Prepared by:
Dr. Salma Elgazzar
 Physiologic differences make
children more sensitive to drugs and
more at risk for adverse drug
reactions.
 Pharmacokinetics and
pharmacodynamics are affected by
changes in body fluid composition,
differences in the cardiovascular,
GIT, renal, and neurological systems.
PHYSIOLOGIC DIFFERENCES
Physiologic differences between children and
adults
 Infants have immature kidneys and liver
delays metabolism and elimination of many
drugs.
 Slow gastric emptying time and
decreased gastric acid secretion may
delay absorption.
 Infants have lower concentration of
plasma proteins, therefore toxicity can
occur with drugs that need to be bound to
proteins.
Infants have less total body fat and more
total body water.
 Therefore, lipid soluble drugs require
smaller doses with less fat present,
and water soluble drugs require larger
dosages.
 As children grow, the changes in fat,
muscle, body water, and organ
maturity will alter the pharmacokinetics of drugs.
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Oral
Rectal
Ophthalmic
Otic
Topcial
Intramuscular
Intravenous
 Be truthful
 Minimally threatening
 Use the 5 rights: pt, drug, dose,
route, time.
 Discrepancies must be determined
 Lab results or levels may need to be
consulted before administration.
 Do not use if child has vomiting,
malabsorption or refusal.
 Dropper/oral
syringe/teaspoon/cup/nipple
 Give small amounts down side of
mouth in an infant
 Encourage swallowing with a
pacifier in an infant.
 Crushed meds are put in a small amount of
soft food: ice cream, apple-sauce, yogurt;
must take it all.
 Do not mix meds with foods, or formula.
 Do not try to trick child; be honest.
 For liquid medications, an oral syringe or
medication cup should be used to ensure
accurate dosage measurement. Use of a
household teaspoon or tablespoon may
result in dosage error because they are
inaccurate.
•Depress the chin with the
thumb to open infant’s mouth
•Using the dropper or syringe,
direct the medication toward
the inner aspect of the infant’s
cheek and release the flow of
medication slowly.
•Note: child’s hands are held
by the nurse and child is held
securely against the nurses
body.
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Rarely used in the acute setting.
Immunizations
Antibiotics
Use emla
A local skin anaesthetic that is applied to
the skin prior to procedures such as
needles, to help prevent pain.
IM INJECTION SITES
Vastus Lateralis is the preferred site in
young children
Birth to 2yrs: vastus lateralis only
Except:
 DTaP given IM in deltoid at 5yrs.
 Ventrogluteal site can be used if muscle is well
developed and amount is 0.5-2ml.
 Gluteus maximus (dorsal gluteal site) must not
be used in the child less than 1 yr or before the
child has been walking for one year; but vastus
lateralis is the preferred site.
Largest muscle in infant / small
child.
0.5 ml in infant
1 ml in toddler
2 ml in pre-school
Use 5/8 to 1 inch (2.5 cm) needle
Compress muscle tissue at upper
aspect of thigh, pointing the
nurse’s fingers toward the infant’s
feet
Needle is inserted at a 90-degree
angle.
Use ½ to 1 (2.5 cm)
inch needle
0.5 to 1 ml injection
volumes
More rapid absorption
than gluteal regions.
Gluteal muscle does not
develop until a child begins
to walk; should be used for
injections only after the child
has been walking for a year
or more
½ to 1 ½ inch needle
1.5 to 2 ml of injected
volume.
-IV
route provides direct access into the vascular
system.
-Adverse effects of IV medication administration:
• Extravasation of drug into surrounding
tissue.
• Immediate reaction to drug.
-Check for compatibilities with IV solution and
other IV medications.
-Flush well between administration of
incompatible drugs.
-IV medications are usually diluted.
-Infusion
pumps are required
-At least hourly fluid monitoring is required
-Medication volume should not fluid
overload the child.
-Agency specific policies for IV medication
administration
-Given via peripheral or central line
-If a maintenance IV isn’t running, the
medication needs to be flushed with saline,
before and after.
-Central lines require a terminal flush with
Heparin when no longer in use (SASH).
IV push = directly into the tubing
Syringe pump = continuous
administration
Buretrol = used to further dilute
drug
•Morphine
•Solu-medrol
•Lasix
Drug that can
safely be
administered
over 3 to 5
minutes.
Accurate delivery
system for
administering very
small volumes
ICU
NICU
 A buretrol or volutrol is an intravenous
delivery device attached between the IV fluid
bag and the intravenous catheter. It is used to
deliver IV fluids in a safe manner to children
and medications in some nursing units.
 Usual volume capacity is 150 ml. Some units
have a policy that a buretrol will be used on all
children under 10 kg while others may state 20
kg. Individual units vary on policy.
 Current theory is that buretrols should be used
for children weighing <10-15 kg.
 A large bore catheter that are inserted either
percutaneously or by cut down and
advanced into the superior or inferior vena
cava
 Umbilical line may be used in the neonate
-Used for long term administration of meds
-Used for chemotherapy
-Total parental nutrition
Central line equipment, in order of typical usage:
1. Syringe with local anesthetic
2. Scalpel in case venous cutdown is needed
3. Sterile gel for ultrasound guidance
4. Introducer needle (here 18 Ga) on syringe with saline to detect backflow of blood
upon vein penetration
5. Guide wire
6. Tissue dilator
7. Indwelling catheter (here 16 Ga)
8. Additional fasteners, and corresponding surgical thread
9. Dressing
 Infiltration
 Catheter occlusion
 Air embolism
 Phlebitis
 Infection
In children younger than age 3 years the pinna is pulled down and back to straighten
the ear canal
In the child older than 3 years, the pinna is pulled up and back.
Instilling eye drops
 Room temp
 May need to wash eye
 Supine and look up
 Pull down lower lid
 Rest hand holding the
dropper with the
medication on the child’s
forehead to reduce risk of
trauma to the eye.
 Allow child to blink
 Dim lights allow child to
open their eye more easily
 Act as vasoconstrictors excessive
use may be harmful
 Discontinued after 72 hours
 Congested nose will impair infants
ability to suck
 Give 20 minutes before feeding
 Have kleenex
 Keep child’s head below the level
of shoulders for 1 to 2 minutes after
instillation
 Position child with the head hyper
extended to prevent strangling
sensation caused by medication
trickling into the throat.
Usually sedatives and antiemetic
Use little finger
Insert beyond anal sphincter
Apply pressure to anus by gently holding
buttocks together until desire to expel subsides
Vaccine
Type
BCG
Live attenuated Bacteria
DTP
D&T = Toxoids
Route
Intradermal (preferred)
Intramuscular
P = inactivated bacteria
Hepatitis B(HBV)
Inactivated viral antigen
Intramuscular
Haemophilus
Influenza b
(Hib)
Polysaccharide
Intramuscular
MMR
Live attenuated viruses
Subcutaneous