No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Pharmaceutical Care in Pediatrics
Abstract
When providing pharmaceutical care to the pediatric population, pharmacists need to take extra care, and be vigilant to try to prevent some of the common drug-related problems that have previously been reported too commonly for this cohort. Through the medication review process (see Chap. 6), pharmacists make recommendations on appropriate dose adjustments, intercept potentially harmful medication errors, determine patient adherence, identify drug-related problems, and take action where necessary such as educating parents and children themselves. Considering that pediatric patients are more likely to experience adverse drug misadventures, they may need a narrower follow-up period than their adult counterparts, and pharmacists are able to apply advanced pharmaceutical and therapeutic knowledge to monitor for adverse, as well as positive outcomes.Some important general principles when treating children should be followed: 1. If the infant is very young (less than 3-6 months), then most often a referral would be appropriate. 2. If the child is very ill (lethargic, listless, and inconsolable), referral is required. 3. If a medication is to be given, then make sure the dose explained to the caregiver is correct (many medicines will be dosed according to weight). 4. Show the caregiver how to effectively administer/use the medication (e.g., show them how to use a syringe for measuring liquid medications). 5. Involve the child (when old enough to take part) in their own care and encourage communication between the child and their parents, because at some stage the child will be responsible for their own medication use.
ResearchGate has not been able to resolve any citations for this publication.
Background:
Infantile colic is a common disorder in the first months of life, affecting somewhere between 4% and 28% of infants worldwide, depending on geography and definitions used. Although it is self limiting and resolves by four months of age, colic is perceived by parents as a problem that requires action. Pain-relieving agents, such as drugs, sugars and herbal remedies, have been suggested as interventions to reduce crying episodes and severity of symptoms.
Objectives:
To assess the effectiveness and safety of pain-relieving agents for reducing colic in infants younger than four months of age.
Search methods:
We searched the following databases in March 2015 and again in May 2016: CENTRAL, Ovid MEDLINE, Embase and PsycINFO, along with 11 other databases. We also searched two trial registers, four thesis repositories and the reference lists of relevant studies to identify unpublished and ongoing studies.
Selection criteria:
We included randomised controlled trials (RCTs) and quasi-RCTs evaluating the effects of pain-relieving agents given to infants with colic.
Data collection and analysis:
We used the standard methodological procedures of The Cochrane Collaboration.
Main results:
We included 18 RCTs involving 1014 infants. All studies were small and at high risk of bias, often presenting major shortcomings across multiple design factors (e.g. selection, performance, attrition, lack of washout period).Three studies compared simethicone with placebo, and one with Mentha piperita; four studies compared herbal agents with placebo; two compared sucrose or glucose with placebo; five compared dicyclomine with placebo; and two compared cimetropium - one against placebo and the other at two different dosages. One multiple-arm study compared sucrose and herbal tea versus no treatment. Simethicone. Comparison with placebo revealed no difference in daily hours of crying reported for simethicone at the end of treatment in one small, low-quality study involving 27 infants. A meta-analysis of data from two cross-over studies comparing simethicone with placebo showed no difference in the number of of infants who responded positively to treatment (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.73 to 1.23; 110 infants, low-quality evidence).One small study (30 participants) compared simethicone with Mentha piperita and found no difference in crying duration, number of crying episodes or number of responders. Herbal agents. We found low-quality evidence suggesting that herbal agents reduce the duration of crying compared with placebo (mean difference (MD) 1.33, 95% CI 0.71 to 1.96; three studies, 279 infants), with different magnitude of benefit noted across studies (I² = 96%). We found moderate-quality evidence indicating that herbal agents increase response over placebo (RR 2.05, 95% CI 1.56 to 2.70; three studies, 277 infants). Sucrose. One very low-quality study involving 35 infants reported that sucrose reduced hours spent crying compared with placebo (MD 1.72, 95% CI 1.38 to 2.06). Dicyclomine. We could consider only one of the five studies of dicyclomine (48 infants) for the primary comparison. In this study, more of the infants given dicyclomine responded than than those given placebo (RR 2.50, 95% CI 1.17 to 5.34). Cimetropium bromide. Data from one very low-quality study comparing cimetropium bromide with placebo showed reduced crying duration among infants treated with cimetropium bromide (MD -30.20 minutes per crisis, 95% CI -39.51 to -20.89; 86 infants). The same study reported that cimetropium increased the number of responders (RR 2.29, 95% CI 1.44 to 3.64).No serious adverse events were reported for all of the agents considered, with the exception of dicyclomine, for which two of five studies reported relevant adverse effects (longer sleep 4%, wide-eyed state 4%, drowsiness 13%).
Authors' conclusions:
At the present time, evidence of the effectiveness of pain-relieving agents for the treatment of infantile colic is sparse and prone to bias. The few available studies included small sample sizes, and most had serious limitations. Benefits, when reported, were inconsistent.We found no evidence to support the use of simethicone as a pain-relieving agent for infantile colic.Available evidence shows that herbal agents, sugar, dicyclomine and cimetropium bromide cannot be recommended for infants with colic.Investigators must conduct RCTs using standardised measures that allow comparisons among pain-relieving agents and pooling of results across studies. Parents, who most often provide the intervention and assess the outcome, should always be blinded.
