Good prescribing skills are needed by any practicing doctor. Prescribing in paediatrics has some important differences to prescribing in adults.
During this chapter and throughout the e-book you will be asked to undertake a series of prescribing exercises on both drug charts and fluid charts. You can perform these on the drug chart that is used in your local hospital or on the RRAPID drug and fluid charts. These have been designed specially for this e-book and should not be used for clinical work.
Drug chart – click here to download
Fluid chart – click here to download
Paediatric patients range in age from neonates born at extreme prematurity through to adolescents and in some cases young adults. Decisions regarding treatment and drug dosages depend upon body composition, pathophysiology and metabolism. However, the main factors influencing paediatric prescribing are:
• Surface area
You should always check an up to date British National Formulary for Children (BNFc) or local guidelines for up to date prescribing guidance.
Prescribing can be challenging so it is usually good to approach prescriptions with caution and consider the following questions:
- What is the indication for this drug?
If antibiotics it is essential to include this on the drug chart
- Duration required and review date?
Particularly for antibiotics but good practice for all drugs
- What is the preferable route of administration?
Oral is usually first choice in children
- Is the dose calculated based upon age/weight or surface area?
You can calculate surface area if you know the weight of the child. A conversion chart can be found in the BNFc
- What is the maximum dose of this drug?
Consider whether this is a maximum per day and therefore divided doses needed or per dose
- What preparation do you want to use?
Syrup/suspensions versus tablets (syrups/suspensions most commonly used)
- Are you going to prescribe as a dose or in ml?
Always prescribe a concentration if prescribing in ml e.g. 120mg/5ml
- What is the frequency of administration?
Beware this can change particularly in neonates