Children: Administration

Last updated: Monday, December 10, 2018

Questions around the practical administration of medicines to children present similar problems to those described for doses because good quality data and appropriate formulations are often lacking. Below, we look only at enteral administration as an example; for information on other routes refer to the Information Sources.

Enteral administration

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Some children may be able to swallow tablets, but younger children, or patients with a feeding tube, often require a liquid formulation and this forms the basis of many clinical problems that pharmacists deal with. If the medicine is licensed in children, and the manufacturer produces a liquid/dispersible preparation then this is often the preferred option. However there are some exceptions such as with very viscous liquids which may be difficult to administer through more narrow feeding tubes.

If a licensed liquid is not available then consider:

  • A different route of administration.

  • Changing to a different drug that is available as a licensed liquid or dispersible tablet.

  • Sourcing the medicine from an NHS or industry ‘specials’ manufacturer, which in the absence of a licensed product, is usually the next best (safest) longer-term solution. However, do check the cost as some of these are disproportionately expensive. In addition, remember that special products can take some time to arrive from the manufacturer so you may need to investigate other options to resolve the problem in the short-term. Finally they may have a short expiry date, so bear this in mind too.

  • Importing a licensed liquid from outside the UK. The EU and US are preferred as they have similar licensing standards to the UK but note that there may not be an English patient information leaflet. Again advise the enquirer of costs as importing medicines can be expensive and that there may be delay while the medicine is ordered. It is also important to think about the long-term implications of importing – does it mean the patient must rely solely on the hospital for future supplies?

  • Establishing whether a tablet or the contents of a capsule could be dissolved or dispersed in
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    water         and an appropriate volume withdrawn. This isn’t without risk because parents/carers must perform some careful measurement, particularly for less soluble drugs when the concentration may vary throughout the mixture. Remember that the drug should be mixed with water immediately prior to administration, and shaken well. It must never be stored in the aqueous state. Some tablets may also be crushed and mixed with a small amount of food. However the taste of crushed tablets can sometimes be unpalatable.

  • Using a tablet cutter to divide tablets into halves or quarters. This will never give an exact dose and so is not suitable for drugs with a narrow therapeutic range, cytotoxic agents or very small tablets.

  • Giving an injection orally. Remember to establish whether any excipients are suitable for administration by mouth and/or to be given to children (see Medication choice). Think about the practical aspects if the injection ampoule is made of glass: generally this is not a desirable option for children treated at home. If it is essential, you may need to think about the supply and disposal of sharps bins, filtering the injection to remove any shards of glass, education of the carers to ensure safe administration etc.

  • Extemporaneous dispensing of the medicine is seen as a last resort by some specialist paediatric bodies: the variability in standards of manufacture increases the risk of errors.

Practical tip

Medicines should almost never be added to an infant’s feeding bottle (a notable exception is Gaviscon Infant sachets) or added to large quantities of food (another exception here is pancreatin). This is because if the child does not consume the entire bottle or all the food, then an unknown proportion of the dose may have been taken. Occasionally it may be acceptable to use a small amount of food or juice to disguise the medicine (e.g. on a teaspoon) but take care to ensure the child receives the full dose.