MEDICATION USE IN

PAEDIATRIC
IZZATI ABDUL HALIM ZAKI
izzatihalim@uitm.edu.my
After this class, I will be able to

1. explain different stages of childhood.

2. understand drug disposition in paediatric.

3. explain the concept of safe drug therapy in paediatric.

4. suggest the administration method of medication in paediatric.

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Childhood age ranges

Newborn Infants
Children Adolescents
Neonates Toddlers
0 to 27 days 28 days to 23 2 to 11 years 12 to 16 years
months

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Why paediatric?

● Dealing with the development, disease and disorders of children.

● Period of rapid growth and development.
● Different organs, body systems and enzymes responsible for the
medications developed at different rate.
○ Dosage, formulation, response to medication & adverse drug reaction vary.

● Not extensively researched.

● Licensed medications in appropriate dosage forms is limited.

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Drug disposition
Absorption

● Pharmacokinetic factors
○ Essential to
understand the
Excretion Distribution
variability in drug
disposition among
children.

○ Rational and
appropriate therapy. Metabolism

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Drug disposition: Absorption

● Oral
○ Influenced by few factors;
■ Gastric & intestinal transit time, gastric & intestinal pH and gastrointestinal contents.
○ Rate of absorption correlated with age
■ Older infants & children = healthy adults
● Intramuscular
○ Infants & children > neonates
○ Increased muscle blood flow
○ VERY PAINFUL & SHOULD BE AVOIDED IF POSSIBLE
● Rectal
○ Useful during vomiting
○ Infants & children reluctant/unable to take oral medication.
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Drug disposition: Absorption

● Topical
○ Absorption greatly related to skin hydration.
○ Newborn > infants > adults

● Intranasal
○ Medications with local action.
○ Intravenous access is difficult.

● Inhalation
○ Direct delivery of medication to the lung.
○ Mainstay treatment for asthma.

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Drug disposition: Distribution

● Factors determine drug distribution changes with age.

● Total body water and extracellular fluid decrease with age.
Age Total body water (%) Extracellular fluid (%)

Neonate 75 45

3 months 75 30

1 year 60 25

Adult 60 20

● Water - soluble drugs required larger doses in neonates compared to older

child to achieve similar plasma concentrations. 10
Drug disposition: Distribution

● Binding to plasma protein in infants is low.

○ Low concentrations of globulin and albumin.

● Binding capabilities compared to adults

reached within;
○ Third year of life - acidic drugs

○ 7 to 12 years of life - basic drugs

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Drug disposition: Metabolism

● At birth
○ Reduced amount of enzymes responsible for drug metabolism.
○ Various immature body systems.
○ Reduced capacity for metabolic degradation.

● Older infant & young children (1 to 9 years age group)

○ Increase metabolic rate.
○ Greater metabolic clearance compared to adult.
○ Required higher dosage to achieve similar plasma concentration.

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Drug disposition: Excretion

● At birth
○ Kidney is anatomical and functional immature.
○ Limit the renal excretory capacity.

● Below 3 to 6 months of age

○ Glomerular filtration rate lower than adult.

● 6 to 8 months of age
○ Complete maturation of glomerular and tubular function

● After 8 months of age

○ Renal excretion comparable with older children and adults.

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Drug disposition: Other factors

● Nutritional status
○ Malnutrition - low albumin level affecting protein binding
capacity

● Disease states
○ Cystic fibrosis - high excretion of antibiotics
○ Nephrotic syndrome - increased excretion of furosemide
○ Cardiac failure - altered protein binding

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Drug therapy in paediatric

● Dosage

● Choice of preparation
○ Route of administration

● Selecting the drug dosage

regimen
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Drug therapy in paediatric: Dosage

● Use correct references and should not be

extrapolated from adult dose.
● Identify the dosage convention.
○ Total dose in a day and number of doses divided into.
■ e.g. 800 mg daily in 4 divided dose

○ Single dose and number of times the dose should be

repeated in 24 hours.
■ e.g. 200 mg every 6 hours

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 Drug therapy in paediatric:
Choice of preparation

Factors contribute to the choice of preparation and formulation;

● Preferred route of administration

● Age of the child
● Availability of preparation
● Other concomitants therapy
● Underlying disease states

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 Drug therapy in paediatric:
Choice of preparation

● Oral route
○ Most convenient.

○ Accurate administration to ensure safe and effective drug therapy.

■ Use of syringe instead of spoon.

○ Diabetic kids

■ Choose the sugar-free formulations

● Do not add the dose of medicine to their food.

● Do not crush solid dosage form (e.g. sustained-release preparation)

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 Drug therapy in paediatric:
Choice of preparation

● Intranasal route
○ Drugs highly absorbed from the nasal mucosa.
○ Avoid injections but difficult in uncooperative child.
○ May irritate the mucosa or painful.

● Rectal route
○ Limited range of products.
○ Dosage inflexibility.
○ Useful in unconscious child.

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 Drug therapy in paediatric:
Choice of preparation

● Parenteral route
○ Intravenous widely used compared to intramuscular.
○ Difficulties in accessing small veins.
○ Direct administration of intravenous fluid increased risk of fluid overload.

● Pulmonary route
○ Aerosol inhalers required coordination.
○ Use spacer devices or large-volume holding chambers.

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 Drug therapy in paediatric:
Selecting the drug dosage regimen

Questions to ask before we decide on the dosage regimen for paediatric;

1. Is the weight appropriate with the age?

2. Is the dose correctly calculated based on the body weight?
3. Does the dosing interval is suitable with the child’s daily schedule?
4. Is the most suitable route of administration was chosen? Whether the
preparation and formulation available in the facility?
5. Are there any long-term adverse effects to the child?
6. Is there any interactions between drug-drug or drug-food?
7. Is the drug licensed?
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What will be the most effective
way in administering
medication to children?

https://forms.gle/xJoJFLdUEpQ
EygAY9
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thank you
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