Don't Treat Pediatric Patients Like Little Adults

You'll 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 peds 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 EHR 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.

Check med volume. For example, generally use a max IM volume of 0.5 mL for neonates...or 1 to 2 mL for children, depending on the child's size and the muscle used. Split into multiple syringes if needed.

Know tricks to help kids take oral liquids that may taste bad, such as clindamycin or oseltamivir. For example, suggest a chocolate syrup chaser...or a popsicle before and after to numb taste buds.

For more guidance on preventing errors with dosing and ordering, get our chart, Keeping Pediatric Patients Safe.

Key References

  • Am J Health Syst Pharm 2019;76(19):1463-71
  • Am J Health Syst Pharm 2019;76(19):1481-91
  • Am J Health Syst Pharm 2019;76(19):1521-31
  • J Pediatr Pharmacol Ther 2017;22(1):81-3
Hospital Pharmacist's Letter. November 2019, No. 351118



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