Objective:
It is postulated that children with asthma who receive an interactive, comprehensive, culturally relevant education program would improve their asthma knowledge (AK), asthma control, and adherence compared with children receiving usual care. The aim of this study was to develop, implement, and evaluate the efficacy of a culturally relevant asthma education intervention for children with asthma and their parents in India.
Methods:
Children with asthma (7-12 years) and their parents were recruited from an outpatient clinic in a Chest Diseases Hospital in New Delhi, and were randomly assigned to either an intervention or usual care group. At baseline, outcome data collected included pediatric asthma caregiver quality of life (PACQL, primary outcome), AK, asthma control, adherence, inhaler technique, action plan ownership, and goal achievement. These data were collected again at 1 and 6 months after baseline. Outcomes were compared within and between groups using ANOVA techniques.
Results:
Forty parent-child pairs were recruited. Of these, 24 pairs of children with asthma and their parents received the educational intervention. The PACQL significantly improved from baseline to 6 months in the intervention (5.87 ± 0.94-7.00 ± 0.03) versus the usual care group (5.90 ± 0.52-6.34 ± 0.56) (P < 0.001). Other outcomes such as the parents' and child's AK, child's asthma control and inhaler technique were significantly improved in the intervention group across the study. All the participants possessed a written asthma action plan at the end of the intervention. Eighty-five goals were set by children with asthma across all the visits and were achieved by completion.
Conclusion:
An asthma educator delivered interactive program simultaneously involving children with asthma and their parents, improved quality of life, empowered and promoted better self-management skills.
Background and objectives:
Adopting the milliliter as the preferred unit of measurement has been suggested as a strategy to improve the clarity of medication instructions; teaspoon and tablespoon units may inadvertently endorse nonstandard kitchen spoon use. We examined the association between unit used and parent medication errors and whether nonstandard instruments mediate this relationship.
Methods:
Cross-sectional analysis of baseline data from a larger study of provider communication and medication errors. English- or Spanish-speaking parents (n = 287) whose children were prescribed liquid medications in 2 emergency departments were enrolled. Medication error defined as: error in knowledge of prescribed dose, error in observed dose measurement (compared to intended or prescribed dose); >20% deviation threshold for error. Multiple logistic regression performed adjusting for parent age, language, country, race/ethnicity, socioeconomic status, education, health literacy (Short Test of Functional Health Literacy in Adults); child age, chronic disease; site.
Results:
Medication errors were common: 39.4% of parents made an error in measurement of the intended dose, 41.1% made an error in the prescribed dose. Furthermore, 16.7% used a nonstandard instrument. Compared with parents who used milliliter-only, parents who used teaspoon or tablespoon units had twice the odds of making an error with the intended (42.5% vs 27.6%, P = .02; adjusted odds ratio=2.3; 95% confidence interval, 1.2-4.4) and prescribed (45.1% vs 31.4%, P = .04; adjusted odds ratio=1.9; 95% confidence interval, 1.03-3.5) dose; associations greater for parents with low health literacy and non-English speakers. Nonstandard instrument use partially mediated teaspoon and tablespoon-associated measurement errors.
Conclusions:
Findings support a milliliter-only standard to reduce medication errors.
Fever is a normal physiological response to illness that facilitates and accelerates recovery. Although it is often associated with a self-limiting viral infection in children, it may also be a presenting symptom of more serious conditions requiring urgent medical care. Therefore, it is essential to distinguish between a child with fever who is at high risk of serious illness and who requires specific treatment, hospitalisation or specialist care, and those at low risk who can be managed conservatively at home. This guideline aims to assist pharmacists, primary healthcare workers and general practitioners in risk-stratifying children who present with fever, deciding on when to refer, the appropriate use of antipyretic medication and how to advise parents and caregivers.
Over-the-counter medications are often taken by adults, and given to children, to relieve minor ailments. Despite being freely available from a pharmacy or supermarket, many preparations are of unproven benefit. Some have the potential for harm, especially in the young. Health professionals, as well as parents, have a responsibility to be cautious about giving drugs to children.
Context Iatrogenic injuries, including medication errors, are an important problem
in all hospitalized populations. However, few epidemiological data are available
regarding medication errors in the pediatric inpatient setting.Objectives To assess the rates of medication errors, adverse drug events (ADEs),
and potential ADEs; to compare pediatric rates with previously reported adult
rates; to analyze the major types of errors; and to evaluate the potential
impact of prevention strategies.Design, Setting, and Patients Prospective cohort study of 1120 patients admitted to 2 academic institutions
during 6 weeks in April and May of 1999.Main Outcome Measures Medication errors, potential ADEs, and ADEs were identified by clinical
staff reports and review of medication order sheets, medication administration
records, and patient charts.Results We reviewed 10 778 medication orders and found 616 medication errors
(5.7%), 115 potential ADEs (1.1%), and 26 ADEs (0.24%). Of the 26 ADEs, 5
(19%) were preventable. While the preventable ADE rate was similar to that
of a previous adult hospital study, the potential ADE rate was 3 times higher.
