Duration Health — Field Guide: Pediatrics

Pediatrics

Introduction

Infants and children are susceptible to many of the same medical problems that adults are. However, 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 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:

  • if in doubt, check with your healthcare provider before giving an OTC medication
  • check with your healthcare provider if your child is taking a prescription medication for any potential drug interactions with the OTC medication
  • follow the directions on the product label for the proper dose and administration, paying close attention to the amount or concentration of the drug
  • only give drugs that are in a pediatric formulation
  • keep all medication out of the reach of children

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 25 mg daily, 50 mg 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 10 mg/kg every 6 hours as needed; maximum 400 mg per dose

OR

acetaminophen 15 mg/kg every 6 hours as needed; maximum 500 mg per dose

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 45 mg/kg/dose twice daily for 10 days (maximum dose 2000 mg per day)

(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 45 mg/kg per dose taken twice a day; maximum 1000 mg per day

OR

azithromycin 10 mg/kg once; then 5 mg/kg daily for 4 more days

If allergic to amoxicillin or penicillins

(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

Urinary symptoms in children under 12 require in-person evaluation and testing before starting treatment. Younger children may require longer courses of treatment at the direction of a physician.

Consider using

cephalexin (generic for Keflex®) 12 mg/kg four times per day (maximum 500 mg per dose) for 5 days

cephalexin capsules can be opened and sprinkled on food

OR

amoxicillin-clavulanate (generic for Augmentin®) 20 mg/kg twice per day (maximum 875 mg per dose) for 5 days

OR

trimethoprim-sulfamethoxazole (generic for Bactrim®) 4 mg TMP per kg twice a day for 5 days (maximum 160 mg TMP per dose)

(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

AND

diphenhydrAMINE (dosed according to weight, generic for Benadryl®)

Always seek emergency medical care for anaphylaxis

Reference

azithromycin pediatric

Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

Prescription only

InfectionMedication

azithromycin suspension

Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

Prescription only

InfectionMedication

amoxicillin-clavulanate pediatric

Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.

Prescription only

InfectionMedication

amoxicillin-clavulanate suspension

Amoxicillin-clavulanate (generic for Augmentin) is an antibiotic. It can be used to treat skin infections like bite wounds, ear infections, sinus infections, tooth infections, and other infections. This medication should be taken with food.

Prescription only

InfectionMedication

amoxicillin capsule

Amoxicillin is an antibiotic. It is used to treat infections of the ear, nose, throat, urine, skin, and lungs.

Prescription only

InfectionMedication

acetaminophen pediatric

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

PediatricsMedication

ibuprofen pediatric

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

PediatricsMedication

amoxicillin pediatric

Amoxicillin is an antibiotic. It is used to treat infections of the ear, nose, throat, urine, skin, and lungs.

Prescription only

PediatricsMedication

amoxicillin

Amoxicillin is an antibiotic. It is used to treat infections of the ear, nose, throat, urine, skin, and lungs.

Prescription only

PediatricsMedication

trimethoprim-sulfamethoxazole pediatric

Trimethoprim-sulfamethoxazole (TMP-SMX, generic for Bactrim, and also abbreviated SMZ-TMP) is an antibiotic. It may be used to treat urinary tract or ear infections in pediatric patients. Other antibiotics are usually preferred as first-line treatment options. The suspension form of this medication contains sulfamethoxazole (SMX) 200 mg and trimethoprim (TMP) 40 mg together in each 5 mL liquid. Dosing is based on the trimethoprim (TMP) component.

Prescription only

PediatricsMedication

prednisoLONE pediatric

Prednisolone is a corticosteroid used to treat inflammation (not the same as an anabolic steroid, like testosterone). PrednisoLONE, more commonly used by pediatric patients, is similar to, but should not be confused with, predniSONE, more commonly used by adults. One common use of prednisolone is to treat the inflammation in the airways that happens with an asthma attack. Prednisolone can also be used to treat severe allergic reactions, including anaphylaxis if used with epinephrine. Prednisolone is often used in conjunction with albuterol which takes minutes to start treating the symptoms of asthma, while prednisolone takes hours to work. This medication should be taken with food.

