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Prescribing for children

While all the foregoing advice on avoiding medication errors applies to both children and adults, special care is needed when prescribing, preparing and administering drugs to children. Drugs that are relatively innocuous in adults may have adverse effects in children.

Variations in height, weight and body mass can make them more susceptible; or they may quickly accumulate toxic levels as a result of slower metabolism and excretion. In many cases referred to MPS, errors occurred because the doctor failed to check the appropriateness of the drug and its route of administration in children or infants, or to prescribe the correct dose.

Drugs that are relatively innocuous in adults may have adverse effects in children

Box 14: Case report

Receptionist changing a prescription has profound repercussions

A four-month-old baby girl died in the UK following an error in issuing a repeat prescription for Frusemide at her local general practice surgery.

She had been taking Frusemide since she was four weeks old, but the strength of solution had recently been changed because she was having trouble swallowing it in 5ml doses.

When her mother rang the surgery to ask for a repeat prescription, the receptionist seemed to be confused by the two prescriptions on the system and apparently changed the dosage on screen before printing off the prescription and adding it to the pile of repeat prescriptions for signing.

A doctor, unaware that changes had been made to the prescription, signed it on the assumption that it was a normal repeat prescription. The prescription he signed, however, was for a 10x strength, 5ml to be taken twice a day. A solution at that strength should, however, have been taken in 0.5ml doses.

Source: Daily Mail 17 March 2010

Advice for safer paediatric prescribing 

  • Limit the drugs you use to a well-tried few and familiarise yourself with their dosages, indications, contraindications, interactions and side-effects.
  • Refer to a paediatric formulary when appropriate.
  • If you are prescribing in very small amounts of less than 1 milligram, prescribe in micrograms (written out – not abbreviated) to avoid confusion over the placing of decimal points. 
  • When prescribing for a child, it is particularly important to give the parents all relevant information such as:
    • the name of the drug
    • the reason for the prescription
    • how to store and administer the drug safely (if appropriate)
    • common side-effects
    • how to recognise adverse reactions.
Parents must always be warned about side-effects, particularly those that will be distressing to the child
Parents must always be warned about side-effects, particularly those that will be distressing to the child. It is also helpful to remind them of the importance of storing drugs in their labelled containers and out of the child’s sight and reach.
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