Prescribing for children

While all the foregoing advice on avoiding medication errors applies to both children and adults, special care is needed when prescribing, preparing and administering drugs to children. Drugs that are relatively innocuous in adults may have adverse effects in children. Variations in height, weight and body mass can make them more susceptible; or they may quickly accumulate toxic levels as a result of slower metabolism and excretion.

In many cases referred to MPS, errors occurred because the doctor failed to check the appropriateness of the drug and its route of administration in children or infants, or to prescribe the correct dose.

Advice for safer paediatric prescribing

Parents must always be warned about side-effects, particularly those that will be distressing to the child

• Limit the drugs you use to a well-tried few and familiarise yourself with their dosages, indications, contraindications, interactions and side-effects.
• Refer to a paediatric formulary when appropriate.
• When writing a prescription, include the child’s age and write the exact dose in weight and (if liquid) volume required for administration.
• Always calculate doses on paper and, if possible, get a competent colleague to check your arithmetic.
• When writing dosage, take special care not to lead with a decimal point – put a zero in front of it, eg, 0.2mg.
• Never abbreviate micrograms.
• For amounts less than 1 milligramme, prescribe in microgrammes to avoid confusion over the placing of decimal points.

When prescribing for a child, it is particularly important to give the parents all relevant information such as:

• The name of the drug.
• The reason for the prescription.
• How to store and administer the drug safely (if appropriate).
• Common side-effects.
• How to recognise adverse reactions.

Parents must always be warned about side-effects, particularly those that will be distressing to the child. It is also helpful to remind them of the importance of storing drugs in their labelled containers and out of the child’s sight and reach.