Medicines for Children
Paediatric Palliative Care
For Home Based Carers
Funded by
British High Commission, Pretoria
Small Grant Scheme
Children with HIV
Need to prevent infections
Need to treat infections
Need to manage symptoms
May need to manage side effects of drugs
So, they usually need lots of medicines
Types of Medicines
Preventing Infections Bactrim, Vitamins, Immunisations, ARVs
Treatment for infections Antibiotics, Antifungals
Symptom Management Analgesia, Anti-pyretics,
Anti-diarrhoeals, Anti-emetics,
Management of Side Effects Antihistamine, Anti-diarrhoeals,
Anti-emetics
Other Types of Medicine
Home Remedies ?
Traditional Medicines ?
Herbal Remedies ?
©TALC
Medicine Chain
Prescription Certain medicines can be prescribed by Doctor only Some Professional nurses may prescribe with special training
Dispensing Prescription is prepared by a pharmacist Ensures correct drugs, dosage and timing of doses is in a
labelled container for patient
Administering Professional nurses may administer drugs to patient Care givers may only do this under supervision of Professional
Nurse
Scope of Practice
Your scope of practice means you will not usually be
administering pharmaceutical medicines, but you have a vital role!
Children MUST get the medicines they are prescribed If they don’t they can’t work!
Check the child has access to and is getting the drugs
Assess whether carer knows how to give them correctly
Refer any concerns to the Professional Nurse
Ensure any side effects are reported immediately
Reinforce the importance of completing the course to the carer
Support the carer in giving the medicines
Caution
Medicines which are not used correctly can be dangerous
The sale, prescription and dispensing of medicines is controlled by law
All medicines which are sold to the public must be tested and registered with the Medicines Control Council
Medicines Control Council
Schedule 1 and 2 Aspirin, Vitamins, Milk of Magnesia Can be bought at supermarkets and cafes
Schedule 3 Can only be bought by an adult from a pharmacy
Schedule 4 Can only be obtained on the prescription of a doctor from a
pharmacy
Schedule 5,6 and 7 Must be prescribed by a doctor, dispensed by a pharmacist and
prescription renewed every time
(Department of Health, 1997)
Side Effects
Be aware of the more common side effects of medicines
You need to be able to:
Recognise them if a child experiences them
Refer the child for appropriate management
Teach the carer about common side effects of the medicines
Teach her when to seek advice
Ensure the side effects have been managed appropriately
Refer again if they have not
Expiry Date
Medicines are all marked with a date
They MUST be used before that time or they may be harmful or of no use
04Jul06
Adherence
If the medicines are to work, they must be taken
All medicines must be taken in exactly the way they have been
prescribed
This is known as adherence
You have a vital role in assessing: Assessing whether the child is adherent to the medication Identifying any causes of non-adherence Supporting the carer Referring any concerns
Causes of Non-adherence
A child is dependent on the carer. If the carer:
Does not understand the importance of the medicines Does not know which medicines to give to the child and when Does not know how to give the medicines to the child Is unable to remember to give the medicines Does not believe the child should have them Is unable to collect the medicines Is unable to get the child to take the medicines Thinks the child is better now so stops the medicines
The child may be non-adherent!
5 Golden Rules
The right patient The right medicine The right dose The right route The right time
These apply to everybody but…
They are even more important
when giving medicines to children!
(Department of Health, 1997)
The Right Patient
The only person who should receive the medicines prescribed by the doctor, dispensed by the pharmacist and
administered by the professional nurse is
the child whose name is on the bottle/box/bag
The right medicine
If the wrong medicine is given to a child, this could also be very
dangerous
The wrong medicine may not treat or prevent infection, manage
symptoms or side effects
Some medicines should not be given to children
The child may be allergic to that drug
The Right Dose
Children are much smaller than adults
Their bodies have different ways of coping with medicines
Drug doses are extremely carefully calculated for children so:
Drugs achieve their aim but do not harm the child
Doses are calculated by weight (and sometimes height)
Children grow quickly so need regular monitoring of weight
The Dose You MUST give an accurate dose!
NEVER guess the amount to give
NEVER just pour syrup in to the child’s mouth
This could be dangerous for the child:
- He may get too much medicine
- He may get too little medicine
Measuring The Right Dose
Different methods may be used to measure accurate doses of syrups or liquids before giving them to the child
Droppers Marked Medicine Cap Medicine Cup Syringe Spoon
The Right Route
Medicines must always be given by the correct route
Medicines may be administered in the following ways:
By mouth Under the tongue On the skin In to the eye Into the nose In to the rectum By injection By inhalation
The Right Route
The route by which drugs are given to children is extremely
important
Children do not like medicines
May cause trauma and distress to both the child and the carer
If the child cannot/will not take the medicines, they cannot work
The way medicines are given can have a great impact on a child’s quality of life
Medicines By Mouth
Most medicines given to a child
will normally be given by mouth
They come in the form of:
Pills and tablets Capsules Suspensions/mixtures Syrup Drops
Helping the Child Take Medicine
If the medicines are to work, the child must be able to swallow them
A child may have been dispensed medicine that he cannot swallow
This causes unnecessary distress for the child and the carer
The child will not get the medicines he needs
Giving Medicines to a Child
If the medicines are to work, the child needs you to make regular
assessments
Does he like the taste of the medicine?
Is he able to swallow the tablets?
Can he tolerate the volume of syrup?
Giving the Medicine Medicine Cups
Syringes (1ml, 2.5ml, 5ml, 10ml)
Spoon
Plastic dropper©TALC
Giving the Medicine
Need to prevent aspiration
Hold child in semi-reclining position
Place medicine in spoon, plastic cup, plastic dropper, plastic syringe (without needle!)
Place medicine along side of infant’s tongue
Administer slowly
Wait for child to swallow
Handy Hints!
Some medicines are only available as tablets orcapsules
Handy Hints for Children!
Crush tablet if possible/allowed
Mix with jam, porridge
Divide tablet if scored
Empty capsule and sprinkle contents on jam(only allowed for some drugs!)
Handy Hints!
Talking with the Child
Taking Medicines Together
Sticker Charts
Play Therapy
Nasogastric Administration Oral medications may be given
via NG tube
Removes distress of giving medicines
Does not disturb the child
Medicines in liquid form or safe to crush only
Risk of clogging the tube
Always flush tube with clean water
Rectal Administration
Useful for children unable to take anything by mouth
Sedatives, analgesia, anti-pyretic, anti-emetics, anti-convulsants
Often absorbed more quickly and quicker response
Faeces may delay absorption
Unsuitable for child with diarrhoea
Eyes, Ears & Nose Not usually painful but drugs can cause unpleasant sensation
Usually distressing for a child
Difficult for carer to gain child’s cooperation
Infant and young child need to immobilise head
Older child needs explanation and direction
The Right TimeMedicines must be given at the right time or they will not be
effective
Medicines may be ordered
4 hourly (06h00, 10h00, 14h00, 18h00, 22h00) 6 hourly (06h00, 12h00, 18h00, 24h00) Daily (in the morning, after breakfast) Every evening (at bed time) Three times a day (usually after meals) Twice a day (after breakfast and supper)
Medicines must never be given more often than prescribed as thiscould be dangerous for the child
The Right Time
Note! Some drugs must be taken on an empty stomach or with food
These instructions MUST be adhered to
Otherwise the drugs will not work or may be harmful to the child
The importance of this must be explained to the carer
This can cause difficulties for carers when children want to eat / do not want to eat
Summary
Working within your scope of practice, you are not usually involved in administering of medicine
But
You have a vital role in ensuring the children are receiving their medicine, safely and accurately and
that any problems are referred