group 2 of slides for clinical pharmacy student .read group 1 first

1. Pediatric Drug Use (2)Pediatric Drug Use (2)
Prof Dr Hussein AbdeldayermProf Dr Hussein Abdeldayerm
Professor of PediatricsProfessor of Pediatrics
Facebook/ Dayem PedoFacebook/ Dayem Pedo

2. CHILD GROWTHCHILD GROWTH
/DEVELOPMENT/DEVELOPMENT
AgeAge –– related development terms are: -related development terms are: -
 Newborn (1Newborn (1stst
4 wks after birth)4 wks after birth)
 Infant (1Infant (1 –– 12 m)12 m)
 Toddler, early childhood, preschool (1Toddler, early childhood, preschool (1 –– 4 yrs)4 yrs)
 SchoolSchool –– aged child (5aged child (5 –– 12 yrs)12 yrs)
 Adolescent (12Adolescent (12 –– 20 yrs)20 yrs)

3. STAGESSTAGES
 • Prenatal: Conception to the Birth
 • Infancy: Birth to 12 months
 • Neonatal period: Birth to 28 days
Early neonatal period: Birth to 7 days
Late neonatal period: 7 days to 28 days
 • Infancy Period: 29 days to 12 months
 • Early Childhood : 1 year to 4 years
(Toddler Period or Preschool Period)
 • late childhood: 5- 12 years (school age)
 • Adolescent: 12- 20 years
 • Puberty Period: Male: 12-14 years
Female: 11-13 years

4. GROWTHGROWTH

5. Growth
 Increase in physical size and weight of the
body (Height and Weight)
 Due to increase in
1- cell number by multiplication &
2- increase in cell size

6. DEVELOPMENTDEVELOPMENT
 FUNCTIONAL andFUNCTIONAL and
PHYSIOLOGICAL maturationPHYSIOLOGICAL maturation
of systems and organsof systems and organs
 Leading to developing of newLeading to developing of new
skills , adaptation ability andskills , adaptation ability and
assuming responsibilitiesassuming responsibilities
 Denotes maturation of brain.Denotes maturation of brain.
Leading to increase in Mental,Leading to increase in Mental,
Physical, Social and EmotionalPhysical, Social and Emotional
abilities of the child.abilities of the child.

7. Factors influencing
Growth and Development
 Heredity
 Nutrition
 Endocrinal factors (GH, Thyroid Hs, sex Hs)
 Illness and Disease ( chronic )
 Physical activity
 significant congenital anomalies
 emotional and social environment
 Age and gender
 Others- Birth order, Birth interval,

8. Assessment of Growth
Growth can be measured in term of:
• Nutritional Anthropometry (Wt., Ht., Hc., Cc.)
• Assessment of Tissue growth (Muscle mass, Skin fold
thickness)
• Bone age (Radiological assessment of epiphysis)
• Dental age
• Biochemical and histological means

9. Formulas for Approximate Average Height and
Weight of Normal Infants and Children

10. WeightWeight
 At birth: 3 kgAt birth: 3 kg
 At 4 mo: 6 kgAt 4 mo: 6 kg
 At 6 mo: 7 kgAt 6 mo: 7 kg
 At 8 mo: 8 kgAt 8 mo: 8 kg
 At 12 mo: 9 kgAt 12 mo: 9 kg
 Wt = age (yrs) X 2 + 8Wt = age (yrs) X 2 + 8
 >7 yr =>7 yr = age (yrs) x7 - 5age (yrs) x7 - 5
22

11. Assessment of Weight
 Newborn looses weight of
10% of Birth weight till early 7
days and regain by 10th
Day.
 • Birth weight doubles by 4
month and triples by a year
& 4 times by 2 years.

