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Chapter 5
Drug Therapy for
Pediatric Clients
Leslie Lehmkuhl, RN 2008
Pediatric Drug Therapy
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Approximately 75% of all prescription
drugs in the U.S. lack full approval by the
FDA because most drugs are not studied
on children.
Studying the effects of drugs in children
is a problem.
5-2
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Absorption
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5-3
Gastric acid
(hydrochloric acid)
secretion in infants is
reduced until >3yrs
PO meds are effected
by the pH, gastric
emptying and gastric
motility *
Enteric coated meds
may not break down d/t
high PH
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Choosing the
intramuscular injection
site most well
developed muscle
Peripheral circulation
often r/t weather (e.g.
vasoconstriction,
vasodilatation)
Topical drug absorption
is more rapid D/T
thinner skin layers *
Intravenous drug
administration least
variable as it
completely bypasses
absorption *
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Distribution

Passage of drug
from its site of
absorption to
peripheral tissues.
60-85%
55%
Total body water
Dependent upon the
amount of water and/or
fat present in the child,
as well as plasma
affinity of the drug and
protein-binding activity
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Receptor site
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Water-soluble drugs
effectively utilized (<fat
>H20)
Fat soluble with variation
Protein binding capacity
is less * … possibly r/t
lower protein
concentration
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Metabolism
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Inactivating
enzymes in liver
that inactivates
drugs in prep for
excretion from the
body
Difficult to predict d/t
developmental and
genetic variation
from child to child

Maternal drug
history is important
5-5
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Excretion

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Renal excretion is
the primary pathway
to eliminate drugs
from the body
Does not reach
adult like capability
to filter until 5
months (glomerular)
and 12 months
(tubal secretion).
Kidney maturation
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Excretion increases
as the kidney
matures.
Drug toxicity
decreases as the
kidney matures.
5-6
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Pediatric Drug Sensitivity
Central nervous system drugs
CNS is not fully mature until 8 months.

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Barbiturates and morphine (IV push
method of choice for analgesics).
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Depressant effects are exaggerated
Lowering body temperature

Ibuprofen
•

Acetaminophen
•

Drug of choice currently
Becomes toxic easily with large doses
Salicylates
•
Do not give to children under the age of 12.
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Pediatric Dosages
Determined by
using a nomogram

Nomograms (BSA)
are generally
accurate after the
attainment of mature
liver and kidney
function

2
Childs BSA in m
--------------------------------------- X adult dose
2
1.73 m
(BSA of Avg Adult)

With immature
organ development
the usual and best
method to dose a
child is by weight. *

Age is the least
accurate method to
determine pediatric
drug dosages
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BSA
5-9
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Rights to Follow
Allow adequate time for drug administration.
Gain the child’s trust.
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Never lie to the child.
Inform parents that medicine should not be
referred to as candy because when they taste they
will know it is not candy.
Consider the child’s developmental level
(remember all care plans are based on this).
Prevent choking.
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Administration Methods
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Liquid medications are
administered using an
infant dropper, syringe
without a needle, or a
small spoon
If the child is less than
3 months old give
w/meals*
Allow child to choose
beverage to wash down
meds
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For bitter tasting meds
have child place ice in
mouth prior to taking
med *
If old enough give the
child choice in order to
receive medications.
Use age appropriate
dialogue to explain
medication
Avoid disguising
medication in foods or
formula.
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Parenteral Medications
Explain the procedure to the child and to
the parents.
Use additional materials such as:
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Booklets
Coloring books
Puppets
Dolls
IV setup with colored water
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Painful Procedures
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Allow the parents to stay.
Painful procedures should
be done in a separate room
designated as the “owie”
room.
Use a firm positive manner.
Assemble equipment first.
Maintain the child’s safety.
Bolus meds use IV Push for
analgesics.
Syringe pump for fluid
volume greater than 2ml
(good for ATB)
For IV site selection
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Select a site that does not
limit child's activity, place on
non-dominant side and use
smallest gauge
needle/catheter that will
appropriately deliver the
medications.
Use local anesthetic cream
1-2 hours before the
procedure
Equipment pumps usually
infuse 60-100 gtts per
milliliter (low-volume
tubing).
5 - 13
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IM/SC Injections
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5 - 14
Deltoid muscle is not
fully developed until
adolescence and is
rarely used.
Vastus lateralis is the
preferred site for
children under the age
of 3.
Dorsogluteal site have
child lie on abd with
toes pointing inward to
relax the buttocks.
Ventrogluteal site is the
preferred site for
children over the age of
3.
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The child should be
walking.
The proper needle
length for SC is 3/8-1/2
inch.
(continues)
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(continued)
5 - 15
Anterior view of the location of the vastus
lateralis muscle in a young child <3 yrs.
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Rectal Suppositories
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Explain procedure
to child
Have child lay on
left side with right
leg drawn up or on
back with legs
flexed on infant or
toddler
Lube medication tip
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Use index finger to
advance the
suppository past the
anal sphincter..if < 3
years use little
finger instead.
Instruct child not to
push out
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Ear and Eye Medications
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Have child in side lying
position with affected
ear up
Pull the pinna down
and back for children
under 3 years old
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Place in supine position
w/head slightly
hyperextended.
Rest dominant hand on
forehead w/eye dropper
½ to ¾ inch from
eyeball.
Place nondominant
hand on cheekbone
and expose lower
conjuctival sac while
applying slight pressure
to inner canthus.
5 - 17
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Accidental Poisoning
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Teach children to stay
away from dangerous
items by using easily
identifiable labels.
Syrup of ipecac
should/should not be
available.
Activated charcoal or
magnesium is more
effective in preventing
gastric absorption.
Mr.
Yuk
Do not induce vomiting:
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if the child is comatose.
if corrosive or petroleum
product was ingested.
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Herbals
No current regulations on
herbal medications in the
U.S.
Adverse effects are seen
more commonly in
children d/t absorption,
distribution, metabolism
and excretion rates.
FDA categories:
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Food, food additives,
dietary supplements or
drugs.
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Parents should not assume
“natural” is “safe”.
Herbal teas, juniper oil are
powerful diuretics can lead
to rapid dehydration and
electrolyte balance in an
infant or small child).
Traditional Chinese
medicines toxic metals,
multiple drugs.
Nearly 18,000 children
poisonings in 2004 from
herbal medicine.
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Final Step in Administering Drugs
Evaluate drug action
Remember…
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Children are vulnerable.
Be kind and patient.
Enjoy the children; you will
receive more than you give.
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5 - 21
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5 - 22
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