So, when is it OK to drug the kids?

If an over-the-counter medicine calms the kid, is it good?
By TYRA DAMM
KNIGHT RIDDER NEWSPAPERS
My 4-year-old son has two settings: on and off. When he's on, he's nonstop, full of energy, 100 percent devoted to his task, a constant whirl of motion. When he's off, which isn't often, he's either falling asleep, sleeping or waking up.
My husband and I love that he's so invested in his life. But to be honest, we're sometimes exhausted. Our lives would be easier if he mellowed out when we wanted him to -- at restaurants, during worship services, on plane trips. A surefire way to calm him would be with a teaspoon of Benadryl. We've given him the appropriate dose of the antihistamine to battle allergies probably a dozen times in his life. The pink liquid not only stops his runny nose; it knocks him out and gives his body a chance to rest and recover from what ails him.
We've never given Benadryl to him when he doesn't have a runny nose, watery eyes or isn't sneezing. But would there be any harm if we occasionally gave him a dose just to calm him?
It's a question many parents struggle with and often broach with friends and doctors. And while most doctors on the record will advise against it, there is a quiet acceptance of using the drug occasionally as a sedative.
Cathy Knauber of Plano, Texas, has given Benadryl to her 3-year-old daughter for two plane trips and one 19-hour car ride.
"She's very high-maintenance, high-strung, with lots of energy," Knauber says. "I wanted her to be calm, to not interfere with other passengers."
She says she knows the practice is frowned upon, but she doesn't hesitate recommending off-label use to other parents. Her mom, a retired nurse with 40 years' experience, agrees, she says.
Out of the question
Knauber emphasizes that she'd never use Benadryl to calm her daughter at home or for everyday events.
Using medicine to alter a child's behavior isn't new. An article published in 2004 in Pediatrics, the journal of the American Academy of Pediatrics, notes an increase in the late 19th century of parents medicating children for social reasons.
"Proprietary medicines became a common feature in the home and were administered to children almost as soon as they became restless or 'cross' in the night," wrote three Australian physicians. "To pacify children, chemists, confectioners, and door-to-door salesmen sold narcotic lozenges, prepared with morphine and opium."
Opiates, of course, aren't stocked on neighborhood drugstore counters these days. But we do have access to legal, inexpensive sedatives.
And most of us have felt the effects of Benadryl or another over-the-counter drug containing its active ingredient diphenhydramine, which is also in the sleeping pills Tylenol PM, Sominex and Nytol. Benadryl, which more than 20 years ago was available by prescription only, is an antihistamine that sedates. Adults sometimes use it as a sleep aid.
"Adults say, 'I take it, and I'm fine. Why can't I give it to my child?"' says Dr. Casey Drake, a pediatrician at Children's Medical Center Dallas.
"Benadryl is a fairly safe drug in the adult population," she says, "but children are not little adults."
Pfizer Inc., the pharmaceutical company that makes Benadryl, says through a spokeswoman: "Consumers should not use Benadryl for any purpose other than those stated on the product label, and we cannot comment on the possible effects, if any, of misappropriate or off-label use."
Drake, like all the doctors who agreed to speak for this article, advises parents not to give Benadryl as a sedative, especially to very young children. But there are doctors who suggest its use for calming fussy infants and toddlers or at least hint that it's a reasonable option.
More trouble
Mary Birch of Prosper, Texas, recalls traveling with her twin infant daughters a few years ago. They suffered chronic ear infections, and Birch wanted to make them both comfortable for a flight from Dallas to Atlanta.
"We wanted to calm their nerves," she says. On her pediatrician's recommendation, she says, she gave them each some Benadryl, though they weren't ill when they flew.
The medicine had the opposite effect, though. "It made them hyper as heck," Birch says. "They cried the whole time and wouldn't sit still. It was the worst plane trip ever."
That adverse reaction isn't uncommon, says Dr. Richard Nail of Centennial Pediatrics in Frisco, Texas.
"There are some ... kids who can get hog-wild nuts" on the drug, says Dr. Nail, a father of three.
As with any drug, parents have to weigh potential benefits with potential side effects. Dr. Drake says that when a child is given Benadryl for an off-label use, he or she is at risk of side effects including dry mouth, low blood pressure, dizziness and restlessness. In cases of an overdose, children have had severe side effects such as hallucinations and convulsions, and some have even died.