Consent Form for Commonly Used Homely Remedies Medication Indication Child Dose Maximum Daily Contra-indications, Special Dose Precautions Bonjela Teething Gel Mild oral lesions From 2 months - 16 years No more than None applicable to children. 6 applications in Massage a small amount of Bonjela gel 24 hours on to the sore area This can be repeated every 3 hours Simple linctus Dry or painful 6 - 12 years 3 doses in 24 hours Caution in asthma, renal impairment. (paediatric) cough 5 - 10 ml Possible side effects include constipation. Kalms – herbal remedy Insomnia Over 12 years 3 doses in 24 hours Allergy to ingredients 2 tablets Sudocrem Pressure sores, None None None rashes Vaseline/Lypsyl Sore and chapped Use frequently No limit Allergy to ingredients. lips E45 cream Dry skin and As necessary No limit Allergy to ingredients. minor irritations Consent Form for Commonly Used Homely Remedies Name of Child/Young Person:- (DOB:-) Medication Indication Child Dose Maximum Daily Contra-indications, Special
Consent Form for Commonly Used Homely Remedies Medication Indication Child Dose Maximum Daily Dose Contra-indications, Special Precautions Bonjela Teething Gel Mild oral lesions From 2 months - 16 years Massage a small amount of Bonjela gel on to the sore area This can be repeated every 3 hours No more than 6 applications in 24 hours None applicable to children. Simple linctus (paediatric) Dry or painful cough 6 - 12 years 5 - 10 ml 3 doses in 24 hours Caution in asthma, renal impairment. Possible side effects include constipation. Kalms – herbal remedy Insomnia Over 12 years 2 tablets 3 doses in 24 hours Allergy to ingredients Sudocrem Pressure sores, rashes None None None Vaseline/Lypsyl Sore and chapped lips Use frequently No limit Allergy to ingredients. E45 cream Dry skin and minor irritations As necessary No limit Allergy to ingredients. Consent Form for Commonly Used Homely Remedies Name of Child/Young Person:- (DOB:-) Medication Indication Child Dose Maximum Daily Contra-indications, Special
home_meds_consent.docx