Many medicines used in children are not licensed for such use. This does not mean that they should not be used, but that the pharmaceutical com-pany has not sought a license from the regulatory authorities. Hence, many medicines in children are used off label, i.e. they are used at a dif-ferent dose, route, age, or indication than specified within the product license. It is important that medicines are used in children in relation to the scientific evidence available. In certain circumstances this may involve off label use.
Certain diseases, e.g. cystic fibrosis, or clinical conditions, e.g. shock, may affect drug metabolism. Both liver and renal failure delay drug elimination, and so require dosage reduction.
Most medicines taken by a breastfeeding mother are safe for her infant. Mothers should not be discouraged from breastfeeding because of uncer-tainty about possible toxic effects. The British National Formulary (BNF) for children gives detailed information regarding which medicines to avoid.1
Medication errors are a significant problem in children. In particular, ten-fold errors have been associated with significant mortality and morbidity, especially in the very young. All health professionals will commit a medica-tion error during their career! Medication errors include:
• Incorrect dose: commonest error and also the type most likely to be associated with a fatality. Knowledge of the child’s actual weight and checking of dose calculation is vital, especially on the neonatal unit and with parenteral medicines.
• Incorrect drug: second most common type of error and also associated with significant fatalities.
• Incorrect route: this is a particular problem with IT drugs. This is a procedure for specialists and great care should be taken when drugs are to be given this way!
Other errors: include incorrect rate of administration, duplicate dosing, and administration of the drug to the wrong patient.