Magic mouthwash

In infants, do NOT use oral lidocaine due to risk of methemoglobinemia and FDA black box warning[1][2]

Background

  • Some experts recommend Magic Mouthwash / oral Lidocaine in children if not tolerating PO intake, although evidence suggests no better than placebo[3]

Warnings

  • DO NOT EXCEED dosing limits especially for lidocaine.
  • DO NOT use under 2 years old
  • Never give a family an amount that can be toxic if unintentionally swallowed in its entirety

Lidocaine

  • 1 cc Viscous 2% lidocaine = 20mg lidocaine
  • Max dose = 5mg/kg
  • For a 10 kg child = 50mg lidocaine = 2.5 cc

Diphenhydramine

  • Diphenhydramine 6.25mg/5cc or 12.5mg/5cc
  • Max dose = 5mg/kg/day
  • For a 10 kg child = 50mg benadryl =20 cc of 12.5mg/5cc

Makeup

Equal parts:

  1. Viscous lidocaine 2%
  2. Diphenhydramine
  3. Maalox

Management

0.5-1mL before feeds

See Also

References

  1. FDA recommends not using lidocaine to treat teething pain. http://www.fda.gov/Drugs/DrugSafety/ucm402240.htm
  2. Curtis LA, Dolan TS, Seibert HE. Are one or two dangerous? Lidocaine and topical anesthetic exposures in children. J Emerg Med 2009;37:32-39
  3. Hopper S. et al. Topical lidocaine to improve oral intake in children with painful infectious mouth ulcers: a blinded, randomized, placebo-controlled trial. Ann Emerg Med. 2014 Mar;63(3):292-9

Authors:

Ross Donaldson