The rate of potential ADEs was significantly higher in neonates in the neonatal
intensive care unit. Most potential ADEs occurred at the stage of drug ordering
(79%) and involved incorrect dosing (34%), anti-infective drugs (28%), and
intravenous medications (54%). Physician reviewers judged that computerized
physician order entry could potentially have prevented 93% and ward-based
clinical pharmacists 94% of potential ADEs.Conclusions Medication errors are common in pediatric inpatient settings, and further
efforts are needed to reduce them.
The goals were to determine the prevalence of community-acquired methicillin-resistant Staphylococcus aureus colonization in patients with atopic dermatitis and to determine whether suppression of S aureus growth with sodium hypochlorite (bleach) baths and intranasal mupirocin treatment improves eczema severity.
A randomized, investigator-blinded, placebo-controlled study was conducted with 31 patients, 6 months to 17 years of age, with moderate to severe atopic dermatitis and clinical signs of secondary bacterial infections. All patients received orally administered cephalexin for 14 days and were assigned randomly to receive intranasal mupirocin ointment treatment and sodium hypochlorite (bleach) baths (treatment arm) or intranasal petrolatum ointment treatment and plain water baths (placebo arm) for 3 months. The primary outcome measure was the Eczema Area and Severity Index score.
The prevalence of community-acquired methicillin-resistant S aureus in our study (7.4% of our S aureus-positive skin cultures and 4% of our S aureus-positive nasal cultures) was much lower than that in the general population with cultures at Children's Memorial Hospital (75%-85%). Patients in the group that received both the dilute bleach baths and intranasal mupirocin treatment showed significantly greater mean reductions from baseline in Eczema Area and Severity Index scores, compared with the placebo group, at the 1-month and 3-month visits. The mean Eczema Area and Severity Index scores for the head and neck did not decrease for patients in the treatment group, whereas scores for other body sites (submerged in the dilute bleach baths) decreased at 1 and 3 months, in comparison with placebo-treated patients.
Chronic use of dilute bleach baths with intermittent intranasal application of mupirocin ointment decreased the clinical severity of atopic dermatitis in patients with clinical signs of secondary bacterial infections. Patients with atopic dermatitis do not seem to have increased susceptibility to infection or colonization with resistant strains of S aureus.
Iatrogenic injuries, including medication errors, are an important problem in all hospitalized populations. However, few epidemiological data are available regarding medication errors in the pediatric inpatient setting.
To assess the rates of medication errors, adverse drug events (ADEs), and potential ADEs; to compare pediatric rates with previously reported adult rates; to analyze the major types of errors; and to evaluate the potential impact of prevention strategies.
Prospective cohort study of 1120 patients admitted to 2 academic institutions during 6 weeks in April and May of 1999.
Medication errors, potential ADEs, and ADEs were identified by clinical staff reports and review of medication order sheets, medication administration records, and patient charts.
We reviewed 10 778 medication orders and found 616 medication errors (5.7%), 115 potential ADEs (1.1%), and 26 ADEs (0.24%). Of the 26 ADEs, 5 (19%) were preventable. While the preventable ADE rate was similar to that of a previous adult hospital study, the potential ADE rate was 3 times higher. The rate of potential ADEs was significantly higher in neonates in the neonatal intensive care unit. Most potential ADEs occurred at the stage of drug ordering (79%) and involved incorrect dosing (34%), anti-infective drugs (28%), and intravenous medications (54%). Physician reviewers judged that computerized physician order entry could potentially have prevented 93% and ward-based clinical pharmacists 94% of potential ADEs.
Medication errors are common in pediatric inpatient settings, and further efforts are needed to reduce them.
Up to 20% of parents report a problem with infant crying or irritability in the first 3 months of life. Crying usually peaks at 6 weeks and abates by 12-16 weeks. For most irritable infants, there is no underlying medical cause. In a minority, the cause is cow's milk and other food allergy. Only if frequent vomiting (about five times a day) occurs is gastro-oesophageal reflux a likely cause. It is important to assess the mother-infant relationship and maternal fatigue, anxiety and depression. Management of excessive crying includes: explaining babies' normal crying and sleeping patterns; helping parents help their baby deal with discomfort and distress through a baby-centred approach; helping parents recognise when their baby is tired and apply a consistent approach to settling their baby; encouraging parents to accept help from friends and family, and to simplify household tasks. If they are unable to manage their baby's crying, admission to a parenting centre (day stay or overnight stay) or local hospital should be arranged.
To examine how autonomy and pubertal status explain age decreases in maternal involvement in type 1 diabetes management across adolescence, how they relate to metabolic control, and the reasons that guide declines in maternal involvement.
One hundred twenty-seven children ages 10-15 years with type 1 diabetes and their mothers participated. Data included maternal and child report of diabetes management, child report of autonomy level, maternal report of pubertal status, maternal reports of reasons for transfer of diabetes responsibility, and glycosylated hemoglobin (Hba(1c)) values.
Autonomy and pubertal status partially mediated age effects on reports of maternal involvement. Mothers' reasons for transferring responsibility included responding to the child's competence, promoting competence and maturity in their child, and minimizing hassles and conflict. The transfer of diabetes responsibility from mother to child without sufficient autonomy and when pubertal status was low was related to higher Hba(1c) values.
The importance of chronological age for changes in maternal involvement suggests the need to examine mothers' and adolescents' developmental expectations for diabetes management. The reasons for transferring responsibility from mother to child suggest many avenues for intervention.
