A mother wants controls beefed up on the sale of a medicine commonly used to treat babies' pain and discomfort from teething, after watching her infant daughter nearly die from an overdose.
Jessica Vermunt, of Napier, said she was using Bonjela gel last week to help 7-month-old Athena Vermunt-Sergent cope with teeth pushing through her gums.
"She kept screaming at us. Over a period of a few days I slowly gave her a bit more."
After four days of this, Athena had some breathing difficulties, but she also had a respiratory virus. Vermunt took her to the family's doctor.
She told the doctor they had been using more than the recommended Bonjela dosage; the doctor approved.
Six hours later the baby went deathly pale and was unresponsive and limp.
Athena was rushed to a nearby medical centre, where her oxygen level was found to be low. She was taken to Hawke's Bay Hospital and the next day, last Saturday, was flown to the Starship children's hospital in Auckland.
In Starship's intensive care unit, Athena was sedated, put on a breathing machine and given infusions of chemicals to correct a dangerous acidity in her blood.
"They diagnosed her with salicylate overdose. Salicylate is the active ingredient in Bonjela."
Vermunt said her baby was "minutes away from dying after having too much Bonjela". Following treatment she was now sitting up, smiling and giggling - but it was not yet known if there would be any long-term complications.
"I'm not blaming the doctor … I accept if I followed the recommended dose this wouldn't have happened. I accept my part in it. I feel incredibly guilty for it … I know a lot of parents that go over the recommended dosage without any side effects."
Vermunt wants Bonjela teething gel, which can be purchased in supermarkets, restricted to sales by a pharmacist. She also wants more information about its risks provided with the product and circulated to GPs.
The medicine's supplier, Reckitt Benckiser, said it was trying to contact Vermunt to investigate the case. All Bonjela products in New Zealand were approved by drugs regulator Medsafe. Teething and mouth-ulcer gels should be used only in accordance with the packaging's directions and any concerns should be referred to a healthcare practitioner.
Britain's medical products regulator in 2009 declared that products such as Bonjela oral gel containing choline salicylate and for direct application to the body should not be used in children under 16.
The move was based on a case of suspected Reye's syndrome, a rare but serious condition that causes swelling in the liver and brain, in a toddler after use of Bonjela oral gel. A review concluded it wasn't Reye's; it was more likely salicylate toxicity from overuse of the product.
Medsafe, the New Zealand regulator, decided not to follow Britain. Its review found the recommended dose was sometimes exceeded.
The agency said healthcare practitioners should remind parents to stick to the recommended dose. This was to apply a small quantity - "i.e. the tip of index finger" - to the affected area no more than every three hours when required for relief of pain and discomfort from infant teething.
Medsafe also says aspirin - which is derived from salicylic acid - should not be used in children due to the risk of Reye's syndrome.
Medsafe manager Chris James said yesterday the Centre for Adverse Reactions monitoring had not received any reports about Bonjela gel since 2009.
"We cannot take action if there is no evidence of harm but we strongly encourage the family or healthcare professionals treating the child to report to CARM."
The National Poisons Centre said that since August 2016 it had received inquiries about 198 children aged 6 or younger regarding exposure to teething gels. Forty-five of them were referred for medical follow-up.
Director Dr Adam Pomerleau said salicylate poisoning - including from teething gels - was rare. It could cause various health problems and could be fatal. Survivors could make a full recovery or be left with long-term problems.