Focus on Pediatrics

Medication safety is not for adults only

Oversight and proper administering important

Safety issues for administering medications to children are different from those for adults. Staff members need to take into account the age and the size of the child, says Vicki Wendt, RN, BSN, CPON, a clinical educator for pediatric services at Sacred Heart Children’s Hospital in Spokane, WA. An 8-year-old child could be the size of a 4-year-old, so it is important that doses simply are not based on age.

Although children are too young to partner with hospital staff in the oversight of their medication, parents should know what the prescription is for, its side effects, and what it looks like.

When the family goes home, parents need to watch out for side effects. The child doesn’t need to know the list of side effects, but parents can ask the child the right questions to determine whether he or she is having any adverse reactions to the medication. For example, if nausea might be a side effect, parents can ask, "How does your tummy feel?"

Also important for parents to know upon discharge is how the medication can be taken. While its OK to crush some pills, others will lose some of their effectiveness if crushed, says Wendt. Some medications cannot be mixed into certain liquids such as apple juice.

The medication might come in several forms, such as a chewable tablet or an elixir, so the child won’t have to swallow a pill. Wendt usually does not teach a child to swallow a pill until about age 8, but it depends on the maturity of the child and their illness. She has taught children as young as 2 years old to swallow a pill when they have leukemia. "I do look at age, but also what is the illness that the patient has and how many meds they are going to have to take," she says.

To teach the technique, Wendt has children put miniature M&M candies on the back of their tongue, take a sip of water, and swallow. "If a child is small, I will try to get a form of medication they can handle, such as an elixir or chewable tablet, but if it doesn’t come in those forms, I would show the parents how to teach the child to swallow a pill. If the child is there and willing to learn, the nurse discharging the patient could work with the child and parents," she says.

Also important for parents to know is the timing of the doses. If a child is supposed to take the medicine four times a day, that doesn’t mean that they can take it twice one day and six times the next day to make up for missed doses, says Wendt. It’s also important for parents to know whether to repeat the dose or wait if the child vomits. The medication may have been in the child’s system long enough.

Incorporate child into teaching

The pharmacist will provide information on what to avoid while taking the medication, such as the sun or dairy products. "This is all part of the education. If children are older than 5, it is good for them to listen, especially if the family is busy, because a second or third pair of ears is helpful," says Wendt. In this way, if Mom or Dad starts to give the child the medication with apple juice after being told not to the child might remember and remind the parent.

While teens will be able to take their own medications, it’s important for parents to monitor the process because it is easy to forget doses. Parents also can help watch for side effects. "I think good communication with any kind of medication is important within the family," says Wendt.

It’s also important to communicate with school staff if the child has to take the medication during school hours. The parents probably will have to provide a written note from the physician.

Whenever an antibiotic has been prescribed, parents must be told to give the child the complete prescription and not put the pills in the cupboard when the child starts to feel better. If they don’t have the child take the full prescription so that the organism is completely knocked out it, will come back with a vengeance, says Wendt.

For more information on pediatric medications, contact:

Vicki Wendt, RN, BSN, CPON, Clinical Educator for Pediatric Services, Sacred Heart Children’s Hospital, P.O. Box 2555, Spokane, WA 99220. Telephone: (509) 474-5772. E-mail: