Duration Health

Pediatrics

Introduction

Infants and children are susceptible to many of the same medical problems that adults are. But not all medications approved for adults are approved for use in pediatrics. Infants and children handle drugs differently in the body because of differences in kidney and liver function, body water content, body surface area, and other factors. There are certain drugs that adults use that may be toxic to children. Special attention must be paid to whether a drug can be safely used in pediatrics, what dose should be given, and how long the medication can be safely administered. As the common mantra states, "children are not just little adults."

The general age groups for pediatrics are defined as: neonate (newborn) — birth to <1 month; infant — 1 month to <2 years; child — 2 years to <12 years; adolescent — 12-17 years (or <18 years). Medications used in one age range may be dangerous to use in a different age range.

Medication doses are not based on the age or size of the infant or child, but rather on the infant or child's weight. Dosing based on weight is more accurate and can avoid potential adverse reactions, toxicity, or lack of clinical effectiveness that could occur if the drug is not dosed properly.

Treatment

Prescription drugs ordered by a pediatrician for infants and children will have clear dosing instructions on the label. If you decide to give an OTC medication to your child, general rules include the following:

Pediatric-specific formulations may be available as tablets and capsules (like those used for adults), but can also include liquids such as solutions, syrups, suspensions, and drops; chewable tablets; and oral granules or powder that can be mixed in liquid or food like chocolate or pancake syrup, pudding, applesauce, yogurt, or ice cream (make sure the drug does not interact with dairy products). Liquid formulations will be provided with a dosing cup or syringe clearly marked with mL. As a reference, 5 mL = 1 teaspoon, 15 mL = 1 tablespoon.

Drug doses for pediatrics are clearly expressed in the product label to decrease the likelihood of improper dosing. They can appear as a specific mg dose (such as 25mg daily, 50mg twice daily), or a specific mL amount (such as 5 mL) or specific number of tablets or powder packets (3 tablets, 2 powders) based on weight and age.

Many prescription drugs are dosed based on weight, such as mg/kg/dose or mg/kg/day, but the amount to be given to the child will be clear on the prescription label. For reference, know that 1 pound = 2.2 kg, so for example, a 50 pound child weighs 50/2.2 = 22.7 kg or 23 kg (rounding up or down to the nearest decimal fraction). To properly weigh your child, remove shoes and heavy clothing first and use a digital scale as it is more accurate.

When To Worry

Seek medical care if the symptoms of the disease that is being treated in your child do not improve or if they show signs of worsening, or if you suspect an adverse reaction from the medication that is being administered.

Quick Guide

If your child has

  • fever
  • sore throat
  • earache
  • headache
  • body aches

Your child may have

a viral illness

Consider using

ibuprofen pediatric dosed according to the child's weight (see label)

OR

acetaminophen pediatric dosed according to the child's weight (see label)

If your child has

  • itching
  • hives
  • runny nose
  • sneezing

Your child may have

allergic reaction or allergic rhinitis (seasonal allergies or "hay fever")

Consider using

diphenhydrAMINE pediatric (generic for Benadryl®) dosed according to the child's weight (see label)

Not for use in infants

If your child has

  • fever
  • inner ear pain

Your child may have

otitis media (inner ear infection)

Consider using

amoxicillin pediatric dosed according to the child's weight (see label)

(see: Ear section)

If your child has

  • fever
  • white pus in your throat
  • NO cough
  • NO nasal congestion
  • tender lymph nodes ("swollen glands") in neck

Your child may have

strep throat

Consider using

amoxicillin pediatric dosed according to the child's weight (see label)

OR

trimethoprim-sulfamethoxazole pediatric (generic for Bactrim®) dosed according to the child's weight (see label)

(see: Throat section)

If your child has

  • fever
  • foul-smelling urine
  • pain with urination
  • history of urinary tract infections
  • urinalysis test showing nitrites or leukocyte esterase (see: urine test strips)

Your child may have

urinary tract infection

Consider using

amoxicillin pediatric dosed according to the child's weight (see label)

OR

trimethoprim-sulfamethoxazole pediatric (generic for Bactrim®) dosed according to the child's weight (see label)

(see: Pelvic and Urinary section)

If your child has

  • severe allergic reaction including
    • lip, tongue or face swelling
    • shortness of breath
    • low blood pressure
    • rash (including hives)

Your child may have

anaphylaxis

Consider using

EPINEPHrine pediatric (generic for EpiPen Jr®) for children 15 to 30 kg (33 lbs to 66 lbs)

OR

EPINEPHrine (adult dose, generic for EpiPen®) for children 30 kg (66 lbs) or more

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