Medication in Children

Encouraging children to take medication isn't anywhere in the CEM syllabus. Parents do sometimes ask if we can give their children anything nicer - and sometimes, the answer is yes, we can!
We give a lot of medication to children in EM, and we also send them home with medication. We know that compliance is always lower than we'd like it to be...but there's more factors at play in children than there are in adults...

Taste

Dr Carley at St Emlyns has a good post here about which antibiotics taste good, and which don't. He also mention that most children take tablets as well as they take syrup. My childhood memories of being poorly are of taking tablets mixed with a spoonful of jam - so maybe this is something we should try!

Thinking about taste, I checked my trust guidelines for antibiotic use. Luckily, flucloxacillin is only suggested for impetigo, mild cellulitis and acute localised otitis externa (eg. pustules or furuncles). Clindamycin is recommended only for human or animal bites or empyema in penicillin allergic patients. Moving on to antibiotics that might be spat out trimethoprim OR nitrofurantoin is recommended by our trust for UTI. I used to prescribe trimethoprim as first line - it might be time to change! Erythromycin is indicated for  asplenia/sickle cell disease or prevention of rheumatic fever in penicillin allergic patients. Amoxicillin we use a lot for CAP, acute otitis media and acute sinusitis. Clarithromycin we use in penicillin allergic patients <6months with CAP, tonsilitis if penicillin allergic, acute localised otitis externa if pen allergic, impetigo and cellulitis if penicillin allergic. Pen V is recommended for acute tonsilitis. The solution to nasty antibiotics seems quite clear - don't be penicillin allergic and make sure antibiotics are really indicated before giving them!

There is a good video on YouTube where Paediatricians try some of the medications we give to children as part of one Doctor's NHS Change Day pledge.

Medicines for Children is a whole website about giving medicines to children. It's brilliant! If you're like me, parents ask how they give chloramphenicol eye drops, and you go quiet and tell them to read the instructions in the packet. Or you tell them how to use their salbutamol inhaler + spacer, and they all go quiet. It's all on here - sensible, well written, and clear advice written for children. Excellent!

There is a good page here with some tips - mainly for older children. 

There are some good resources from the Royal College of GPs for patients about why aren't giving them antibiotics.

Dosing

When we give TTOs out from our department, we often give the parents a syringe to take home with them. Most TTOs given from pharmacy seem to just have the measuring spoon. We do know that syringes are more accurate,and Nurses are (thankfully) more accurate than parents. Should we dispense with the plastic spoons inside the TTOs, and instead, give all parents syringes?

There are lots of apps available, and one of the best is the NICE BNF for Children. It's available free, on your smartphone, needs no internet after it's been set up, and is generally a very good app to have!