Hard Candy: The Risks of Flavored Medication for Children

By Katie MacBride 07/26/16

When a bottle of children's acetaminophen can kill a small child, does it make sense to make medicine taste so good?

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Hard Candy
A spoonful of sugar?

When I was six years old, I nabbed a bottle of Children’s Cherry Tylenol from a high-up cabinet by climbing up on the counter and reaching up to the top shelf, like the sneaky little alcoholic I was destined to become. I hid the bottle in my room so I could have a couple sips of the yummy cherry candy before bed. The medicine we took when we got ear infections was known in our house as “pink treat” because of its delicious bubblegum flavor. In high school, when I came home stoned with the munchies and didn’t want my parents to know, I would feast on the caramel-flavored calcium chews to ease my endless sweet tooth. 

Misuse or abuse of candy-flavored medication can range from the harmless (a stoned teenager with too much calcium) to the dangerous (a six year-old who could have easily OD’ed on acetaminophen). Flavoring medication, especially for children, has become so ubiquitous, in fact, that it’s challenging—if not impossible—to find common children’s medications like pain relievers and cough syrups without it. But as more flavored medications, like the amphetamine Adzenys, start being approved for younger and younger children, the question arises: should medicine taste like candy?

The benefit to flavoring medication is obvious: one of the biggest challenges in patient care is medication compliance. This is especially true if the patient is a child. “When your child is fighting to breathe and has a high fever, you will do just about anything to relieve their pain. This winter, flavored medication helped [my child] choke down a medication that helped him get enough oxygen to calm down and stop coughing,” one parent told me. To which the only response can be, of course. Of course it makes sense to do whatever it takes to get your child to take the medication they need. 

When I asked a group of parents* about this, they universally agreed that they’d never considered not giving their child flavored medication. “I had no idea unflavored was an option,” another parent told me. As it turns out, I was the one who was making assumptions. I can find dye-free children’s medication, but nothing without flavoring. Still, the idea of unflavored meds was intriguing to some parents. Paul, a parent of a four-year-old daughter, told me, “As a recovering pill addict who has struggled with abusing (and physical dependence on) all sorts of medications, I’m very sensitive to the physiological impact of medicine on my kids. I have definitely noticed that my daughter loves the taste of the cherry flavoring, and will affirmatively ask for it when she feels even slightly sick or in pain. I’m very uncomfortable with that and it’s upsetting. I bet it would be incredibly challenging to switch to unflavored now.”

Masking the taste of medicine has been around as long as medicine itself, although some efforts to flavor medication have been more successful than others. In 1970, Dr. Larry Coben was working in Research and Development of Beecham Pharmaceuticals, trying to figure out ways to mask the bitter flavor of penicillin when he received a shipment of a new type of penicillin, amoxicillin. “It was a very strange day,” he said. “I sat down to taste it—you have to know what you’re working with before you try to flavor it—and I braced myself for this awful bitter taste. When I put it in my mouth, it was absolutely flavorless. I was stunned.” Coben immediately understood the implications of his discovery. “I ran down to the head of the R&D Department and said, ‘We can make this taste like anything we want!’” Thus, bubblegum-flavored amoxicillin—or “pink treat” as my family called it—was born. 

For Dr. Coben, the goal was always to make medication compliance easier for parents. And there’s always been a comfort in the fact that the products he was involved in necessitated a prescription. “No pharmacist is going to let a child purchase prescription medication. The parent is responsible for properly dispensing the medication at that point. With over-the-counter medication, there’s more cause for concern because it’s easier to acquire.” With any medication, Dr. Coben says, the goal is to find a balance between “compliance and abuse.” “When striking that balance, the control is going to be the person closest to the patient. In children, that’s most often a parent.” 

