Use these tips for giving medications to children

Pediatric Corner

Giving medicines to children can be trying even on your best days, says Theresa Cromling, RN, an advanced clinical staff nurse for the ED at Duke University Medical Center in Durham, NC. "There are many reasons that giving medicine to your smallest patients can conjure up some bad memories," she says. "On many days, we may go home with several different doses of medicines on our scrubs." Here are effective strategies to administer medications to pediatric patients:

Use droppers to give oral medicines to infants. When giving oral medicines to infants, Cromling recommends using a dropper or small syringe without the needle. "Drip the medicine into the side of the baby’s mouth, keeping their head elevated," she advises. Do not mix medicines with formula or juice because the medicine may not all be taken, adds Cromling.

Use straws when giving pills to children. If a school-age child has difficulty swallowing pills, Cromling recommends having the child put his or her pill in his or her mouth and lean forward. "Then have the child use a straw to drink some liquid and swallow the pill," she says.

Don’t allow threats. Do not allow parents to threaten their children with a shot or medicine if they are not good, says Cromling. "Tell both the child and the parent that medicines are given only for medical reasons, not punishment," she adds.

Give children choices. You can give children some control over what is happening to them, says Nancy Blake, RN, MN, CCRN, CNAA, director of critical care services at Children’s Hospital in Los Angeles. "You can ask kids if they want the shot on one side or the other, or in the arm or leg vs. the bottom," she suggests.

Ask children for their help. Blake recommends asking school-age children to assist with procedures, if possible. "For example, ask them to hold the dressing over the site where they get a shot," she says.

Follow medicine with a treat. Bad-tasting medicine goes down easier when given with a tasty treat, says Blake. "Ice cream, sherbet, pudding, or applesauce work well in hiding the taste," she says. "If a child is old enough for choices, he or she can choose what type of treat to put their medicine in."

Don’t lie. Children must be able to trust what you are doing, says Blake. "If you give them reason to distrust you because you didn’t tell them the truth, they will be unable to trust you in the future," she says. If something is going to hurt, say so, but explain that you will do it as quickly as possible to get it over with, says Blake. "If you do not prepare children, they will get upset, which could exacerbate their medical problem," she adds. "For example, children in respiratory distress will get worse if they get anxious. They need to be calm."

Allow parents to hold children when giving nebulized medicines. Nebulized medicines such as albuterol and Atrovent may be better tolerated by young children if the parent is allowed to hold them, suggests Cromling. "This may be a good time to read a story, listen to music, or use the rocking chair," she says. Encourage the parent to be calm when their child is not, adds Cromling. "Both crying and calmness can be contagious," she says. "Parents should be encouraged to comfort their children during stressful times in the ED."

Use explanations that are developmentally tailored. Avoid using terminology that children don’t understand, says Blake. "Nurses may use medical lingo that is way over a child’s head," she adds. "Kids don’t know what an IV is."

Cromling offers these suggestions to explain intramuscular (IM) injections for various age groups:

Infant: Explain to the parents.

Toddler: "This is going to be an ouch."

Preschooler: "On the count of three, there will be a quick ouch."

School-age: "This medicine is necessary for you to feel better, but it will be a quick ouch. I need your help so that it will go fast. Hold that bandage tightly, because I will need it as soon as I am done."

Adolescent: Explain as you would to an adult patient.

• Give IM medicines quickly and use eutectic mixture of local anesthetics (EMLA) if possible. IM meds should be given as quickly as possible, advises Cromling. "Give the child a brief explanation just prior to the injection," she says. If enough time is available, use a topical anesthetic agent such as EMLA cream on the area prior to giving the medicine, says Cromling. "This procedure may be used for lumbar punctures and IV access," she says. "However, time constraints may be a factor because some of these topical applications take an hour to start to work."

Sources

For more information about medication administration for pediatric patients, contact:

  • Nancy Blake, RN, MN, CCRN, CNAA, Children’s Hospital Los Angeles, 4650 Sunset Blvd., Mailstop 74, Los Angeles, CA 90027. Telephone: (323) 669-2164. Fax: (323) 953-7987. E-mail: Blake@chla.usc.edu.
  • Theresa Cromling, RN, Emergency Department, Duke University Medical Center, Box 3869, Durham, NC 27705. Telephone: (919) 416-8202. Fax: (919) 286-9219. E-mail: croml001@mc.duke.edu.