Behind the Label: Calpol
29th October 2009
The season of flu (and fear of swine flu) is upon us. But before you reach for this sticky pink cocktail dished out by doctors and parents as a cure-all for children, think again...
Practically speaking, swine flu is not all that different from seasonal flu
in symptoms and treatment. And children aren't at any particularly increased
risk, above that they face from normal flu, but somehow the word 'swine' before
flu has got parents in a panic - fuelled by the media - and feeling more
helpless than ever.
Enter Calpol, uncritically accepted by parents - and bizarrely by doctors too - as a kind of sticky pink magic bullet for whatever ails your child. As far as we at the Ecologist know, Calpol is not a cure for swine flu but you wouldn't know if from the conversations floating around on parental e-forums:
`Not much we can do, except keep shovelling in Calpol and keep an eye on them'.
`I called the doctors and was told to give him Calpol and call back in the morning'.
`They told us there [at the A&E] to carry on with Calpol, it most likely is swine flu and that we can put the Tamiflu in her strawberry milk'.
No wonder profits are soaring.
In the UK the whole of the children's medicine category is currently worth £137 million a year and is predicted to grow by more than £20 million in the next five years. This growth is apparently due to a greater emphasis on parents self-selecting over the counter (OTC) medicines to treat children's minor ailments.
The sickness business
Calpol, the number one selling children's medicine, has a commanding 70 per cent share of the 'pain and fever' sub-market, which accounts for around half of the total children's medicine market.
This lofty position, according to former manufacturers Pfizer (the medicine is now marketed by McNeil Healthcare UK), is testament to Calpol's 'heritage and commitment to meeting the changing needs of twenty-first century parents'.
Or maybe it is just a testament to parent's general feelings of fear and vulnerability when their kids get sick.
The Calpol range has grown considerably in recent years to include not just the original infant suspension (which contains paracetamol as its active ingredient and is now also available as handy Calpol Infant Suspension Sachets). It now includes Calprofen (with ibuprofen as its active ingredient) as well as Calpol Six Plus Fastmelts (melt in the mouth paracetamol for the over 6s) as well as Calcold (contains paracetamol and diphenhydramine), Calcough Chesty (contains guaifenesin) and Calpol Night (contains paracetamol and diphenhydramine).
So, there's something for everybody. And if it brings down fever and gives parents a better night's sleep what's the harm?
Well, late in 2008 a paper published in the respected medical journal The Lancet challenged many parent's perceptions of the harmlessness of Calpol. Researchers who analysed data on more than 200,000 children found strong links between their exposure to paracetamol as infants and the development of asthma, eczema and other allergies at age 6-7.
In fact using the drug in the first year of life increased the risk of hay fever and eczema at the age of 6 and 7 by 48 per cent and 35 per cent respectively.
The more paracetamol a child had in the early years of life, the higher the risk. Thus children under 12 months who were given a paracetamol-based medicine at least once a month more than tripled the chances of suffering wheezing attacks by the age of 6 or 7. The researchers noted that increased use of paracetamol - because of earlier fears about giving children aspirin - could be a factor in worrying rise in rates of asthma in many countries.
The problem is that because it is so widely available, and recommended by everyone for everything, we don't tend to think of Calpol as medicine. Parents are not encouraged to be thoughtful or frugal in their use of Calpol.
Nor are they encouraged to understand the basic mechanisms of illness with which medicines like paracetamol interfere. In particular parents' fever phobia is something that urgently needs to be addressed
Many doctors will tell you that at least 95 per cent of childhood illnesses are self limiting. In other words they will heal by themselves and do not require any medical intervention. Of course prevention is an important part of health care, but just-in-case medicine, given without any clinical basis, can make symptoms worse and produce a whole range of new and even more debilitating side effects.
Good examples of this idea abound in our approach to common experiences such as fever, earache and coughs.
Fever often develops during an infection. Although we generally think of fever as a bad thing, fever enhances the inflammatory response of the body, and certain components of the immune system work optimally at increased body temperature. Also fever helps to limit the growth of some germs that cannot grow well at higher temperatures.
Suppressing fever with medicines like Calpol interferes with this essential mechanism.