Background: Topical corticosteroids (TCS) are key to managing chronic inflammatory dermatoses (CID). Parents/patients cite TCS phobia as an impediment to treatment adherence. Family/friends and the Internet are a source of misinformation on TCS which can negatively impact perceptions of TCS safety.
Purpose: To assess information from family/friends and the Internet, as related to and reported by patients/parents using long term TCS.
Methods: A multicenter cross-sectional survey of patients (aged 18+) and parents of patients (aged <18) with a history of CID requiring long-term (≥ 1 month) TCS use assessing messages about TCS received from family/friends and the Internet.
Results: A total of 123 patients and 78 parents completed the survey (n = 201). Parents/Patients were more likely to be informed by the Internet “[having] my [child’s] skin condition means that [I/he/she] will need to use topical corticosteroids” (p <0.001) and that “inflamed skin conditions will improve with the topical corticosteroids” (p = 0.007). Family/Friends were more likely to recommend parents/patients “try non-prescription creams/ointments before resorting to the use of prescription topical corticosteroids” (p = 0.014).
Conclusions: High rates of messages about TCS ‘risk’ from family/friends and the Internet may affect patient/parent understanding about TCS safety. This may contribute to treatment non-adherence.
OBJECTIVE
This study aimed to evaluate the effectiveness of an asthma first-aid training tool for childcare staff in Australia. The effects of training on both asthma knowledge and skills were assessed.
METHODS
A pre/post study design was utilised to assess changes in asthma knowledge and asthma first-aid skills in childcare staff before and after an educational intervention. Asthma first-aid skills were assessed from the participant's response to two scenarios in which a child was having a severe exacerbation of asthma. Asthma knowledge and asthma skills scores were collected at base-line and three weeks post the education session which involved feedback on each individual's skills and a brief lecture on asthma delivered via PowerPoint presentation.
RESULTS
There was a significant improvement after intervention in asthma knowledge (Z = −3.638, p<0.001) and asthma first-aid skills for both scenario 1 (Z = −6.012, p<0.001) and scenario 2 (Z = −6.018, p<0.001). In scenario 1 and 2, first-aid skills improved by 65% (p<0.001) and 57% (p<0.001) respectively. Asthma knowledge was high at baseline (79%) and increased by 7% (p<0.001) after the educational intervention. These asthma knowledge results were not significant when adjusted for prior knowledge. Results suggest that knowledge assessment alone may not predict the practical skills needed for asthma first-aid.
CONCLUSIONS
Skills assessment is a useful adjunct to knowledge assessment when gauging the ability of childcare staff to manage acute asthma exacerbation. Skills assessment could be considered for incorporation into future educational interventions to improve management of acute asthma exacerbation.
Purpose:
To assess pharmacist and general practitioner (GP) advice and behaviors, as related to and reported by patients and parents of patients using topical corticosteroids (TCS) on a long-term basis.
Materials and methods:
Multicenter cross-sectional survey of patients (aged 18+) and parents of pediatric patients (aged <18) with a history of long-term (≥ 1 month) TCS use, assessing: TCS treatment adherence and reasons for non-adherence; beliefs regarding TCS use and safety; messages regarding TCS received from community pharmacists, general practitioners (GPs), family/friends, and the Internet; and experiences of GP and pharmacist counseling regarding TCS use.
Results:
A total of 123 patients and 78 parents completed the survey (n = 201). 76.6% of respondents reported consistently ('Often' or 'Always') receiving one or more message(s) regarding TCS 'risk' from a GP and/or pharmacist (n = 192). Respondents reported being told to 'try natural or complementary and alternative therapies before resorting to the use of TCS' significantly more often by pharmacists than by GPs (p = 0.039).
Conclusions:
High rates of consistently-delivered messages about TCS 'risk' from GPs and pharmacists affect patient/parent understanding about TCS safety and may lead to treatment non-adherence. This indicates a need for re-education of these groups on the safety of TCS use.
Aim • To examine how over-the-counter medicines for children are handled in the home and identify any potential risks associated with their use. Design • Self-report questionnaire survey. Subjects and Setting • Parents of children under the age of 12 years from three general practices in the East Midlands area of the UK. Outcome Measures • Identification of risks in parental choice, administration, source of purchase, storage and disposal of over-the-counter medicines for children. Results • 21% of children's OTC medicines are purchased from non-pharmacy outlets. 93% of parents believe they store OTC medicines safely despite storage in inappropriate places. The risk of dental caries from sugar in medicines seems to be appreciated by most parents as this is the least favoured additive. 11% of parents use an inappropriate measuring device. Paracetamol is administered more frequently than every four hours by 12% of parents, and 4% exceed the maximum recommended number of daily doses. Most keep their children's medicines until they are needed again, significant numbers dispose of them in the dustbin, and only 5% return them to a pharmacy for disposal. Conclusions • A number of risk areas in parental use of OTC medicines for their children have been identified. An important role for the pharmacist is suggested in educating parental choice, dosing, administration, safe storage and disposal of children's OTC medicines. The pharmacist has a responsibility to take steps to minimise risks and ensure safe and effective use of medicines in children.
