Appendix 1 CONSENT FORM FOR COMMONLY USED HOMELY REMEDIES Name of Child/Young Person:- (DOB:-) Medication Indication Child Dose Maximum Daily Contra-indications, Special Dose Precautions Paracetamol tablets Mild to moderate Over 12 years 4 doses Caution in renal/kidney conditions 500 mg pain including 1 to 2 tablets (2,000 - 4,000 mg) risk of liver damage if maximum dose period pain (500 - 1,000 mg) every 4 to 6 hours in 24 hours is exceeded. Side effects are rare but possible rashes, blood disorders and acute pancreatitis. Calpol 6 Plus Mild to moderate Child over 6 years 4 doses Caution in renal/kidney conditions Meltlets 250 mg pain 1 or 2 tablets (1,000 - 2,000 mg) risk of liver damage if maximum dose (250 - 500 mg) every 4 to 6 hours in 24 hours is exceeded. (Paracetamol) Tablets to be dissolved in the mouth or Side effects are rare but possible can be mixed in a little milk or water rashes, blood disorders and acute pancreatitis. Kwells/Joy Rides Motion sickness Child 4 - 10 years 3 doses Possible side effects include 75 - 150 micrograms in 24 hours drowsiness, dry mouth, dizziness, They can be taken 20 - 30 minutes blurred vision, difficulty in micturition. before travelling or at the onset of sickness Child over 10 years 150 - 300 micrograms They can be taken 20 - 30 minutes before travelling or at the onset of sickness
Appendix 1 CONSENT FORM FOR COMMONLY USED HOMELY REMEDIES Name of Child/Young Person:- (DOB:-) Medication Indication Child Dose Maximum Daily Dose Contra-indications, Special Precautions Paracetamol tablets 500 mg Mild to moderate pain including period pain Over 12 years 1 to 2 tablets (500 - 1,000 mg) every 4 to 6 hours 4 doses (2,000 - 4,000 mg) in 24 hours Caution in renal/kidney conditions risk of liver damage if maximum dose is exceeded. Side effects are rare but possible rashes, blood disorders and acute pancreatitis. Calpol 6 Plus Meltlets 250 mg (Paracetamol) Mild to moderate pain Child over 6 years 1 or 2 tablets (250 - 500 mg) every 4 to 6 hours Tablets to be dissolved in the mouth or can be mixed in a little milk or water 4 doses (1,000 - 2,000 mg) in 24 hours Caution in renal/kidney conditions risk of liver damage if maximum dose is exceeded. Side effects are rare but possible rashes, blood disorders and acute pancreatitis. Kwells/Joy Rides Motion sickness Child 4 - 10 years 75 - 150 micrograms They can be taken 20 - 30 minutes before travelling or at the onset of sickness Child over 10 years 150 - 300 micrograms They can be taken 20 - 30 minutes before travelling or at the onset of sickness 3 doses in 24 hours Possible side effects include drowsiness, dry mouth, dizziness, blurred vision, difficulty in micturition.
home_meds_consent.docx