Class notes
Paediatric prescribing
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Pharmacy students notes for paediatric prescribing
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Paediatric prescribing issues - 8.11— PART 1 —
⚡ Learning outcomes:
Define age ranges
Differences in ADME
⚡ Paediatric stages of development:
Descriptor The age of the child Key stages
Rapid growth, fully formed, most systems
Preterm neonate Born at < 37 weeks gestation
not fully developed
Term Neonate: Born at 37 to 42 weeks Normal initial period of human
Neonate
gestation development and growth
Post-term neonate: Born at ≥42 weeks Normal initial period of human
gestation development and growth
Neonate: From 0 up to 28 days of age (or Normal initial period of human
first 4 weeks of life) development and growth
Infant From 28 days up to 24 months of age High growth rates and rapid changes
Child From 2 years up to 12 years of age Slower growth and development
Final period of growth and puberty,
Adolescent From 12 years up to 18 years of age
stretching into adulthood
The average gestation of a pregnancy is 37 to 42 weeks, so a child born at less than 37
weeks gestation is classed as a pre-term neonate.
Pre-term neonate - At this stage there is rapid growth and the neonate is fully formed, but
most systems are not fully developed.
Paediatric prescribing issues - 8.11 1
, Different stages of development mean that the ADME of drugs is different to that of adults.
⚡ Absorption:
Drug absorption refers to how a drug is absorbed into the body to reach the circulation and is
relevant to all routes of administration except intravenous.
Two factors should be taken into consideration:
Rate of absorption – More rapidly, higher peak concentration, sooner therapeutic effect
Extent of absorption – greater extent of absorption greater overall exposure
Oral absorption:
Altered by:
Gastric acid secretion- reduced secretion of gastric acid during the first few months of life
can affect the extent of absorption of some drugs
Gastrointestinal motility- in neonates and young infants gastric emptying and
gastrointestinal transit time may be prolonged. Acute diarrhoea which is particularly
common during childhood can also affect absorption, this is particularly relevant in children
taking medications such as anti-epileptics and immunosuppressants
Drug metabolising enzymes in the gut wall
Biliary function
Gastrointestinal flora- changes as the diet alters from milk to solids
Disease states such as GORD(gastro-oesophageal reflux disease)- changes as the diet alters
from milk to solids
Intramuscular absorption:
Particularly important in premature neonates.
Altered by:
Paediatric prescribing issues - 8.11 2
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