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...
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
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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. Available at: https://academic.oup.com/ajhp/article-abstract/76/19/1463/5570019?redirectedFrom=fulltext&login=false
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. Available at: https://academic.oup.com/ajhp/article-abstract/76/19/1481/5570021?redirectedFrom=fulltext&login=false
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. Available at: https://meridian.allenpress.com/jppt/article/22/1/81/82004/Medication-Dosage-in-Overweight-and-Obese-Children