Infantile colic is a benign process in which an infant has paroxysms of inconsolable crying for more than three hours per day, more than three days per week, for longer than three weeks. It affects approximately 10% to 40% of infants worldwide and peaks at around six weeks of age, with symptoms resolving by three to six months of age. The incidence is equal between sexes, and there is no correlation with type of feeding (breast vs. bottle), gestational age, or socioeconomic status. The cause of infantile colic is not known; proposed causes include alterations in fecal microflora, intolerance to cow's milk protein or lactose, gastrointestinal immaturity or inflammation, increased serotonin secretion, poor feeding technique, and maternal smoking or nicotine replacement therapy. Colic is a diagnosis of exclusion after a detailed history and physical examination have ruled out concerning causes. Parental support and reassurance are key components of the management of colic. Simethicone and proton pump inhibitors are ineffective for the treatment of colic, and dicyclomine is contraindicated. Treatment options for breastfed infants include the probiotic Lactobacillus reuteri (strain DSM 17938) and reducing maternal dietary allergen intake. Switching to a hydrolyzed formula is an option for formula-fed infants. Evidence does not support chiropractic or osteopathic manipulation, infant massage, swaddling, acupuncture, or herbal supplements.
Atopic eczema is a chronic inflammatory disease affecting about 30% of Australian and New Zealand children. Severe eczema costs over AUD 6000/year per child in direct medical, hospital and treatment costs as well as time off work for caregivers and untold distress for the family unit. In addition, it has a negative impact on a child's sleep, education, development and self-esteem. The treatment of atopic eczema is complex and multifaceted but a core component of therapy is to manage the inflammation with topical corticosteroids (TCS). Despite this, TCS are often underutilised by many parents due to corticosteroid phobia and unfounded concerns about their adverse effects. This has led to extended and unnecessary exacerbations of eczema for children. Contrary to popular perceptions, (TCS) use in paediatric eczema does not cause atrophy, hypopigmentation, hypertrichosis, osteoporosis, purpura or telangiectasia when used appropriately as per guidelines. In rare cases, prolonged and excessive use of potent TCS has contributed to striae, short-term hypothalamic-pituitary-adrenal axis alteration and ophthalmological disease. TCS use can also exacerbate periorificial rosacea. TCS are very effective treatments for eczema. When they are used to treat active eczema and stopped once the active inflammation has resolved, adverse effects are minimal. TCS should be the cornerstone treatment of atopic eczema in children.
© 2015 The Australasian College of Dermatologists.
To profile medication dosing behaviour of caregivers of children aged 5 years and under in fever and cough/cold management.
Caregivers (n = 97), recruited from childcare centres in Sydney, Australia, were presented two scenarios in a face to face consultation with the researcher, requiring them to make decisions about the management of a child, including medicine dosing. Accuracy of doses and appropriateness of management were documented. Focus groups explored factors surrounding caregivers' skills.
In the fever scenario, 45% (44/97) chose to medicate when temperature was below 38°C. Many measured incorrect doses and stated inappropriate dosage intervals. Only 23% managed the scenario appropriately. In the cough/cold scenario, 43% (38/89) chose to medicate. Overall, only 35% (45/127) of dose measurements observed were accurate based on the child's weight. Focus groups revealed that caregivers are not aware of risks associated with children's medicines and when to medicate.
The ability of caregivers to accurately measure and administer doses is important. Determining the motivations to use medicines, as well as dosing behaviours is necessary to improve the quality use of medicines.
Functional health literacy is founded on general and numerical literacy and practical skills and is required for the appropriate and effective management of health symptoms in children. This study aimed to assess the health literacy skills of parents and caregivers of preschool-aged children, using a progressive scenario describing a child with fever and presenting tasks relating to selection of a medicine and hypothetical dosing of their child. Participants (n = 417) from 33 childcare- and health-related sites in Sydney, Brisbane, Melbourne and Auckland completed the study. Participants' responses were largely appropriate regarding actions in response to worsening symptoms, selection of an appropriate product (from a limited range), whereby 84.5% of responses were for a single-ingredient paracetamol product and use of the package directions to state the frequency of dosing (93.1% of frequencies appropriate for paracetamol and 66.7% for ibuprofen). However, in only 50.8% of cases was an appropriate weight-based dose calculated, and doses were not measured to within 10% of the stated dose in 16.7% of cases. Future studies should focus on skill development via educational campaigns for parents and caregivers.
The classic Health Belief Model (HBM) was adapted to explain children's expected medicine use for five common health problems. To evaluate this Children's Health Belief Model (CHBM), 270 urban preadolescents, stratified by socioeconomic status, grade level, and sex, and their primary caretakers (93% mothers) were individually interviewed. Analyses were performed in two steps. First, regression analysis evaluated the influence of the child's primary caretaker on the child's expected medicine use; Individual differences in children's motivations, perceived benefits and threats, and expectations to take medicines were partially explained by caretakers' perceptions of these children. Second, path analysis evaluated hypothesized causal relationships in the CHBM, accounting for 63% of the adjusted variance in children's expected medicine use. Two readiness factors, perceived severity of illness and perceived benefit of taking medicines, had the highest path coefficients, with illness concern and perceived vulnerability to illness accounting for a smaller, but significant, portion of the variance. Cognitive/Affective variables, notably children's health locus of control, contributed to indirect paths between demographic and readiness factors. The CHBM appears to be a promising model for studying the development of children's health beliefs and expectations.