Prescription only

PediatricsMedication

diphenhydrAMINE pediatric

Diphenhydramine (generic for Benadryl) treats allergic reactions. It may be used for both mild and severe allergic reactions.

PediatricsMedication

EPINEPHrine pediatric

Epinephrine pediatric (adrenaline, generic for EpiPen Jr) injection is used to treat life-threatening allergic reaction in children, known as anaphylaxis. Anaphylaxis is defined as a severe allergic reaction with one or more of lip, tongue, or face swelling, shortness of breath, vomiting, low blood pressure, and rash. If anaphylaxis is suspected, give epinephrine right away and seek further medical attention.

Prescription only

PediatricsMedication

cephalexin pediatric

Cephalexin (generic for Keflex) is an antibiotic. It is used to treat respiratory infections, ear infections, skin infections, and urinary tract infections. It is in the cephalosporin category of antibiotics.

Prescription only

InfectionMedication

clindamycin pediatric

Clindamycin is an antibiotic. Is is used to treat serious respiratory tract, skin, and soft tissue infections. Clindamycin is used to treat infections cause by a class of bacteria called anaerobic bacteria. Clindamycin is sometimes used in place of penicillin-family antibiotics in people allergic to penicillin.

Prescription only

InfectionMedication

polymyxin B-neomycin-hydrocortisone otic

Polymyxin B-neomycin-hydrocortisone otic is an antibiotic ear drop. It is used to treat otitis externa, an infection of the ear canal. Otitis externa, also called swimmer's ear, presents with ear pain, swelling of the ear canal, pain with movement of the outer ear, and occasionally decreased hearing. Do not use this medication if a ruptured ear drum (ruptured tympanic membrane) is suspected. This medication should not be relied upon to treat ear pain and a fever. Presence of a fever suggests an infection of the middle ear (otitis media) or a more serious infection, which may require oral antibiotics or other treatment.

Prescription only

InfectionMedication

dexamethasone pediatric

Dexamethasone (generic for Decadron) is a corticosteroid used to treat inflammation (not the same as an anabolic steroid, like testosterone). It is a versatile and common medication used in a wide variety of diseases. One common use of dexamethasone is to treat the inflammation in the airway that happens with croup or with an asthma attack. Dexamethasone can also be used to treat severe allergic reactions, including anaphylaxis if used with epinephrine. This medication should be taken with food.

Prescription only

GeneralMedication

artemether-lumefantrine pediatric

Artemether-lumefantrine is used to treat malaria infection. It works by stopping the synthesis of the malaria parasite's genetic material.

Prescription only

PediatricsMedication

atovaquone-proguanil pediatric

Atovaquone-proguanil (generic for Malarone) is used for malaria prophylaxis in areas with chloroquine-resistant Plasmodium falciparum, and can be used in most parts of the world where malaria occurs. Take it daily for 1-2 days before possible exposure to malaria, and continue daily for 7 days after leaving an exposed area.

Prescription only

PediatricsMedication

acetaminophen pediatric chewables

Acetaminophen (generic for Tylenol) is a pain reliever and fever reducer. Acetaminophen is used to treat pain.

PediatricsMedication

ibuprofen pediatric chewables

Ibuprofen (generic for Motrin, generic for Advil) is a pain reliever and the most commonly used non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is used to treat pain.

PediatricsMedication

diphenhydrAMINE pediatric chewables

Diphenhydramine (generic for Benadryl) treats allergic reactions. It may be used for both mild and severe allergic reactions.

PediatricsMedication

EPINEPHrine pediatric (Adrenaclick)

Epinephrine pediatric (adrenaline, generic for Adrenaclick) injection is used to treat life-threatening allergic reaction in children, known as anaphylaxis. Anaphylaxis is defined as a severe allergic reaction with one or more of lip, tongue, or face swelling, shortness of breath, vomiting, low blood pressure, and rash. If anaphylaxis is suspected, give epinephrine right away and seek further medical attention.

Prescription only

GeneralMedication

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How to approach Pediatrics Only your Duration Health provider can decide, based on your medical history and other factors, whether it is medically appropriate for you to receive prescriptions. We do not sell prefabricated bags of pharmaceuticals. Each Duration Health Med Kit that contains prescription medications is custom assembled, tailored to each individual patient's needs.

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