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Overview of Drug Treatment in Children

By

Bridgette L. Jones

, MD, MS, University of Missouri, Kansas City, School of Medicine, Children's Mercy, Kansas City, MO

Reviewed/Revised Dec 2022
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Drug treatment in children differs from that in adults, most obviously because pediatric drug dosing is usually based on weight or surface area (1 General references Drug treatment in children differs from that in adults, most obviously because pediatric drug dosing is usually based on weight or surface area ( 1). Doses (and dosing intervals) differ because... read more ). Doses (and dosing intervals) differ because of age-related variations in drug absorption, distribution, metabolism, and elimination (see Pharmacokinetics in Children Pharmacokinetics in Children Pharmacokinetics refers to the processes of drug absorption, distribution, metabolism, and elimination. There are important age-related variations in pharmacokinetics. Absorption from the gastrointestinal... read more ) (2 General references Drug treatment in children differs from that in adults, most obviously because pediatric drug dosing is usually based on weight or surface area ( 1). Doses (and dosing intervals) differ because... read more ).Thus, children are not given adult doses. Furthermore, it cannot be assumed that a child’s dose is proportional to an adult’s dose (ie, that a 7-kg child requires 1/10 the dose of a 70-kg adult).

Most drugs have not been adequately studied in children, but, legislation in the US, the Best Pharmaceuticals for Children Act of 2001 and the Pediatric Research Equity Act of 2003 (both made permanent in 2012 [ 3 General references Drug treatment in children differs from that in adults, most obviously because pediatric drug dosing is usually based on weight or surface area ( 1). Doses (and dosing intervals) differ because... read more ]) now provide the statutory and regulatory authority to incentivize and require therapeutic trials in children. As a result of these acts, numerous labeling changes were made to provide dosing, pharmacokinetic, and safety information for children (see also the U.S. Food and Drug Administration [FDA] 2020 status report).

General references

  • 1. Le J, Bradley JS: Optimizing antibiotic drug therapy in pediatrics: Current state and future needs. J Clin Pharmacol 58 (supplement 10):S108–S122, 2018. doi: 10.1002/jcph.1128

  • 2. van den Anker J, Reed MD, Allegaert K, Kearns GL: Developmental changes in pharmacokinetics and pharmacodynamics. J Clin Pharmacol 58 (supplement 10):S10–S25, 2018. doi: 10.1002/jcph.1284

  • 3. Bourgeois FT, Kesselheim AS: Promoting pediatric drug research and labeling—Outcomes of legislation. N Engl J Med 381(9):875–881, 2019. doi: 10.1056/NEJMhle1901265

Adverse effects and toxicity

Children are generally subject to the same adverse effects as adults (see Adverse Drug Reactions Adverse Drug Reactions Adverse drug reaction (ADR, or adverse drug effect) is a broad term referring to unwanted, uncomfortable, or dangerous effects that drugs (including medications ) may have. Adverse drug reactions... read more ), but they have increased risk with certain drugs because of differences in pharmacokinetics or because of drug effects on growth and development. Some common drugs with unique or higher risk of adverse effects in children are listed in table Some Drugs Manifesting Differential Toxicity in Children Drugs Manifesting Differing Toxicity in Children Drugs Manifesting Differing Toxicity in Children .

Table

Younger children are at especially high risk of accidental poisoning when they discover and take caregivers’ vitamins or drugs, even vitamins and drugs that have been thrown away. When discarding a drug, consumers may seek disposal instructions on the package insert or review information at the FDA web site. Options include taking the drug to a local drug collection program (possibly at a pharmacy or local law enforcement site) or mixing the drug with an undesirable material (eg, cat litter, coffee grounds), tightly wrapping it in plastic, placing it in a watertight container or bag, and then disposing it in the trash.