In 1996, an open conference sponsored by the US Pharmacopeia (USP) and attended by more than 100 health care professionals established the need and rationale for teaching children and adolescents about medicines. After the conference, a public, iterative, consensus-development process including participation by 35 health-professional organizations was undertaken. This process resulted in a USP position statement, “Ten Guiding Principles for Teaching Children and Adolescents About Medicines,” which supports the right of children and adolescents to receive developmentally appropriate information and direct communications about medicines that are consistent with their health status, capabilities, and culture. The position statement is intended to stimulate activities that will help children become active participants in the process of appropriate use of medicines and prepare them for the day they begin to use medicines independently.
Three main analgesics are routinely used for treating pain in children - paracetamol, ibuprofen and codeine. Paracetamol and ibuprofen are equally effective when used in recommended doses. Codeine has high inter-individual variation in its effectiveness, particularly in children, which significantly limits its routine use in paediatrics. Paracetamol is associated with fewer adverse effects than ibuprofen and so generally remains the first-line analgesic drug in children. However, paracetamol may not be the most appropriate choice in all patients depending on the type of pain being treated and the presence of comorbid illnesses. Paracetamol has unpredictable absorption with rectal administration so this route is no longer recommended. The combined use of paracetamol with non-steroidal anti-inflammatory drugs may be of benefit for some postoperative and musculoskeletal pain.
Objective To quantify the extent and types of minor ailments in children that were presented at community pharmacies and the types of over-the-counter (OTC) medicines purchased in response to these ailments.
Method Data on all requests and sales of OTC medicines for children (aged 16 years and under) and consultations for minor ailments in children were recorded in eight community pharmacies for one week every month over a 12-month period. Participants were members of the public who consulted the pharmacists or other pharmacy staff in the community pharmacies.
Key findings A total of 976 consultations was recorded with 61.5% requesting an OTC medicine by name and 38.5% by symptom presentation. An average of 10.2 consultations was made per pharmacy per week. Requests for treatment were usually made within five days of symptom occurrence (86%). Most of the consultations were made by mothers (75%), although 17% were by fathers. The most commonly purchased OTC medicine was paracetamol. There were five requests for aspirin and one was for a 2-year old child. A total of 62 cases (6%) was referred back to the child's primary care physician (general practitioner).
Conclusions Symptoms related to cough and cold were the most common problems in children presenting to community pharmacies for treatment. Paracetamol was the most widely used OTC medicine in children. Pharmacy staff do question the request for OTC medicines such as aspirin, to ensure its safe use. Community pharmacies play an important role as the first port of call for advice on minor ailments in children and have an opportunity to provide health promotion to carers of children.
The global burden of pediatric asthma is high. Governments and health-care systems are affected by the increasing costs of childhood asthma--in terms of direct health-care costs and indirect costs due to loss of parental productivity, missed school days, and hospitalizations. Despite the availability of effective treatment, the current use of medications in children with asthma is suboptimal. The purpose of this review is to scope the empirical literature to identify the problems associated with the use of pediatric asthma medications. The findings will help to design interventions aiming to improve the use of asthma medications among children.
A literature search using electronic search engines (i.e., Medline, International Pharmaceutical Abstracts (IPA), PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature (CINAHL)) and the search terms "asthma," "children," and "medicines" (and derivatives of these keywords) was conducted.
The search terms were expanded to include emergent themes arising out of search findings. Content themes relating to parents, children themselves, health-care professionals, organizational systems, and specific medications and devices were found. Within these themes, key issues included a lack of parental knowledge about asthma and asthma medications, lack of information provided to parents, parental beliefs and fears, parental behavioral problems, the high costs of medications and devices, the child's self-image, the need for more child responsibility, physician nonadherence to prescribing guidelines, "off-label" prescribing, poor understanding of teachers, lack of access to educational resources, and specific medications.
These key issues should be taken into account when modifying the development of educational tools. These tools should focus on targeting the children themselves, the parent/carers, the health-care professionals, and various organizational systems.
To examine the association between parent's headache and symptom load and children's medicine use, and whether these associations are robust across countries and socio-demographic strata.
The study population included random samples of children from age 2 to 17 in five Nordic countries (participation rate 67.6%, n = 10,317). Outcome measure was child's medicine use for headache. Determinants were the mother's and father's headache and symptom load. Analyses were stratified by country, age group and socio-economic status.
The prevalence of children's medicine use varied across countries between 13.7 and 21.3%. Girls' medicine use for headache was associated with mother's headache (OR = 2.00), father's headache (OR = 1.85), mother's symptom load (OR = 1.84) and father's symptom load (OR = 1.48). Boys' medicine use was only associated with mothers' headache (OR = 1.68) and symptom load (OR = 1.51). Associations remained significant after adjustment for the child's headache and were robust across countries and socio-demographic strata.
Parents' symptom experience seems to influence their children's medicine use over and above medicine use indicated by symptoms. Two potential explanations are suggested: a socialization pathway and/or a pathway through adverse living conditions.
