Benadryl is typically not recommended for use in infants or children under 2 years of age, and there are no Benadryl products available in the United States for children under the age of 6. Benadryl contains the antihistamine diphenhydramine, which can have serious, even fatal, side effects in infants.
What are antihistamines?
Antihistamines like Benadryl are used to treat allergies caused by histamines, which are released to defend the body against allergens. Histamines are responsible for allergy symptoms such as itching, congestion, and redness, as well as as the increased mucus secretion seen in cold and cough.
With allergies, the immune system misidentifies typically harmless agents such as pollen and dust as foreign invaders and responds with the same inflammatory responses. Therefore, during allergic reactions, people experience symptoms such as itching and skin swelling.
Antihistamines have been at the forefront of allergy treatment for many years because they effectively relieve symptoms of seasonal, indoor, and food allergies. They can also be used to treat hives and skin rashes.
Antihistamines work by blocking or reducing the amount of histamines, thereby alleviating allergy symptoms. They cannot, however, treat every symptom. For example, for nasal decongestion, decongestant medications may be prescribed in addition to antihistamines.
How safe are antihistamines?
Generally, antihistamines are classified into two groups:
- First-generation or sedating antihistamines can cause drowsiness in most people. They include chlorpheniramine, promethazine, hydroxyzine, triprolidine, and diphenhydramine.
- Second-generation or nonsedating antihistamines cause less drowsiness and are usually recommended. They include cetirizine, loratadine, desloratadine, and fexofenadine.
The safety of first-generation antihistamines has never been fully examined in children of any age group. Second-generation antihistamines, however, have been the focus of multiple studies in children, allowing for a greater understanding of their safety profiles and suitable doses.
What are potential side effects of antihistamines?
Side effects of antihistamines are generally more pronounced with first-generation antihistamines and may include:
- Dry mouth
- Nausea and vomiting
- Restlessness or moodiness (in some children)
- Lack of concentration
- Changes in appetite
- Trouble urinating or inability to urinate
- Blurred vision
Rare side effects of antihistamines include:
- Insomnia (difficulty sleeping)
- Itchy skin
- Rapid heartbeat
- Chest tightness
Children, particularly those younger than 6 years old, are more vulnerable to the side effects of antihistamines like Benadryl. Parents are therefore advised not to give antihistamines to their children without first consulting a doctor or pharmacist.
What medications are used to treat allergies?
Common treatment options for allergies include:
- Antihistamines: Alleviate symptoms by inhibiting the release of histamine from mast cells. Antihistamine nasal and ocular sprays can be used to treat seasonal allergies.
- Intranasal corticosteroid nasal sprays (INCS): Help with mild to severe allergies. A prescription may be required for higher doses.
- Combination therapies (INCS and antihistamine): Used to treat moderate to severe allergic rhinitis and combine the advantages of both medications.
- Adrenaline (epinephrine): Used to treat life-threatening severe allergic reactions (anaphylaxis). In an emergency, an adrenaline auto-injector is commonly used.
- Allergen immunotherapy (also called desensitization): Long-term treatment that alters the immune system's response to allergen and involves regularly injecting or administering sublingual tablets, sprays, or drops containing progressively increasing doses of allergen extracts.
The best way to avoid allergy symptoms is to limit exposure to allergens. Management strategies include closing your windows when indoors, removing allergens from your hair, skin, and clothes, etc.
If none of these methods work to alleviate your allergy symptoms, see an allergist. If symptoms become severe enough to cause difficulty breathing, seek medical attention right away. It is critical to inform your doctor about how your allergies are affecting your life in order to receive the best treatment.
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The Organization of Teratology Information Specialists. Diphenhydramine. https://mothertobaby.org/fact-sheets/diphenhydramine-pregnancy/
St. Louis Children's Hospital. Diphenhydramine (Benadryl) Dose Table. https://www.stlouischildrens.org/health-resources/dosage-tables/diphenhydramine-benadryl-dosage-table
American College of Allergy, Asthma & Immunology. Seasonal Allergies. https://acaai.org/allergies/seasonal-allergies
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Cold and Cough Medicine for Infants and Children
The safety of giving infants and children over-the-counter (OTC) cold and cough medicine is important for caregivers to understand. While there is no "gold standard" recommendation for giving infants and children OTC cold and cough medicine for fever, aches, cough, and runny nose, a few standards have been recommended.
The American Academy of Pediatrics recommends that OTC cold and cough medicine only be used in children age four years and older.
The American College of Chest Physicians recommend that these medicines only be used in children age 15 years and older.
The FDA recommends that OTC cold and cough medicine be used in children 2 years of age and older.
However, there is agreement in regard to which OTC medications should not be used in children under the age of four (or the age of two, depending upon which guidelines are used), and they are 1) certain antihistamines like brompheniramine, chlorpheniramine maleate, and diphenhydramine (Benadryl); 2) cough expectorants (guaifenesin); 3) cough suppressants (dextromethorphan, DM); and 4) decongestants (pseudoephedrine and phenylephrine).
Aspirin should never be given to infants, children, and adolescents due to the possibility of a rare, but often severe and even fatal illness called Reye's syndrome.
FDA. "Most Young Children with a Cough or Cold Don't Need Medicines." July 18, 2017.
FDA. "Use Caution When Giving Cough and Cold Products to Kids." Updated: Nov 04, 2016.
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