While there may not be many seven-year-olds wandering the local drug stores buying Children’s Cherry Tylenol, parents may be less strict about guarding OTC medications because they’re perceived as safer than prescription meds. Dr. Nick Koch, a senior Emergency Medicine resident at Maimonides Medical Center in Brooklyn, New York says, “I have taken care of several children with accidental ingestions of children’s liquid acetaminophen (Tylenol) and ibuprofen (Motrin, Advil). Both medications in the children’s liquid formulations are bright-colored, extremely sweet and essentially taste like candy. While ibuprofen is relatively benign in an acute ingestion, acetaminophen can be extremely dangerous, even lethal, as it causes acute liver failure.” Dr. Koch estimates that “a full bottle of children’s acetaminophen contains enough of the drug to cause liver damage in a 55-pound child or an average eight-year-old, and can kill a smaller child if completely ingested as the toxic dose is weight-related.”

When considering the severe consequences of an acetaminophen overdose, it makes one wonder why an unflavored children’s liquid pain reliever, or even minimally flavored children’s medication, isn’t an option (or if it is, I couldn’t find any examples). As a result of concerns about artificial coloring, pharmaceutical companies developed dye-free flavored medications, which would decrease the visual appeal for a child. 

Until a minimally flavored option exists, and for parents who would (understandably) rather have their kids take medicine without the fuss, proper storage is essential—and it might be more involved than you think. Dr. Koch says that inadequate storage is the primary cause of accidental and intentional pediatric cases of medication ingestion he has seen. “Children can be very resourceful when it comes to finding and accessing things around the house that they shouldn’t be getting into, such as medications.” This isn’t necessarily the result of overt negligence on the part of the parents. Dr. Koch says that most often, “the medication was stored in a cabinet somewhere in the bathroom where the parents thought it was inaccessible to the child, but the child was able to gain access.” This was certainly true for my Cherry Tylenol smuggling days. 

While OTC medication results in many emergency pediatric visits, Dr. Koch is also concerned about the impact of flavoring highly addictive drugs. When discussing Adzenys, the orange-flavored dissolvable amphetamines approved for children with ADD/ADHD he says, “Adzenys definitely has a very high abuse potential. Essentially somebody has taken a class of medication that is already widely abused, and added additional incentive by making it taste like orange candy.” One of the parents I spoke to echoed this concern. “My 16-year-old takes Adderall for ADD,” she said. “If she had trouble swallowing pills, I would let her take [Adzenys]. But I would keep it with me. I don’t think I’d let her take responsibility for taking it herself.” Still, the “candy-flavored” part of the equation gives her pause. “A chewable pill is one thing. A candy-flavored treat is another.” 

So how can parents best protect their children in a world full of candy-flavored drugs? Dr. Koch recommends, “medications need to be stored somewhere that is secured and completely inaccessible to children, ideally in some sort of locked cabinet.” Dr. Howard Forman, director of the Addiction Consultation Service at Montefiore Medical Center and Assistant Professor of Psychiatry at Albert Einstein College of Medicine offers another suggestion: “I would recommend only removing the needed dose from the package and then re-securing the rest, rather than removing the entire package and then dispensing a dose. In a time of permanent distractions, a distraction that leaves potent medication unsecured is bound to happen.”

While parents may be the major control in dispensing medications to children, Dr. Forman admits that prescribing doctors also play a significant role. “Medicine is just climbing out of the darkest valley of a crisis that prescribers played a major role in creating. Stimulants are critical treatment for many with ADHD. I hope that doctors will have learned from past errors and be thoughtful about who needs stimulants and furthermore, who needs to have stimulants packaged to be so attractive.” After all, Dr. Forman says, “who doesn’t like candy?”

*Parents are either quoted anonymously or using pseudonyms

Katie MacBride is a writer living in the Bay Area. You can find more of Katie’s work on her website and follow her on Twitter @msmacb

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Katie MacBride is a writer and the Associate Editor of Anxy Magazine. In addition to The Fix, her work has appeared in Rolling Stone, New York Magazine, Quartz, and The Establishment. She writes an advice column about recovery for Paste Magazine. Follow her on twitter at @msmacb; find her work at www.katiemacbride.com.

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