A finger-tip unit (FTU) is the amount of ointment expressed from a tube with a 5 mm diameter nozzle, applied from the distal skin-crease to the tip of the index finger. Thirty adult-patients treated various anatomical regions using FTU's of ointment. The number of FTU's required was: face and neck 2.5 (s.d. +/- 0.8); front of trunk 6.7 (s.d. +/- 1.7); back of trunk 6.8 (s.d. +/- 1.2); arm and forearm 3.3 (s.d. +/- 1.0); hand 1.2 (s.d. +/- 0.4); leg and thigh 5.8 (s.d. +/- 1.7); foot 1.8 (s.d. +/- 0.6). One FTU covers 286 cm2 (s.d. +/- 80, n = 30). In males one FTU covers 312 cm2 (s.d. +/- 90, n = 16) and in females 257 cm2 (s.d. +/- 55, n = 14). The use of the FTU in dermatological prescribing provides a readily understandable measure for both patients and doctor.
The classic Health Belief Model (HBM) was adapted to explain children's expected medicine use for five common health problems. To evaluate this Children's Health Belief Model (CHBM), 270 urban preadolescents, stratified by socioeconomic status, grade level, and sex, and their primary caretakers (93% mothers) were individually interviewed. Analyses were performed in two steps. First, regression analysis evaluated the influence of the child's primary caretaker on the child's expected medicine use. Individual differences in children's motivations, perceived benefits and threats, and expectations to take medicines were partially explained by caretakers' perceptions of these children. Second, path analysis evaluated hypothesized causal relationships in the CHBM, accounting for 63% of the adjusted variance in children's expected medicine use. Two readiness factors, perceived severity of illness and perceived benefit of taking medicines, had the highest path coefficients, with illness concern and perceived vulnerability to illness accounting for a smaller, but significant, portion of the variance. Cognitive/Affective variables, notably children's health locus of control, contributed to indirect paths between demographic and readiness factors. The CHBM appears to be a promising model for studying the development of children's health beliefs and expectations.
Over-the-counter stimulants (phenylpropanolamine hydrochloride, ephedrine, pseudoephedrine, caffeine) are used widely as decongestants, anorectic agents, amphetamine substitutes, and "legal stimulants." Toxic effects may result from overdose, drug interactions, or diseases that increase sensitivity to sympathomimetic agents. The most important toxic effect of the alpha-adrenergic agonist phenylpropanolamine is hypertension, which may result in hypertensive encephalopathy or intracerebral hemorrhage. The therapeutic index of phenylpropanolamine is low, and severe hypertension may occur after ingestion of less than three times the therapeutic dose. Ephedrine and pseudoephedrine may also cause hypertension, as well as tachyarrhythmias due to beta-adrenergic stimulation. Toxic reactions from caffeine are characterized by agitation, seizures, tachyarrhythmias, and hypotension. Management of toxic reactions to over-the-counter stimulants includes control of hypertension with a rapidly acting vasodilator, beta-blockers for tachyarrhythmias, and control of seizures.
There are hundreds of nonprescription medications available to the consumer. Among these are a number that have potential for toxicity when taken in overdoses or in combination with other medications. This article addresses the pathophysiology, diagnosis, and treatment of selected over-the-counter medication intoxications including antihistamines, dextromethorphan, sympathomimetics, nutritional supplements, and herbal preparations.
Hyoscyamine, one of the principal alkaloid components of belladonna, is a potent anticholinergic agent. Because of its anticholinergic properties, hyoscyamine sulfate drops are often prescribed for the treatment of colic in infants. Anticholinergic poisoning in infants is rare. However, five cases are reported of infants with anticholinergic toxicity following the administration of hyoscyamine drops for the treatment of colic. Common presenting symptoms included irritability, tachycardia, and erythematous flushed skin. These cases emphasize the need for a heightened awareness by emergency physicians and pediatricians of possible anticholinergic toxicity caused by the use of hyoscyamine for infant colic.
In 1996, an open conference sponsored by the US Pharmacopeia (USP) and attended by more than 100 health care professionals established the need and rationale for teaching children and adolescents about medicines. After the conference, a public, iterative, consensus-development process including participation by 35 health-professional organizations was undertaken. This process resulted in a USP position statement, "Ten Guiding Principles for Teaching Children and Adolescents About Medicines," which supports the right of children and adolescents to receive developmentally appropriate information and direct communications about medicines that are consistent with their health status, capabilities, and culture. The position statement is intended to stimulate activities that will help children become active participants in the process of appropriate use of medicines and prepare them for the day they begin to use medicines independently.
Childhood ingestion of medications remains a substantial problem. Medication available over the counter (OTC) is widely used and has significant toxicity. The present study aims to investigate the nature and extent of unintentional ingestion of OTC medication in children < 5 years old in Victoria, Australia, during the period 1996-2000, in order to highlight critical factors.
Numbers of enquiries relating to unintentional ingestion of OTC medication in children < 5 years old and medication types were obtained from the Victorian Poisons Information Centre for 1998-2000. Emergency Department presentations involving poisoning of children < 5 years old, the medication types and subsequent admissions were obtained from the Victorian Emergency Minimum Dataset for 1996-2000.
