Pediatric Pharmacology
Introduction to Pediatric Pharmacology
Pediatric pharmacology is a specialized branch of medicine
focused on understanding the effects, dosages, administration, and monitoring
of medications in children. Children are not simply "small adults,"
as their physiological differences influence drug absorption, distribution,
metabolism, and excretion. This chapter delves into the unique aspects of
pediatric pharmacology, emphasizing safe and effective medication use.
1. Drug Dosages and Calculations for Children
Factors Influencing Pediatric Dosage
- Age:
Newborns, infants, toddlers, and adolescents have varying metabolic rates.
- Weight:
Dosages are typically calculated in milligrams per kilogram of body weight
(mg/kg).
- Body
Surface Area (BSA): Often used for chemotherapeutic agents and certain
specialized medications.
- Organ
Maturity: Immature liver and kidney functions in neonates and infants
affect drug metabolism and excretion.
Dosage Calculation Methods
- Weight-Based Dosing:Formula:
Dose (mg)=Weight (kg)×Dosage per kg\text{Dose
(mg)} = \text{Weight (kg)} \times \text{Dosage per
kg}Dose (mg)=Weight (kg)×Dosage per kg
Example: For a 10-kg child requiring 5 mg/kg of a drug:
10×5=50 mg10 \times 5 = 50 \text{ mg}10×5=50 mg
- BSA-Based Dosing:Formula:
Dose (mg)=BSA (m2)×Dosage per m2\text{Dose
(mg)} = \text{BSA (m\(^2\))} \times \text{Dosage per
m\(^2\)}Dose (mg)=BSA (m2)×Dosage per m2
Example: A child with a BSA of 0.8 m² requiring 100 mg/m² of
a drug:
0.8×100=80 mg0.8 \times 100 = 80 \text{
mg}0.8×100=80 mg
Common Errors to Avoid
- Incorrect
weight or unit conversions.
- Misunderstanding
dosage frequency (e.g., daily vs. per dose).
- Rounding
errors leading to underdosing or overdosing.
2. Common Medications Used in Pediatric Care
Categories of Medications
- Antipyretics:
- Example:
Paracetamol (Acetaminophen)
- Indication:
Fever and mild pain
- Typical
Dose: 10–15 mg/kg every 4–6 hours
- Antibiotics:
- Example:
Amoxicillin
- Indication:
Bacterial infections
- Typical
Dose: 20–40 mg/kg/day in divided doses
- Vaccines:
- Examples:
MMR, DTP, and Hepatitis B
- Indication:
Immunization against specific diseases
- Administered
as per national immunization schedules
- Bronchodilators:
- Example:
Salbutamol (Albuterol)
- Indication:
Asthma and wheezing
- Typical
Dose: Based on weight or age-specific inhaler/spacer use
- Anticonvulsants:
- Example:
Phenobarbital
- Indication:
Seizures
- Typical
Dose: 3–5 mg/kg/day
3. Routes of Administration for Pediatric Patients
Oral (PO)
- Preferred
Route: Safe and convenient for most medications.
- Challenges:
Difficulty swallowing pills; unpleasant taste.
- Tips:
Use liquid formulations, and administer with a syringe for accurate
dosing.
Intravenous (IV)
- Indications:
Immediate effect required, or when oral route is not possible.
- Challenges:
Pain during insertion and potential risk of infection.
- Tips:
Use pediatric-specific IV catheters and infusion pumps for precision.
Intramuscular (IM)
- Indications:
Vaccines or medications requiring depot release.
- Challenges:
Painful; limited muscle mass in young children.
- Sites:
Vastus lateralis for infants; deltoid for older children.
Rectal (PR)
- Indications:
When oral and IV routes are unavailable (e.g., seizures).
- Examples:
Diazepam suppositories for febrile seizures.
- Indications:
Respiratory conditions like asthma.
- Tips:
Use spacers with metered-dose inhalers (MDIs) for accurate delivery.
4. Monitoring for Adverse Drug Reactions (ADRs)
Common ADRs in Pediatric Patients
- Gastrointestinal:
Nausea, vomiting, diarrhea.
- Allergic
Reactions: Rash, urticaria, anaphylaxis.
- Neurological:
Sedation, agitation, or seizures (rare).
Steps for ADR Monitoring
- Baseline
Assessment: Document child's vital signs, lab results, and allergy
history before initiating therapy.
- Frequent
Monitoring:
- Observe
for immediate reactions post-administration (e.g., rash, difficulty
breathing).
- Periodic
assessments for delayed effects like hepatotoxicity (e.g., elevated liver
enzymes).
- Documentation:
Record all suspected ADRs, including drug name, dose, time of onset, and
symptoms.
Management of ADRs
- Mild
Reactions: Stop the drug temporarily and monitor.
- Severe
Reactions: Administer emergency treatment (e.g., epinephrine for
anaphylaxis) and report to pharmacovigilance authorities.
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