Don't treat PEDIATRICS like little adults
Over 70% of pediatric admissions are to hospitals that also treat adults. Use these rules of thumb to help keep your pediatrics patients safe...
Overview
As a hospital pharmacist, you will need to stay on high alert when caring for children if your hospital primarily treats adults to help prevent errors. Over 70% of pediatric admissions are to hospitals that also treat adults. Use these rules of thumb to help keep your pediatrics patients safe...
NPS-adv
Clinical practice
Be familiar with general age definitions, since age can affect dosing. A "neonate" is under 1 month of age, an "infant" is 1 month to 1 year, a "child" is 1 to 11 years and an "adolescent" is 12 years or older. For example, vancomycin may be dosed more frequently in an infant or child compared to a neonate, since renal function revs up shortly after birth.
- Assess renal function in kids by using a pediatric equation, such as Schwartz or Bedside Schwartz. Verify your patients medical records doesn't default to an adult equation, such as Cockcroft-Gault.
- Stay alert for small changes in serum creatinine (SCr). A child whose SCr increases from 0.3 to 0.6 may have acute kidney injury. Calculate most pediatric doses based on weight.
- For neonates and premature babies, ask to have access to a pediatric-specific reference, such as NeoFax or Pediatric & Neonatal Dosage Handbook.
- Be aware, data for obese kids are limited. Generally, use actual body weight. But look for exceptions, such as ideal body weight for acyclovir. Verify that a calculated dose isn't more than an adult max dose.
- For example, ceftriaxone 50 mg/kg for community-acquired pneumonia (CAP) in a 50 kg child is 2,500 mg. Use the max adult dose for CAP of 2 grams.
- Know tricks to help kids take oral liquids that may taste bad, such as clindamycin (Dalacin C) or oseltamivir (Tamiflu). For example, suggest a chocolate syrup chaser or a popsicle before and after to numb taste buds.
References
- Eiland LS, Meyers RS. Caring for and assessing pediatric patients: Aspects to consider as a pharmacy practitioner. Am J Health Syst Pharm. 2019 Sep 16;76(19):1463-1471.
- Kennedy AR, Massey LR. Pediatric medication safety considerations for pharmacists in an adult hospital setting. Am J Health Syst Pharm. 2019 Sep 16;76(19):1481-1491.
- Matson KL, Horton ER, Capino AC; Advocacy Committee for the Pediatric Pharmacy Advocacy Group. Medication Dosage in Overweight and Obese Children. J Pediatr Pharmacol Ther. 2017 Jan-Feb;22(1):81-83.