Many people think that when determining treatments for
children, they can be considered as undersized adults. Because of this, some
people reason that children should be treated with the same mg/kg dosing as
adults, and since they weigh so much less, they always receive a lower dose
according to their weight. This is not the case. Children are physiologically
different from adults in many ways so several elements need to factored in when
determining how much medication they should receive and what route would be
most efficacious. Although in many cases, children do need to receive smaller
doses according to their weight, there are several instances where they do not receive
the same amount of medication per unit weight.
For example, physiological differences in pediatric and
adult skin translate into different amounts of medication per unit weight. A
newly born child’s skin does not fully develop until they are about four months
old. Until then, their skin is thinner and more hydrated than an adult’s. Since
transdermal medications are absorbed much better through thin, hydrated skin,
children under four months of age need to be receiving significantly reduced
amounts of transdermal medications when compared to adults.
Physiological
Differences
Skin thickness and hydration is not the only way that
children are physiologically different than adults. Several differences affect
how medications should be compounded and dosed; some of these include differences
in:
GI
absorption – affecting oral medications
The pH in their stomach is more basic than
an adult’s until they are about 2 years old.
Gastric acid output is not stimulated by
the intake of food until they are about 1 year old.
Muscle
mass – affecting intramuscular medications
Children have much less muscle mass
relative to their size than adults. In addition to this, their muscular
contractions are inefficient and they have more variation in the blood flow to
their muscles.
Water
and fat content – affecting multiple routes of medications
Children have increased total body water
and decreased total body fat relative to adults. This means that the
distribution of medications will depend on whether it is water or fat soluble.
Plasma
protein and tissue binding – affecting multiple routes of medications
Children have decreased plasma protein
concentrations and decreased plasma protein binding capacity. This translates
into more free drug in the blood, causing more adverse reactions.
Some medications will have altered binding
affinity to the tissue of interest.
Blood
brain barrier – affecting multiple routes of medications
The blood brain barrier in children is not
fully developed. This means children will have increased CNS exposure to drugs
with CNS effects.
Enzyme
development – affecting multiple routes of medications
Medications are metabolized in the body by
enzymes. Certain enzymes in children are at different stages of development.
For example, children have only 50-70% of the CYP450 activity compared to
adults. In addition to this, they have immature glucuronidation enzyme systems.
Elimination
– affecting multiple routes of medications
The glomerular filtration rate (GFR) of
children does not reach adult levels until about 5 months of age. This means
that the medication will remain in their bodies for a longer period of time
since it is not cleared by the kidneys as quickly.
Child-Friendly
Formulations
As you can see, determining the most efficacious dose
and route can be a complicated process. That is why compounding a special
formulation for each child can often be the best option. This, however, is often
not the only issue that needs to be dealt with when working with pediatric
patients. It can be an incredibly difficult task to administer medications that
don’t mix well with each child’s unique likes and dislikes. To answer these
issues, the Inland Compounding Pharmacy commonly compounds medications in a
variety of flavors and formulations, and can compound them uniquely for each
patient. Some of the child-friendly formulations that we commonly compound to
contain specific doses include:
Topical
creams, ointments, or gels
Lollipops
Oral
suspensions or solutions
Pills
or capsules (capsules can often be opened and sprinkled on pudding or
applesauce)
Freezer
pops (similar to Otter Pops)
Suppositories
Gelatin
troches (similar to gummy bears)
Common
Disease States We Compound For
The Inland Compounding Pharmacy compounds medications
for many different disease states. Some of the pediatric disease states we
commonly compound for include:
Sore
throats or recovery from a tonsillectomy – lollipops or freezer pops
Children
who have GI tubes – suspensions that will not clog the tubing
Diaper
rash – topical butt balm
Malaria
prevention or treatment – Mefloquine (requires much smaller dosing for
children)
Autism
– Naltrexone, CoQ, and vitamin suspensions
Multiple
sclerosis – Aminopyridine
Infections
in uncircumcised children – Triamcinolone/Silvadine Cream
GI infections - Metronidazole (benzoate salt for improved taste)
Sleep apnea - Caffeine citrate solution
ICP - Providing quality solutions with maximum benefits for a healthier you.