Pediatric Patients Are Unique
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.
- 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.
- 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.
- 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.
- The blood brain barrier in children is not fully developed. This means children will have increased CNS exposure to drugs with CNS effects.
- 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.
- 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
