Did you know that pilots are not allowed to fly for 30 hours after taking even one dose of Benadryl? This is due to the potential for sedation and profound impairment that can slow reflexes and interfere with motor skills. Yet parents and pediatricians routinely give this medication to infants and children of all ages for a myriad of reasons. Diphenhydramine, brand name Benadryl®, is one of the oldest and most frequently used over-the-counter medications for children. However, many better options are now widely available, all of which are faster acting, longer lasting, with less side effects.
Antihistamines counteract the effect of histamine throughout the body, and treat a range of symptoms including itching, hives, sneezing, and runny nose. Older 1st generation antihistamines such as Benadryl® are not very selective and interfere with many other pathways in the body, causing side effects. Newer 2nd generation antihistamines offer the same benefit in counteracting histamine but are much more selective in their mechanism of action.
It’s challenging to try and undo 60 years of routine use of Benadryl®. Change can be hard to understand or accept. It’s important to remain current to provide the best care we can to children. Misconceptions surrounding Benadryl® are common – here are some of the common questions I receive from parents and medical professionals.
Can Benadryl® Make My Child Sleepy?
Yes, one of the main side effects is sedation. This can make children very drowsy, to the point of falling asleep. In addition, sedation can cause lingering confusion and significantly impair gross motor and even affect learning abilities. This can be a big problem when it comes to school performance.
My Child Becomes Hyperactive With Benadryl®. Is This Normal?
Hyperactivity occurs in roughly 10-15% of children as sort of an opposite effect. The only way to know if your child will react this way is by giving it to them. Tip: Do not give them Benadryl® for the first time right before you board an airplane or get in a car for a long road trip!
I Often Use Benadryl® to Help My Child Go to Sleep at Night. Is This Ok?
Not really. If your child is having difficulty sleeping, it is very important to discuss possible reasons with their doctor. Sleep aids, in general, are not effective as they don’t address the underlying problem causing insomnia. If your child is itching so much from eczema or other causes, then antihistamines may be helpful to calm this down so they can rest, but we can still use 2nd generation options instead of older medications.
I Use Benadryl® for My Child’s Seasonal Allergies. Is There a Better Option?
Absolutely. Newer 2nd generation over-the-counter antihistamines such as loratadine, cetirizine, and fexofenadine (Claritin®, Zyrtec®, and Allegra®) last much longer (18-24 hours compared with 4-6 hours for Benadryl®) and have much fewer side effects, most notably sedation.
My Child’s Runny Nose Got Better After Taking Benadryl®. Does This Mean They Have Allergies?
Not at all. This is a prime example of how the side effects of Benadryl® can improve symptoms. Benadryl® can dry out secretions and mucous membranes. This can create problems not only in the eyes, nose and throat but throughout the rest of the body as well. Improvement in a runny nose during a cold is not due to the anti-histamine properties of the medication. In general, Benadryl® is not an effective medication to use during upper respiratory infections due to short duration of action and unfavorable side effects.
Can My Child Become Tolerant to Antihistamines?
Not really. There are many reasons why these medications may no longer offer benefit. Most commonly, they are used inappropriately for symptoms that do not improve with antihistamines. For example, nasal congestion does not improve with antihistamines, which only treat sneezing and itching. The dose may also need to be increased with age or growth.
Should I Give Benadryl® for Treatment of an Allergic Reaction?
First line treatment of any severe, rapidly progressive allergic reaction (anaphylaxis) is ALWAYS self-injectable epinephrine. This is prescribed for children who have known food allergies or history of anaphylaxis to venom or other allergens. However, for mild symptoms such as rash or localized swelling without any breathing problems or other symptoms, antihistamines can help. 2nd generation antihistamines actually work faster than Benadryl® and last much longer as well. Many food allergy/anaphylaxis treatment plans are being changed to remove Benadryl® and list medications such as cetirizine instead.
This is, by no means, a comprehensive list of indications for use or possible side effects but hopefully will answer some of your questions. As always, please talk to your child’s personal doctor if you have any questions regarding Benadryl® or any other medications.
David Stukus, MD, is an associate professor of pediatrics in the Section of Allergy and Immunology at Nationwide Children’s Hospital. Dr. Dave, as his patients call him, is passionate about increasing awareness for allergies and asthma.
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