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Optimising medicines for children: considerations for clinical pharmacists

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Introduction

The scope of the pharmacist working within paediatrics is broad, involving optimising medicine use for patients from newborn to young adult, where there are large changes in physiology, psychology, vulnerabilities, abilities and needs impacting both physical handling of medicines and medicines adherence. This provides a hugely rewarding and fascinating career.

While the provision of safe and effective medicines for children should be imperative, it has lagged behind that available to adults since licensing was introduced in the 1960s. In recent years, regulatory and strategic initiatives have led to some significant and positive movements towards this goal, but there is further progress to be made. Challenges, complexity and risk are common and necessitate highly skilled pharmacists to be included in the team delivering healthcare to children.

Physical development

The developmental changes throughout childhood and their impact on drug handling provide the most obvious contrast between children and adults. From premature neonates of 24 weeks' gestation under 500 g to teenagers of adult size; developmental changes in body composition and function alter pharmacokinetic parameters and influence the dosing and provision of medicines. Medicines do not always have the efficacy and adverse effects in children that we would expect from experience in adults. The requirement for appropriate growth and the immature immune system of children are other areas affecting medical treatment that are unique to paediatrics. Paediatric pharmacists use their knowledge and understanding of these factors to optimise regimes for individual patients.

Pharmacokinetics

The maxim ‘children are not small adults’ is often quoted to highlight that medicines cannot be assumed to work in the same way at proportional doses to body size; however, Anderson and Holford argue that by 2 years of age ‘children are small adults’ due to maturation of drug-handling systems (although with an allometric scaling factor applied).1 It is in infants and neonates that age-related …

Correspondence to Chloe Elizabeth Benn, Principal Pharmacist for Women's and Children's Services, Royal Free London NHS Foundation Trust, Pond St, London, NW3 2QG, UK; Chloe.benn{at}nhs.net

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