A common painkiller is sending a steady stream of New Zealand children to the liver transplant waiting list and now a new study is hoped to stem the tide.
The Health Research Council, the Ministry of Health, and ACC have granted nearly $400,000 for the study aimed at preventing paracetamol poisoning in children.
“Mums and dads think they are doing the right thing by giving paracetamol,” Starship Hospital children’s liver specialist Helen Evans said. “It is devastating for them.”
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Paracetamol, often given to unwell children under the brand name Pamol, is hailed by health professionals as an effective and usually-safe medication for pain and fever but dosed wrongly – particularly over a long period – it can lead to liver damage and, in rare but real situations, death.
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“It is devastating for them. They feel they are doing the right thing,” Starship Hospital doctor Helen Evans said of parents who accidentally poison children with paracetamol. (File photo)
The National Poisons Centre (NPC) takes about 800 calls a year about paracetamol ingestion in children. Evans sees those when the worst happens: The poisoning means hospitalisation and, if not caught in time, the need for a liver transplant.
Evans was an author of a 2014 study, Paracetamol-associated acute liver failure in Australian and New Zealand children: High rate of medication errors, which found that in Queensland, Australia, and New Zealand, 14 out of 54 cases of acute failure were attributed to paracetamol. Twelve of the 14 cases were children aged under 5. Three children had liver transplants and two died, including one who received a transplant
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Parents are giving paracetamol to children to ease pain and fever but the wrong dosage – particularly over a prolonged period – can lead to the need for a liver transplant.
Evans said that there was nothing to suggest those figures had changed. . A big part of the problem was that paracetamol came in different doses and strengths meaning parents did not always get the dosage right. Problems were exacerbated by children who were already sick and dehydrated.
“Some need liver transplants. There’s a chance of them dying if we can’t do that in time,” Evans said.
But, if caught in time, a full recovery was the usual outcome, she said.
“We have seen children drink a whole bottle, but they are okay because it’s a one -off. It’s the repeated doses in unwell children.”
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Parents are giving paracetamol to children to ease pain and fever but the wrong dosage – particularly over a prolonged period – can lead to the need for a liver transplant. (File photo)
Education was the best remedy, particularly for Māori and Pacifika parents, who were disproportionally more-likely to end up over-dosing their children, she said.
Rawiri McKree Jansen, the lead author of the two-year study looking at how to educate parents about the dangers of paracetamol, said nearly one-third of the 804 annual calls to the poison centre were due to parents giving the incorrect dose.
“This suggests to me that many more whānau struggle with accurate paracetamol dosing than the small number who end up in emergency departments,” he said.
More than half of all paediatric acute liver failure patients in New Zealand children were Māori, he said.
His study – lasting two years but which would hopefully have some results within the year – was looking at the challenges parents and caregivers faced in accurately dosing paracetamol.
Dr Adam Pomerleau, a clinical toxocologist and NPC director at University of Otago, said it appeared the 804-call-per-year figure came from a 2014 paper but he believed numbers would now be “on par or higher”.
“There is a good antidote, but it needs to be given in a timely manner,” he said.
