• Research
• Off-label instructions
• Expert opinions
• Small clinical trials
• Lack of knowledge of effects, uses and doses of pediatric medications
• Practitioners’ personal experience with the medication

Becuase of differences in body composition and organ maturity

with differences being more pronounced in neonates and younger infants

1. Lack of maturation of the GI tract
2. Gastric pH is less
   
3. Gastric emptying is prolonged
   
4. Feeding methods differ
   
5. Altered perfusion affects IM/Subq absorption
6. Topical: skin is thin and porous
7. GI Surface area higher than in adults, may get systemic effects

As children grow and develop the absorption of medications generally becomes more effective therefore absorption in infants and neonates must be considered in dosing and administration.

A contradiction to this occurs during the adolescent years, during which poor nutritional habits, changes in physical maturity & hormonal differences may cause a slowing of medication absorption

• Body fluid composition
  • Greater volume of fluid, decreased concentration of the drug therefore neonates to about age two require higher concentration of water soluable drugs
    
• Body tissue composition
  • neonates and young infants tent to have Less fat in body composition which means they require less fat-soluble medication
• Protein-binding capability
  • Less albumin, fewer protein receptor sites, means we decrease the dosage
  • High bilirubin in neonates binding with the receptors meant for drug =  more free drug
• Effectiveness of barriers
  • - Skin more absorptive, BBB immature

How is the Metabolism in pediatric pharmacology different?

• Decreased level of hepatic enzymes results in slower metabolism of drugs until about age 2
• Child >2 = higher metabolic rate so dosage adjusted
• First-pass effect high, this is why we will sometimes use the rectal route to avoid the first pass effect with children.
  

Less than 9 months of age

1. Decreased renal blood flow
2. Decreased glomerular filtration rate
3. Reduced renal tubular function
4. Medications excreted more slowly
5. Dehydration

With the Toddler you will want simple explainations, a firm approach and enlist their imagination and play for sucessful administration

With a preschooler use age appropriate explainations, and allow some level of choice and control to sucessfully administer medication

Though cooperative school aged children may fear bodily injury and need even more control, involvement in the process, and information. age appropriate fears related to pain, changes in body image and injury are prevalent among older school age and adolescent clients.

The nurse should establish a positive rapport with the client. contract with the adolescent related to the plan of care, and ensure privacy in all aspects of medication admin

Gluteal

the ventrogluteal or vastus lateralist is the preferred site

• Slower absorption of oral medications
• Impaired circulation can delay transportation of drugs to the tissues
• Drugs metabolized more slowly & less completely
• Drugs excreted less completely

• Slow
• Increase alkaline GI secretions
• Decrease motility
• Distribution
• Loss of protein binding sites
• Loss of body water
• Increase in body fat

Metabolism

• Decrease hepatic blood flow
• Decrease enzyme function
• Drug clearance by the liver is reduced
• Excretion
• Decreased blood flow to liver & kidneys
• CLcr normally 80-130 mL/min
• Half-life of drug prolonged = toxicity

• Reason, route, dose, side effects and when to notify the HCP
• Adherence to drug regimen
• Keep record of drugs and when they are taken
• Diet considerations
• Supportive and available to answer questions
• One pharmacy, discuss OTC with pharmacist
• Easy open cap if needed