitude is based on anecdote and studies of adult physiological interactions.
“The TIRED study results demonstrated that at the most commonly used dose, diphenhydramine may play no role in treating infant sleep problems,” Dr. Merenstein and his associates said.
Their findings also highlight the need for “rigorous studies of common primary care interventions” in children, as well as studies of sleep in healthy children. “Because of a lack of evidence, parents and physicians often are forced to make important decisions on the basis of anecdotal experiences,” the investigators noted.
BY MARY ANN MOON
Contributing Writer
COPYRIGHT 2006 International Medical News Group
COPYRIGHT 2008 Gale, Cengage Learning

PERCENT
BRAND SALES * CHANGE

CATEGORY TOTAL $2,429.9 10.2%
CLARITIN 151.9 14.2

CLARITIN D 146.6 5.4
MUCINEX 146.4 15.7
BENADRYL 137.9 3.9
MUCINEX DM 123.9 29.5
AIRBORNE 102.9 -7.2
SUDAFED PE 101.2 -4.9
ZYRTEC 99.5 N/A
TYLENOL 97.3 19.0
THERAFLU 70.1 4.6

* in millions

Source: Information Resources Inc. for the 52 weeks ended May 18,
2008, for food, drug and mass, excluding Wal-Mart

COPYRIGHT 2008 Reproduced with permission of the copyright holder. Further reproduction or distribution is prohibited without permission.
COPYRIGHT 2008 Gale, Cengage Learning

Benadryl, called “diphenhydramine” in many medicines, is often used in the hospital to help people sleep. In addition, it is in many allergy medicines that can be found over the counter. But Benadryl is also known to have some effects on the body that could potentially cause problems in more susceptible people.

Researchers at the Yale University School of Medicine looked at 426 people in the hospital who were aged 70 and older. Just over a quarter of them had received Benadryl while in the hospital, and the researchers wanted to determine if the drug was causing any problems with memory or concentration.

They found that those people who had been given Benadryl while in the hospital were more likely to be confused at some point in addition to having temporary moments of altered speech and coming in and out of consciousness.

The results of this study, which appear in the Sept. 24 issue of the Archives of Internal Medicine, leave us asking if this effect of Benadryl might also be a concern in elderly people who take the medicine at home.

The researchers suggest that this issue definitely needs to be looked into further.

However, in the meantime, what should you do?

I would not suggest that you change anything you are doing right away based on what this study is telling us. But if you are elderly and you take Benadryl regularly for allergies, to help you sleep, or for any other reason, I would recommend you pay close attention to whether the medicine seems to be causing you to act differently.

Of course, this can be a very difficult thing to tell about yourself. So if you know someone who is elderly and taking Benadryl, pay close attention to see if they seem to have any difficulty with confusion or memory problems within several hours after having taken it.

If so, I would suggest that you contact the doctor to learn of other ways to treat your allergies or insomnia.

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COPYRIGHT 2002 Reproduced with permission of the copyright holder. Further reproduction or distribution is prohibited without permission.
COPYRIGHT 2008 Gale, Cengage Learning

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COPYRIGHT 2001 Racher Press, Inc.
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“The results were quite a surprise,” commented Dr. Bruce Bender, head of pediatric behavioral health at National Jewish and lead author of the study. “Our hypothesis was that the group receiving diphenhydramine would score
significantly lower. We thought the kids’ reactions to the medications would be similar to those of adults.”
Bender did identify two previous studies that reported conflicting results, suggesting that the effects of diphenhydramine on children needed to be more closely examined. According to Bender, the study also highlights the physiological differences between children and adults and the need to study the effects of drugs in children before approving them for pediatric use.
COPYRIGHT 2001 Reproduced with permission of the copyright holder. Further reproduction or distribution is prohibited without permission.
COPYRIGHT 2008 Gale, Cengage Learning

Interestingly, those with asthma, liver problems or other allergies are most susceptible to sulfite reactions. But anyone can be affected by ingesting sulfites.
Sulfites are found virtually everywhere today. But there are things you can do to avoid sulfites. Most importantly, if you are allergic, do not eat in restaurants or places where food is prepared for you. Never eat food from a salad bar, which is probably the most common source of sulfite containing foods. Additionally, be sure you have your Epi-pen with you at all times.
When you cook at home, prepare your meals with organic foods. Stay away from processed and canned foods. Do not eat dried fruits, and remember that alcoholic beverages probably contain sulfites. And finally, ask your doctor or pharmacist if your vitamins or medications have been preserved with sulfites.
If you experience a mild reaction to sulfites, drink lots of water. You may also reduce your symptoms by taking Pepsid AC. Benadryl may give you relief as well.
If you believe you are allergic to sulfites, make an appointment with your physician to be tested, and immediately begin to avoid sulfites.

Measles virus (MV) is an enveloped, nonsegmented negative-stranded RNA virus of the Paramyxoviridae family. Measles is more common in lesser developed countries, particularly where people suffer from vitamin A deficiency as part of malnutrition. In the UK all children between the age of 12 and 15 months are offered the MMR vaccination, which will protect them from measles, mumps and rubella. Measles is often an unpleasant mild or moderately severe illness. Severe measles is particularly likely in poorly nourished young children, especially those who do not receive sufficient vitamin A, or whose immune systems have been weakened by HIV/AIDS or other diseases. Complications are more common in children under the age of five or adults over the age of 20.

Antibiotics should be prescribed for treating eye and ear infections and pneumonia. Ribavirin, an anti-viral medicine, may be helpful in severe cases or when a child’s immune system is weakened. Use a cool-mist vaporizer to relieve cough and to soothe breathing passages. Clean the vaporizer each day to prevent mold from growing. Avoid hot-water or steam vaporizers that can cause accidental burns and scalds in children. Routine immunization is highly effective in the prevention of measles. MMR vaccine is recommended for all measles vaccine doses to provide increased protection. Don’t give aspirin to children because of the risk of Reye’s syndrome. Diphenhydramine (Benadryl) or calamine lotion may help to ease the itch of the rash. Drink plenty of fluids to help avoid dehydration.

Measles Treatment and Prevention Tips

1. Routine immunization is highly effective in the prevention of measles

2. Rest in bed, if that makes you or your child more comfortable.

3. Sponge baths with lukewarm water to the face and upper body.

4. Drink plenty of fluids to help avoid dehydration.

5. Use a cool-mist vaporizer to relieve cough and to soothe breathing passages.

6. Clean the vaporizer each day to prevent mold from growing.

8. Avoid hot-water or steam vaporizers that can cause accidental burns and scalds in children.

9. A humidifier or vaporizer may ease the cough.

10. Diphenhydramine (Benadryl) or calamine lotion may help to ease the itch of the rash.