Infants may be at risk of toxicity from drugs used by adults; toxicity may occur prenatally when they are exposed via placental transfer or postnatally when exposed through breast milk (numerous agents— see Some Drugs Contraindicated for Breastfeeding Mothers Some Drugs Contraindicated for Breastfeeding Mothers Some Drugs Contraindicated for Breastfeeding Mothers and see Table: Some Drugs Contraindicated for Breastfeeding Mothers Some Drugs Contraindicated for Breastfeeding Mothers Some Drugs Contraindicated for Breastfeeding Mothers ). Because there are limited data regarding the potential for drug exposure during pregnancy and lactation, the 21st Century Cures Act established a task force to identify gaps in knowledge and research on safe and effective therapies for pregnant women and lactating women (1 Adverse effects and toxicity references Drug treatment in children differs from that in adults, most obviously because pediatric drug dosing is usually based on weight or surface area ( 1). Doses (and dosing intervals) differ because... read more ).

Other types of inadvertent exposure include skin contact with caregivers who have recently applied certain topical drugs (eg, scopolamine for motion sickness, malathion for lice, diphenhydramine for poison ivy).

Adverse effects, including death, have occurred in children receiving over-the-counter cough and cold preparations containing some combination of an antihistamine, sympathomimetic decongestant, and the antitussive dextromethorphan (2 Adverse effects and toxicity references Drug treatment in children differs from that in adults, most obviously because pediatric drug dosing is usually based on weight or surface area ( 1). Doses (and dosing intervals) differ because... read more ). Current recommendations are that over-the-counter cough and cold preparations should not be given to children < 4 years old, and should be given cautiously to children 4 to 6 years old.

Adverse effects and toxicity references

More Information

The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.

Drugs Mentioned In This Article

Drug Name Select Trade
Isopto Hyoscine, Maldemar, Scopace, Transderm Scop
Ovide
Aid to Sleep, Alka-Seltzer Plus Allergy, Aller-G-Time , Altaryl, Banophen , Benadryl, Benadryl Allergy, Benadryl Allergy Children's , Benadryl Allergy Dye Free, Benadryl Allergy Kapgel, Benadryl Allergy Quick Dissolve, Benadryl Allergy Ultratab, Benadryl Children's Allergy, Benadryl Children's Allergy Fastmelt, Benadryl Children's Perfect Measure, Benadryl Itch Stopping, Ben-Tann , Children's Allergy, Compoz Nighttime Sleep Aid, Diphedryl , DIPHEN, Diphen AF , Diphenhist, DiphenMax , Dytan, ElixSure Allergy, Genahist , Geri-Dryl, Hydramine, Itch Relief , M-Dryl, Nighttime Sleep Aid, Nytol, PediaCare Children's Allergy, PediaCare Nighttime Cough, PediaClear Children's Cough, PHARBEDRYL, Q-Dryl, Quenalin , Siladryl Allergy, Silphen , Simply Sleep , Sleep Tabs, Sleepinal, Sominex, Sominex Maximum Strength, Theraflu Multi-Symptom Strip, Triaminic Allergy Thin Strip, Triaminic Cough and Runny Nose Strip, Tusstat, Unisom, Uni-Tann, Valu-Dryl , Vanamine PD, Vicks Qlearquil Nighttime Allergy Relief, Vicks ZzzQuil Nightime Sleep-Aid
AeroTuss, Buckley's Cough Suppressant , Buckley's DM, Buckley's Mixture, Cough DM, Cough Suppressant , Delsym, Delsym Children's, Delsym Children's Cough Relief, Delsym Cough, Dexalone, ElixSure Cough, ElixSure Cough DM, Giltuss DM, PediaCare Children's Long Acting Cough, PediaCare Infants' Long-Acting Cough, PediaCare Long-Acting Cough , Robafen Cough, Robitussin, Robitussin Children's Cough, Robitussin Cough, Robitussin CoughGels, Robitussin Lingering Cold Long-Acting Cough, Robitussin Pediatric Cough, Scot-Tussin CF, Silphen DM, Theraflu Long Acting Cough Strip, Triaminic Long Acting Cough , Triaminic Long Acting Cough Strip, Tylenol Children's Simply Cough, Vicks DayQuil Cough, Vicks DayQuil Nature Fusion, Vicks Formula 44, Vicks Nature Fusion Cough, Zicam Concentrated Cough, Zicam Cough Max, Zicam Cough Nite
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