What are the implications of withholding a dose for a pediatric patient?

From the Guidelines

Withholding a dose for a pediatric patient can have significant implications, including potential harm or adverse effects, and it is crucial to prioritize accurate dosing and administration to minimize errors. When administering medication to a pediatric patient, it's essential to keep the dose appropriate for their age, weight, and condition. Pediatric dosing is typically calculated based on the child's weight (mg/kg) or body surface area (mg/m²), rather than using standard adult doses, as highlighted in a study published in Pediatrics in 2019 1.

According to the study, children are at greater risk of medication errors than adults due to childhood development, demographics, dependency on parents and other care providers, and the different epidemiology of medical conditions. The study also notes that electronic health records (EHRs) are most often designed for adults and have limited effectiveness in reducing pediatric-specific errors.

Key considerations for pediatric medication administration include:

• Verifying the correct dose using a reliable pediatric dosing reference or formulary before administration
• Double-checking calculations, as even small errors can be significant for children
• Using appropriate measuring devices like oral syringes rather than household spoons to ensure accuracy
• Documenting the dose given, time of administration, and the child's response
• Consulting with a pharmacist or physician if unsure about a dose

A previous study published in Pediatrics in 2011 1 also emphasized the importance of accurate dosing and administration in pediatric patients, highlighting that 15% of new prescriptions for common medications in outpatient pediatric clinics were issued with potential dosing errors.

Therefore, it is essential to prioritize accurate dosing and administration in pediatric patients to minimize errors and potential harm, and to always consult with a reliable pediatric dosing reference or formulary before administration.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Implications of Withholding a Dose for a Pediatric Patient

• Withholding a dose for a pediatric patient can have significant implications, including potential harm or even fatal complications, due to the unique pharmacokinetic parameters and individualized dosing requirements of this population 2.
• Pediatric patients are not simply smaller versions of adults, and their physiological changes, growth, and development must be taken into account when assessing and administering medications 3.
• The absence of appropriate pediatric dosage forms and the potential for dosing errors can increase the risk of harm, highlighting the need for specific dosing guidelines and useful dosage forms for pediatric patients 2, 4.
• Medication dosing errors can occur in up to 17.8% of hospitalized children, and emergency medical services (EMS) paramedics may have limited experience with pediatric patients, increasing the risk of errors 5.
• The co-administration of pediatric medicines with food and drinks can affect the bioavailability and physiochemical properties of the medication, and recommendations should be made on a case-by-case basis, considering the drug's biopharmaceutical classification system (BCS) class and the type of formulation 6.

Factors to Consider

• Age, size, and level of organ maturity of the pediatric patient 2
• Weight-based dosing and variability in medication concentrations available in the EMS setting 4
• Physiological changes and growth of the pediatric patient 3
• Type of food and drinks used for co-administration with pediatric medicines 6
• Biopharmaceutical properties of the medication, including its BCS class and formulation 6

Strategies for Improvement

• Development of specific dosing guidelines and useful dosage forms for pediatric patients 2
• Individualized medication dosing based on patient factors such as age, weight, or body surface area 3
• Use of standardized medication formularies to enhance dosing safety 4
• Education and training for EMS paramedics on pediatric medication dosing and administration 5
• Harmonization of recommended administration strategies for pediatric medicines with food and drinks 6