Numbers of enquiries and Emergency Department attendances for poisoning were substantially higher for OTC medication than for prescription medication; however, a lower proportion of cases involving ingestion of OTC medication (24.8%) required hospital admission during the study period compared with cases involving ingestion of prescription medications (33.8%). Overall, the peak incidence was at 2 years of age, with a slight male over-representation. Paracetamol and cough/cold preparations were the most common agents.
The causes of unintentional ingestion of OTC medications by children might include lack of child-resistant closure (CRC), inadequate design of CRC, attitudes concerning the toxicity of OTC medications, or lack of vigilance by parents and carers in the storage and administration of OTC medications. Consideration should be given to restricting sales of toxic OTC medications to pharmacies, and increasing counselling of consumers concerning the toxicity and safe storage of OTC medications and the correct usage of CRC. The adequacy of CRC design and OTC medications warranting CRC should be reviewed by the relevant authorities.
This paper reports a review which draws together findings from studies targeting parents' temperature-taking, antipyretic administration, attitudes, practices and information-seeking behaviours.
Parents' concerns about the harmful effects of fever have been reported for more than two decades. These concerns remain despite successful educational interventions.
Medline, CINAHL, PsycINFO, PsycARTICLES and Web of Science databases were searched from 1980 to 2004 during November 2004. The search terms were fever, child, parent, education, knowledge, belief, concern, temperature, antipyretic and information, and combinations of these.
In the 1980s, studies were mainly descriptive of small single site samples of parents with a febrile child seeking assistance from healthcare professionals. From 1990, sample sizes increased and multi-site studies were reported. Educational interventions were designed to increase knowledge and reduce unnecessary use of health services. One 2003 study targeted knowledge and attitudes. Parental knowledge about normal body temperature and the temperature that indicates fever is poor. Mild fever is misclassified by many as high, and they actively reduce mild fever with incorrect doses of antipyretics. Although some parents acknowledge the benefits of mild fever, concerns about brain damage, febrile convulsions and death from mild to moderate fever persist irrespective of parental education or socio-economic status. Many base their fever management practices on inaccurate temperature readings. Increased use of antipyretics to reduce fever and waking sleeping febrile children for antipyretics or sponging reflects heightened concern about harmful effects of fever. Educational interventions have reduced unnecessary use of healthcare services, improved knowledge about fever and when to implement management strategies, and reduced incorrect parental accuracy of antipyretic dosing. Information-seeking behaviours in fever management differ according to country of origin.
Despite successful educational interventions, little has changed in parents' fever management knowledge, attitudes and practices. There is a need for interventions based on behaviour change theories to target the precursors of behaviour, namely knowledge, attitudes, normative influences and parents' perceptions of control.
To describe parent-perceived mastery of Continuous Subcutaneous Insulin Infusion (CSII) specific skills and level of autonomy for these tasks among youth with type 1 diabetes.
One hundred and sixty-three parents of youth using CSII and 142 diabetes clinicians participated. Parents reported their child's mastery and autonomy of CSII-specific skills. Clinicians indicated the age at which 50% of their patients mastered these skills.
Parents report CSII skill mastery between 10.9 and 12.8 years. Very few achieved skill mastery on all CSII-related tasks. Parent- and clinician-expectations for age of skill acquisition were consistent with one another. Parents shared CSII task responsibility with their children even after their children have attained skill mastery.
The recent emphasis on maintaining parental involvement in diabetes care seems to have been translated into clinical practice. Parents remain involved in their child's CSII care even after they believe their child has mastered these skills.
Education before medication: empowering children as medicine users. Katri Hämeen-Anttila
- K Hämeen-Anttila
Hämeen-Anttila K. Education before medication: empowering children as medicine users.
Katri Hämeen-Anttila: University of Kuopio; 2006.
The effectiveness of interventions for infant colic
- Joanna Briggs Institute
Joanna Briggs Institute. The effectiveness of interventions for infant colic. Aust
Nurs J. 2008;16(4):31-4.
International Association for the Study of Pain
International Association for the Study of Pain. Pain 2016 Available from: http://www.iasppain.org/Taxonomy.
Children’s over-the-counter medicines pharmacoepidemiological (COPE) study
- Ick Wong
- S S Chua
- H Edmondson
Wong ICK, Chua SS, Edmondson H. Children's over-the-counter medicines pharmacoepidemiological (COPE) study. Int J Pharmacy Pract. 2007;15(1):17-22.
Caregivers’ management of childhood fever and their rationale for their practice. The University of Sydney
- E So
- R Moles
So E, Moles R. Caregivers' management of childhood fever and their rationale for their
practice. The University of Sydney;2014.
Treating colds: keep it simple
- D Pappas
- G Hayden
- J Hendley
Pappas D, Hayden G, Hendley J. Treating colds: keep it simple. Contemp Pediatr.
1999;16:109-19.
Improving childcare staff management of acute asthma exacerbation-an Australian pilot study
- Y Y Soo
- K H Luckie
- B Saini
- V Kritikos
- J D Brannan
- R J Moles
- YY Soo
Soo YY, Luckie KH, Saini B, Kritikos V, Brannan JD, Moles RJ. Improving childcare staff
management of acute asthma exacerbation-an Australian pilot study. J Asthma. 2017;54
(7):732-40.
Infantile colic: recognition and treatment
- J D Johnson
- K Cocker
- JD Johnson