What questions should a pediatric provider ask before prescribing medications to patients of various ages, including infants, young children, and adolescents, with consideration of their medical history, current medications, and potential allergies?

Essential Pre-Prescribing Questions for Pediatric Patients

Before prescribing any medication to a pediatric patient, you must systematically obtain patient-specific weight in kilograms, current medication list including over-the-counter drugs and supplements, allergy history with specific reaction details, and relevant medical and family history that affects medication safety. 1

Critical Patient Information Required

Age-Specific Measurements

• Document date of birth or age in units more specific than years to enable accurate weight-based dosing calculations 1
• Obtain current weight in kilograms (not pounds) as this is mandatory for calculating mg/kg dosing for most pediatric medications 1
• Record height in centimeters for medications requiring body surface area calculations (mg/m² per day) 1

Complete Medication History

• Ask specifically about all prescription medications currently taken, including dosages and duration of use 1
• Inquire about over-the-counter medications such as acetaminophen, ibuprofen, antihistamines, and cough/cold preparations 1
• Document all dietary supplements, herbal products, and vitamins as these frequently interact with prescription medications—31-68% of patients fail to disclose supplement use unless directly asked 2
• Question about "vitamins, herbs, teas, or natural products" using this specific phrasing rather than just asking about "medications" to improve disclosure rates 2
• For adolescents, ask about recreational drug use including marijuana, cocaine, methamphetamine, and vaping products in a nonjudgmental manner 1

Allergy and Adverse Reaction History

• Document any history of intolerable adverse effects or allergies to medications with specific details about the type of reaction (rash, anaphylaxis, gastrointestinal upset) 1
• Ask specifically about hypersensitivity reactions to sulfonamides, penicillins, and other common pediatric antibiotics 1
• Inquire about previous reactions to medication classes you are considering prescribing 1

Medical History Questions

Past Medical Conditions

• Ask about chronic medical conditions including renal insufficiency, hepatic disease, cardiac abnormalities, diabetes mellitus, and gastrointestinal disorders that affect medication choice or dosing 1
• Document history of seizures, structural cardiac abnormalities, or arrhythmias before prescribing stimulants or medications that prolong QT interval 1
• For infants, obtain full birth history and review of maternal history including maternal infections, substance use, and pregnancy complications 1
• Ask where the patient has traveled and lived as endemic exposures (histoplasmosis, coccidioidomycosis) may affect medication safety 1

Family Medical History

• Inquire about family history of malignant arrhythmias or sudden cardiac death before starting medications affecting cardiac conduction 1
• Ask about family history of type 2 diabetes, obesity, and hyperlipidemia before prescribing antipsychotics or other medications causing metabolic effects 1
• Document family psychiatric history when prescribing psychotropic medications 1

Medication-Specific Safety Questions

Before Prescribing Antibiotics

• Review previous antibiotic use and response to avoid repeating ineffective treatments 1
• Ask about recent antibiotic courses as this increases risk of drug-resistant infections 3
• Document any history of Clostridioides difficile infection as this affects antibiotic selection 4

Before Prescribing Psychotropic Medications

• Obtain comprehensive psychiatric evaluation including previous medication trials, responses, durations, reasons for discontinuation, and adherence patterns 1
• Ask about the lowest CD4 count and highest viral load if the patient is HIV-infected 1
• Document baseline abnormal movements during physical examination to avoid later mislabeling them as medication side effects 1, 5

Before Prescribing Asthma Medications

• Verify ability to use delivery device (MDI, DPI, nebulizer) based on age and developmental level—most children under 4 years cannot generate sufficient inspiratory flow for DPIs 1
• Ask about current asthma control including nighttime awakenings, activity limitation, and rescue medication use 1

Social and Environmental Factors

Living Situation and Support

• Ask whom the patient has informed of their diagnosis and what support systems are available 1
• Inquire about the patient's living situation including who administers medications and babysitting arrangements 1
• Document work/school environment and whether disclosure of the condition has occurred there 1

Adherence Assessment

• Ask about previous adherence patterns using non-judgmental language such as "I understand it is very difficult to give medications to children; have you been able to give any doses this week?" 1
• Inquire about barriers to medication administration including work schedules, caretaking responsibilities, child resistance, and lack of disclosure to temporary caregivers 1
• Assess parental health literacy and English proficiency as these significantly affect correct medication administration 1

Communication with Other Providers

Coordination of Care

• Contact the patient's pediatrician or primary care provider to obtain collateral history and coordinate monitoring 1
• Communicate with school nurses who may dispense medications or monitor effects 1
• Reach out to teachers for behavioral observations when prescribing medications affecting attention or behavior 1

Common Pitfalls to Avoid

• Never assume pediatric dosing is simply a reduced adult dose—children require individualized pharmacokinetic considerations based on age, size, and organ maturity 6, 7
• Do not prescribe without verifying current weight—prescribing errors in children range from 5-27%, most commonly with antibiotics requiring weight-based dosing 1
• Avoid overlooking supplement interactions—St. John's wort, grapefruit products, and multiple herbal supplements create clinically significant interactions that reduce medication efficacy or increase toxicity 2
• Do not fail to ask about supplements directly—use open-ended questions about "vitamins, herbs, teas, or natural products" as patients often do not consider these "medications" 2
• Never skip baseline measurements for medications with known metabolic or cardiac risks—obtain BMI, blood pressure, glucose, lipids, and ECG as indicated before starting treatment 1, 5