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Pharmacist to Pharmacist

Optimizing Outcomes in the Pediatric Patient

Yvette C. Terrie, BSPharm, RPh
Published Online: Friday, December 1, 2006

This article is brought to you by McNeil Pediatrics

An increasing number of children are being diagnosed with conditions that require the use of pharmacologic agents as part of the treatment plan (Table 1). More than 200 million prescriptions are written for children and teenagers annually in the United States, and more than 6 million children have a chronic disease whose treatment requires the regular use of a prescription drug.1 Pharmacists are an essential tool in ensuring that both parents and the pediatric patients are adequately counseled on drug therapy, and they also can provide reinforcement and education with regard to a thorough understanding of the specific disease state.

Patient counseling is of course important for all patient populations to provide high-quality care, but certain counseling techniques need to be customized to meet the needs of specific populations, such as the pediatric patient population. The American Academy of Pediatrics has defined the various classes of the pediatric population (Table 2).2

Addressing the Needs of the Pediatric Patient

Making clinical assessments and providing care to the pediatric patient involves special considerations. Certain challenges in drug therapy can exist due to differences in physiology and pharmacokinetics, lack of clinical data, insufficient drug labeling, and problems associated with drug dosing and administration.3 In addition, studies have shown that many pediatric patients and their caregivers are nonadherent with medications.1,4 For example, it is estimated that 75% of asthma patients and 43% of epilepsy patients take their medication therapy incorrectly. Some of the most prevalent types of medication adherence issues that occur in the pediatric patient population include1:

  • Discontinuing medication too soon
  • Administering too little or too much medication
  • Refusal to take medication due to unpleasant taste

Other barriers that may impede the correct use of medication therapy may include frequency of dosing, adverse effects associated with use of medication, lack of parental/caregiver supervision during medication administration, lack of clear instructions regarding medication therapy, and parent or child's lack of understanding the importance of adhering to the medication regimen.4

Tips for Optimizing Therapy in Pediatric Patients

  • Address both the parent and the child, and speak in terms that make it easy for the child to comprehend without being condescending
  • Encourage the child to take an active role in his or her care plan by imparting a "can-do!" attitude
  • Ensure that the parent and child understand the purpose of the medication
  • Address any concerns or apprehensions the parent or child might have about the drug therapy
  • Provide clear and thorough instructions on appropriate dose, administration, and storage conditions
  • Describe how to identify potential adverse drug reactions and what to do if they should occur
  • Explain what to do when a dose is missed
  • Add a flavoring agent or recommend liquid or chewable tablet dosage forms
  • Advise parents to check with a physician or pharmacist prior to using any other medications to prevent possible drug interactions
  • Reinforce the importance of completing the entire course of therapy even if the child feels better
  • Recommend the use of medication compliance devices such as pillboxes or timers
  • Encourage the use of calibrated measuring devices to ensure accuracy of dosing

The American Academy of Pediatrics highly recommends the use of calibrated measuring devices for the administration of liquid medications.3 Parents and patients should be counseled on the appropriate use of these devices. Parents should always be reminded to read all labels and confirm the strength of all medication prior to administration because many nonprescription products formulated for infants are in the concentrated form. Failure to read labels can result in serious medication overdosages. Parents also should be reminded to check the expiration dates of medications prior to administration.

In addition to the many medications manufactured specifically for the pediatric population, the growing field of compounding pharmacy can meet some of the needs of the pediatric population by providing alternative dosage forms when applicable.

Conclusion

Through effective pharmaceutical counseling, the pharmacist can optimize therapy outcomes in the pediatric patient population. Pharmacists should always be prepared to meet the specific therapeutic needs of the pediatric patient population by making appropriate clinical assessments. It is imperative that pharmacists be responsible for thoroughly educating both the parent and child about the proper administration of the drug therapy. Patients also should be encouraged to adhere to the instructions provided to them to reduce the incidence of drug errors. When pediatric patients and their parents are equipped with the essential knowledge about the condition and the drug therapy, they become empowered and remain committed to being proactive with regard to their health.

Ms. Terrie is a clinical pharmacy writer based in Haymarket,Va.

For a list of references, send a stamped, self-addressed envelope to: References Department, Attn. A. Rybovic, Pharmacy Times, Ascend Media Healthcare, 103 College Road East, Princeton, NJ 08540; or send an e-mail request to: arybovic@ascendmedia.com.


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