For children, fever can serve another important function. Our children are not born with mature immune systems and fever is one way of activating and 'educating' the immune system to respond when needed. Because of this, temperatures up to 39 C (102 F) don't usually provide sufficient grounds for action unless your child is prone to convulsions.
There is even research to show that warm sponging can be just as effective at reducing skin temperature as paracetamol.
Calpol of course doesn't just contain paracetamol. It is a veritable cocktail of sweeteners, flavourings, preservatives and colourants to make the product appealing and palatable to infants. These additives include strawberry 'flavouring' and carmoisine (E122- suspected carcinogen, banned in Austria, Japan, Norway, Sweden and the US) to produce its pink colour.
It also contains, Maltitol (a mild laxative), glycerol (E422 - large quantities can cause headaches, thirst and nausea), sorbitol (E420 - large quantities can cause stomach upset), the paraben preservatives methyl parahydroxybenzoate (E218 - suspected hormone disrupter and allergen), propyl parahydroxybenzoate (E216 - suspected hormone disrupter and allergen), ethyl parahydroxybenzoate (E214 - suspected hormone disrupter, banned in France and Australia), and a thickener xanthan gum (E415 - no known adverse effects).
Being such an interesting E-cocktail, it's not surprising that it can cause allergic reactions (such as skin rashes and hayfever-like symptoms), tiredness, unexpected bleeding or tendency towards bruising as well as headache, nausea.
Using paracetamol to treat fever may also result in your child having a seemingly endless round of colds, since the body's natural fever reaction was not allowed to kill the virus causing the illness leaving your child to be reinfected again and again.
E122 and E218 can lead to hyperactivity, and the Hyperactive Children's Support Group identifies them as likely causes of mysterious and sudden cases of ADHD-like hyper-activity.
Is neurofen better?
So is Calprofen, the childrens' neurofen suspension, a better option? Not really. The manufacturers of Nurofen, the UK's best selling adult ibuprofen, list the following adverse effects in their packaging:
Stomach discomfort or pain, nausea, stomach ulcer with or without bleeding, black tarry stools, worsening of asthma, unexplained wheezing or shortness of breath, liver and kidney problems, headache, dizziness, hearing disturbance and rarely skin rash, itching, peeling, easy bruising and facial swelling.
Putting it in a lower dose in a sweet syrup, with a reassuring picture of a happy baby on the packaging, may not be enough to protect your child from such effects. In fact in the US concern was heightened in 2003 when an 11 year old girl developed Stevens Johnson Syndrome - a devastating inflammatory disease that can result in serious gastrointestinal problems, blindness and death - soon after being given a children's ibuprofen for a mild fever.
In 2008 a jury decided, bizarrely, that although manufacturers Johnson & Johnson failed to adequately warn of risks of contracting Stevens-Johnson syndrome on the label, this lack of adequate warning did not make the manufacturers liable for the girl's blindness.
Nevertheless the Stevens Johnson syndrome foundation still insists that the number of reported cases of ibuprofen-related SJS has risen in recent years.
Watch and wait
The medical model of care is action oriented. It pursues germs and suppresses symptoms with single-minded determination. When learning how to take care of their children, parents are encouraged to take this model on board.
The idea of 'watch and wait' caring is still not widely encouraged. Not surprisingly, when faced with the combination of medical opposition to a watch and wait approach and the blind panic whipped up by the media about things like swine flu, many parents end up toeing the line. Calpol is dispensed and all is right with the world - until of course it isn't.
To be health conscious is to understand that there is always 'something going around' which is 'probably a virus'. There are viruses and bacteria in us and around us all the time.
The virus that causes flu or measles may be inside you or your children right now. But you are not ill because your immune system is working efficiently. What makes your child susceptible to these things - allergies, run-down immune system, diet, sleep, emotional distress - is the real question and all play a part in susceptibility to infection and in the course of healing.
Addressing these things first, before you reach for the Calpol, is the most important part of prevention and combined with cuddles, kisses and patience is probably the best way to ensure the speedy recovery of a child with a cold.
Pat Thomas is a former editor of the Ecologist