Children: Medication choice

Last updated: Thursday, July 09, 2015

Besides the normal factors you should consider when choosing a medicine for any patient, there are some extra considerations for children. We have already looked at the problem of dosage, and the practical aspects of administration of oral medicines, but here are two other considerations:

Excipients

There are some excipients that can present special problems in children such as those in the table below. Exposure to these agents should be minimised as far as possible but occasionally a medicine containing a problem excipient may be indicated after a careful risk-benefit assessment (e.g. amiodarone containing benzyl alcohol).

Excipient
Linked with
Glucose and sucrose
Obesity, and tooth decay if taken orally
Benzyl alcohol
A gasping syndrome in neonates
Ethanol
CNS effects
Aspartame
A source of phenylalanine in patients with phenylketonuria
Polyoxyl castor oils
Severe anaphylactoid reactions
Propylene glycol 
CNS effects especially in neonates and children under 4 yrs
Colourants (e.g. tartrazine)
Hypersensitivity and behavioural disturbances
        This table is not a comprehensive list and exclusion does not indicate safety

A more detailed assessment of the risks posed by excipients to children is presented by NPPG and the Welsh Medicines Information Centre here (see p 2).

‘Alarm bell’ drugs

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There are some medicines that are not generally used in children if possible because of specific safety concerns. Examples include:

  • Tetracyclines due to their deposition in growing teeth and bones

  • Systemic chloramphenicol because of 'grey baby' syndrome in newborns

  • Aspirin because of an association with Reye’s syndrome

How you proceed with clinical problems involving these medicines depends upon the exact scenario, but usually you should explore with medical colleagues whether a safer alternative would be suitable, and undertake a risk-benefit assessment. There will be some special situations when it is not appropriate to suggest an alternative such as aspirin for heart disease.