As a parent, when your child is sick, it is not uncommon to have questions about the medications or the type of medications (including the dosage forms, such as tablets, capsules, liquids, suspensions, suppositories, etc.) that you are going to give them. This article is the first of a three-part series that we will cover some of the considerations for safe pediatric medication use. Here we highlight some frequently asked questions by parents regarding pediatric dosage forms and the safety of children medications.
Which dosage form is appropriate for my child?
Choosing the right medication dosage form for a child will depend on many factors – e.g., how the medication works in the body, how it tastes, and how easy it is to give, etc. These factors are also closely related to the age and the stage of development of the child. In both hospital and community settings, healthcare providers often select a dosage form based on the patient’s age group, since children at different stages will have varying physical and mental abilities. Some general age-based guidelines are as follows:
• Neonates (i.e., under 1-month old): Consider liquid formulations; or drops (limited volume)
• Toddlers: Consider liquids; or suspensions
• Pre-school (i.e., 2-5 years old): Consider liquids; crushable tablets (powder); or dispersible tablets
• Early school age (i.e., 6-8 years old): Consider liquids, crushable tablets (powder); dispersible tablets; chewable tablets; or tablets/capsules (smaller ones)
• Later school age (i.e., 9-12 years old): Consider all solid dosage forms
However, it is important to consider that every child is unique. Preferences and capabilities can vary widely, even within the same age group. The best type of medication may also depend on what medical condition is being treated. For these reasons, each pediatric case should be considered individually to ensure safety, efficacy, and accessibility of medication therapy options.
What can I do if my child refuses to take their medication because of the taste?
Studies have shown that children often refuse to take their medication due to its bitter or unpleasant taste. Fortunately, there are several ways to address this. For instance:
• Offer a small amount of food or drink directly before and after giving the medication to reduce the degree or extent that they can taste the medication.
• Let them taste something cold first, like a popsicle, prior to giving the medication.
• Ask the prescriber if it is possible to minimize the dosing frequency of the medication; if a better-tasting option is available; or if a different route of administration is available (e.g., a rectal suppository instead of an oral liquid, etc.)
• Use a straw or an oral syringe to avoid the taste buds at the front of the tongue/mouth
• Ask your pharmacist if the medication can be flavoured at a compounding pharmacy
Note: Always check with your pharmacist or prescriber before trying any of the above options. Some medications cannot be mixed with food or flavouring, as it could affect the efficacy of the medication.
What can I do if my child’s medication isn’t available in the right dosage form or if it is on backorder?
If the medication your child needs isn’t commercially available in the right dosage form or if there’s a drug shortage, discuss alternative options with your doctor and/or your pharmacist. They can help determine whether another medication can be used or if the original medication can be safely compounded into another dosage form without affecting how it works. These are usually prepared by specialty compounding pharmacies that are accredited and regulated by provincial pharmacy regulatory authorities (or Colleges). Additionally, it’s also important to note that some compounded medications may not be covered, depending on your insurance coverage. In some cases, certain medication tablets can be crushed into a powder and mixed with food (such as apple sauce) if the liquid formulation isn’t available. However, not all medications can be safely crushed or split, so always ask your pharmacist before doing so.
How can I be sure my child is getting the right dose of their medication, and what tools can help me give it safely?
Always follow your healthcare provider’s instructions and use proper measuring tools, such as medicine syringes, droppers, or cups that come with the medication, instead of household spoons, which can lead to inaccurate dosing. These tools help prevent giving too much or too little medicine to your child.
To stay organized, try keeping a written list or using a simple routine to remember when to give each dose. Always read the medication label and instructions carefully. Ask your pharmacist if you’re unsure about the medications. As your child grows or their health changes, regular check-ins with your healthcare provider can help make sure the dose stays
appropriate.
Where can I read more about safe pediatric medication use?
Examples of resources are as follows:
• From the Government of Canada
• From ISMP Canada
• From the Canadian Paediatric SocietyÂ
• From SickKids
By utilizing these resources and maintaining open communication with healthcare professionals, you can play an active role in ensuring the safe use of medications for your child.Â
By Laura Brady, Samir Kanji, and Certina Ho
Laura Brady and Samir Kanji are PharmD Students at the Leslie Dan Faculty of Pharmacy, University of Toronto; and Certina Ho is an Assistant Professor, Teaching Stream, at the Leslie Dan Faculty of Pharmacy and Department of Psychiatry, University of Toronto.