12. HEIGHTHEIGHT
 Birth length= 50 cmBirth length= 50 cm
11stst
3 mo : 3 cm/mo3 mo : 3 cm/mo
22ndnd
3 mo : 2 cm/mo3 mo : 2 cm/mo
7-12 mo: 1.5 cm/mo7-12 mo: 1.5 cm/mo
 1 yr = 75 cm1 yr = 75 cm
 2 yr = 87 cm ( 1 cm/mo )2 yr = 87 cm ( 1 cm/mo )
 > 2yr: age X 5 + 80> 2yr: age X 5 + 80

13. Dental Growth
• Most infants have their first teeth erupt at age 6–
8 months of Age.
• Two types of Tooth are
Primary or Deciduous
Secondary or Permanent Teeth

14. BODY SURFACE AREABODY SURFACE AREA
 Surface area ( mSurface area ( m22
):):
wt (kg) X ht (cm)wt (kg) X ht (cm)
----------------------------------------
36003600

15. BODY MASS INDEXBODY MASS INDEX
BMIBMI
WT (kg)WT (kg)
--------------------
HTHT22
(m)(m)

19. Medication errors
 Prevention of medication errors and enhancement of
compliance of pediatric patients are both significant
problems that must be further addressed
 The limited amount of information about existing
drugs in pediatric populations presents another
challenge for the health care provider

21.  Orders for pediatric patients often contain problems
relating to poor handwriting, misused abbreviations,
decimals, and poor calculations.
 Decimals are especially concerning in pediatrics
because they are easily generated from weight-based
dose calculations, especially with patients weighing
less than 1 kg. Without vigilant encouragement to use
decimals properly (ie, avoid the use of "dangling
,unclear" zeros and always have a number to the left
of the decimal]
), 10- or 100-fold dose miscalculations
are possible. Am J Nurs. 1997;97:44

22.  Misuse of abbreviations is a serious error. The
specific misuse of "d" in place of day or dose
(mg/kg/day or mg/kg/dose) is distinctive and can lead
to significant errors.
 Prescribers may add to this confusion by creating
their own abbreviations (eg, HIG = hepatitis immune
globulin) that are mistaken for totally different drugs
(eg, HIG for "HIB" = Haemophilus influenzae B
vaccine). ISMP Medication Safety Alert; 2000

23.  Most pediatric drug doses require calculations to be
performed, which adds to the complexity of pediatric
orders. The prescriber is expected, not only to
remember the appropriate mg/kg/dose and frequency,
but also to calculate the mg amount properly and
apply to the "maximum dose" when necessary.
 This mg/kg/dose will vary based on indication,
whether the patient is a neonate or child and the drug
information reference used. Hence, it is absolutely
crucial to include the mg/kg/dose and the patient
weight on all orders to allow pharmacists and other
healthcare professionals to perform double checks.

24.  The availability of multiple different concentrations
of oral liquid medications, particularly antibiotics,
further complicates calculations. the prescriber must
have an awareness of the various concentrations.
Alternatively, the prescriber may indicate the dosage
as mg and indicate the desire for a liquid formulation
without specifying the concentration, leaving the
pharmacist to choose the concentration Am Fam Physician.
1996;53:1319-1325.

25.  The order for a continuous infusion must include drug
name, concentration, amount/kg/time, amount of drug
per time, route, and rate per hour so that the
pharmacist and other healthcare providers may
perform double checks. Standardization of drug
concentrations and diluents, in addition to dosing
charts that determine rate per hour, will eliminate the
need for any calculations and simplify this process

26.  Prescribing medications where the mg/kg/dose reflects
only 1 of several ingredients (eg, amoxicillin/clavulanic
acid [augmentin]) are confusing, particularly if that
ingredient is not specified. The conc on the drug label
is often expressed as mg of the combination, leaving
the individual who is preparing the dose to wonder
whether the mg of drug already accounts for the
combination or if it still needs to be calculated
 Drugs as iron, calcium, and erythromycin are
available in several different salts. Also, their
mg/kg/dose is based on mg of elemental
ingredient/base and can often lead to error

27.  Errors often occur when the prescriber fails to
recognize that the older pediatric patient has
reached a weight cut off where mg/kg dosing
will lead to doses that exceed the maximum
adult dose..
 Clinical Pharmacy 6:548-64, 1987

39. IMIM
for children less than 2 yearsfor children less than 2 years
use thigh muscle for injectionuse thigh muscle for injection
1-vastus lateralis muscle
2-Upper lateral quarter or
midposition
3-Direct the needle
toward inner knee

47. SCSC

48.  KK
3

51. Not suitable for children below 7-8 years as needed hand oral coordination.Not suitable for children below 7-8 years as needed hand oral coordination.
so use nebulizer or use it with tube inhalorso use nebulizer or use it with tube inhalor

52. THANK YOUTHANK YOU