Children: Reducing risk

Last updated: Monday, May 16, 2022

Reports of medication errors are more common in infants and children. In general the same types of medication errors occur as in adults such as the wrong doses or frequencies being used, doses being missed etc. However, the consequences of such errors are likely to be more severe. Factors that contribute to medication errors are numerous but the panel below highlights some of the more common pitfalls.

Common reasons for medication errors in children

  • Incorrect use of information resources (e.g. doses described in terms of total daily dose [t.d.d] being prescribed three times a day)
  • Lack of familiarity with drug (e.g. in hospitals, errors are more likely to occur in clinical areas where children are treated alongside adults such as in emergency departments or theatres)
  • Use of unlicensed/off-label drugs due to lack of clinical information/experience
  • Lack of licensed paediatric dose units and/or the need to use adult formulations
  • Complex calculations and dilutions
  • Displacement volumes
  • Extemporaneous preparation of oral liquids 

To try to reduce the risk associated with different concentrations of medicines being available, and patients unknowingly being switched between different strengths resulting in under- or overdosing, the NPPG and RCPCH recommend use of a standard concentration liquid, where one exists. The BNF for Children includes this information in the relevant drug monographs in the ‘Prescribing and dispensing information’ section. 

AUDIO: Liquid medicines standardisation for children 
If you want to learn more about this important area of risk and have an hour to spare, listen to expert paediatric pharmacists discuss the challenges of ensuring safe use of medicines in children across the primary and secondary care interface in an SPS webinar. You can come back to this exercise later if you prefer but we strongly recommend it.

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Almost all prescribing and administration of medicines to children requires a calculation at some point. Calculations involving infusions can be particularly complex, especially where doses are expressed in terms of mg/kg/minute, for example.

It goes without saying that correct calculations are vital. Clues that would normally point to you having made an error in an adult, such as needing multiple injection ampoules, are not always present when prescribing or administering medicines for children. In a child it is quite possible to obtain a dose that is ten times too high from a single ampoule or tablet which has been marketed for adult use. You may like to refresh your calculation skills here.

Practical tip

Do not be afraid to get someone to check your calculations. This is particularly important if you are less familiar with prescribing in children.