Pediatric Pharmacy: Dosing and Safety Considerations
Learn pediatric dosing principles, common liquid formulations, weight-based calculations, and safety concerns for dispensing medications to children on the PTCE.
Pediatric Pharmacy Fundamentals
Children are not simply small adults when it comes to drug therapy. Their developing organ systems, different body composition, and unique pharmacokinetics require special attention. Pharmacy technicians dispensing pediatric prescriptions must be meticulous about dosing calculations and formulation selection.
Why Pediatric Dosing Is Different
- Body composition - Infants have higher body water percentage and lower body fat, affecting drug distribution
- Liver metabolism - Enzyme systems mature at different rates; some drugs are metabolized faster or slower than in adults
- Renal function - Kidney function is immature in neonates, affecting drug elimination
- Body surface area - Changes proportionally as children grow, affecting dosing for some medications
Common Pediatric Formulations
Most children cannot swallow tablets or capsules, so liquid formulations are essential:
- Amoxicillin suspension - 125 mg/5 mL, 250 mg/5 mL, 400 mg/5 mL
- Ibuprofen suspension - 100 mg/5 mL
- Acetaminophen suspension - 160 mg/5 mL
- Azithromycin suspension - 200 mg/5 mL
- Prednisolone solution - 15 mg/5 mL
Oral Dosing Devices
Always dispense an appropriate measuring device with liquid medications. Oral syringes are preferred over household spoons because they are more accurate. FDA recommends oral syringes calibrated in mL for all liquid medications for children.
Reconstitution
Many pediatric antibiotics come as powder for reconstitution. Technicians must add the correct volume of purified water and shake thoroughly. Record the beyond-use date (typically 10-14 days refrigerated) on the bottle. Shake before each use.
Safety Considerations
- Always verify the child's weight and age before processing the prescription
- Double-check calculations for weight-based doses
- Be aware of maximum daily doses that should not be exceeded regardless of weight
- Check for age-specific contraindications (e.g., aspirin in children under 18 due to Reye syndrome risk)
- Ensure child-resistant packaging unless the caregiver requests non-child-resistant containers
Pediatric dosing appears in PTCE calculation questions. Practice these scenarios with PTCB practice problems.
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