Podcast
Questions and Answers
What is a significant challenge when treating young patients in pediatric medicine?
What is a significant challenge when treating young patients in pediatric medicine?
What does the Medicines Act allow regarding pediatric medicines?
What does the Medicines Act allow regarding pediatric medicines?
Which of the following is an example of an 'off-label' medicine used in children?
Which of the following is an example of an 'off-label' medicine used in children?
What must all marketed medicines possess before being available for use in children?
What must all marketed medicines possess before being available for use in children?
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Which of the following statements about medicine licensing for children is false?
Which of the following statements about medicine licensing for children is false?
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What is one potential consequence of off-label use in pediatric settings?
What is one potential consequence of off-label use in pediatric settings?
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What is essential to understand when treating childhood illnesses?
What is essential to understand when treating childhood illnesses?
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Which area of pediatric care does not typically require a pediatric specialist?
Which area of pediatric care does not typically require a pediatric specialist?
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What is a significant reason many medicines lack a license for use in children?
What is a significant reason many medicines lack a license for use in children?
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Which factor is typically included in the information for a marketed medicine's product license?
Which factor is typically included in the information for a marketed medicine's product license?
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In what situation might a healthcare professional consider using a medicine off-label in pediatric care?
In what situation might a healthcare professional consider using a medicine off-label in pediatric care?
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What must healthcare providers consider when using off-label medications in children?
What must healthcare providers consider when using off-label medications in children?
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Which of the following statements about salbutamol in children is accurate?
Which of the following statements about salbutamol in children is accurate?
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Which challenge is often faced when treating minor ailments in pediatric patients?
Which challenge is often faced when treating minor ailments in pediatric patients?
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What is a common reason for the cautious approach to using OTC medications in children?
What is a common reason for the cautious approach to using OTC medications in children?
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What should medical practitioners regularly consult when prescribing medicines for children?
What should medical practitioners regularly consult when prescribing medicines for children?
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Study Notes
OSPAP Programme
- This programme covers paediatric medicines, vaccines, and OTC medications.
- The presentation was given by Kathryn Davison and Deanne Marshall.
- The aims of the lecture include better understanding of challenges in dealing with young patients, common childhood ailments, infectious diseases, conditions requiring referral, and treating minor conditions over-the-counter (OTC).
Licensing of Medicines in Children (1)
- All marketed medicines need a product license (see individual SPCs).
- Key components of the product license include indication, route, and appropriate dosages and age guidelines.
- Many medicines lack a license for use in children.
- 'Off-label' use of medicines is permitted by the Medicines Act.
Licensing of Medicines in Children (2)
- Common examples of 'off-label' medication in children include salbutamol (children under 2 years) and paracetamol (children under 2 months).
- Sources of information include the BNF for Children, and patient information leaflets/SPCs.
Children's National Service Framework
- National guidelines provide standards of care for medicines for children in England.
- Standard 10 relates to medicines for children.
- Decisions regarding medications should be made from sound information and best available evidence.
- The relevant DH website is available.
Giving Medicines to Children
- Common routes for administering medications to children include oral liquids, oral solids, inhaled medications (MDI with spacer), ear/eye/nose drops, skin creams/ointments/sprays/lotions, injection (sub-cut, IM, IV, IT), and rectal suppositories/solutions/enemas/ointments.
- How spacers are used are covered as well as inhalers. Specific details are included on the use of spacers with masks.
Considerations
- Factors relating to age of the child and choice of administration tools (e.g., syringe/spoon).
- Importance of administering medication at a suitable rate and avoiding to give too fast.
- Considerations include accuracy of dose, formulation (taste, sugar content and stability), and duration of the treatment.
- Food is not to be mixed with medications in a baby's bottle.
- Tablets/capsules are not usually suitable for children aged under 5-7.
- Crushed or opened tablets/capsules can be sprinkled on soft foods or mixed with yogurt.
- Should not give enteric coated or sustained-release preparations.
- Suitable use of soluble tablets will be examined.
- Special considerations are essential for administering medications in children via NG/NJ tubes.
Giving Medicines to Children
- Preferred route for NG/NJ tubes is liquid medications.
- Consult relevant guidelines (Secondary care)
- Some tablets may mix with water; check guidance in BNF/SmPC.
- Continuous feeding patients - stop feed 15 minutes prior to medication.
Giving Medicines to Children
- Eye preparations must be sterile
- Discard preserved products 4 weeks after opening
- Unpreserved products should be discarded after 7 days
- Products may need refrigeration
- Eye drops are administered by tilting the head back and applying to the corner of the eye.
Giving Medicines to Children
- Rectal administration is suitable for young children but is less ideal for older children.
- Lubrication of suppositories is recommended prior to use.
- Suppositories should not be split.
Dose Calculation
- Children's medication dosages are mostly standardised by weight and body surface area measurements (m²).
- Young children may require higher dosages per kilogram.
- The use of ideal weight estimates from height and age (with reference to BNF) is emphasised when considering the weight of an overweight child.
- Body surface area (BSA) estimates are sometimes recommended instead of body weight.
Patient Information - Counselling
- Providing clear and comprehensive information to parents on the use and purpose of medication.
- Information should be written on the label and then explained to the parent.
- Information on how to administer medications. What the medicine is for, important cautions for certain medications like (e.g., imipramine and nocturnal enuresis, potential outcomes of missing doses.).
- Frequency & duration of the medicine.
- Storage- keeping out of reach of children and child-resistant packaging.
- Information on refrigeration if required, and no mixing in the same bottle is important.
- Maintaining the medication in its original packaging is also advised.
- Discussion and provision of information on further supplies and any questions are covered.
Medicines at School
- Medication administration at school is a parental responsibility, but staff can be involved.
- The involvement varies dependent on the duration of the medication or child's age.
- Staff may need education on appropriate medicine administration by school.
- Labeling of medication needs to be detailed.
- Some teaching unions recommend that school staff should not give medicines to children
- Local education authorities provide guidance on medicine management in schools including medication policies.
Immunisation
- Immunisation recommendations are based on the Joint Committee on Vaccination and Immunisation (Green Book)
- Professionals receive updates on current immunisation schedules from CMO and other relevant government departments (DH and WHO).
- Most children are immunised unless having a specific contraindication; however, vaccination rates have been decreasing.
- Vaccination details on the NHS website regarding immunisations and when they should be given.
Immunisation - First Year/ Immunisation 1-15
- Specific vaccines for every age range. Detailed tables provide specific dates and relevant vaccines for every age group, from 8 weeks to 15 years inclusive.
- Hib/MenC (1st dose Men C and 4th dose Hib), MMR , PCV , Men B (3rd dose), Flu , MMR (2nd dose) , 4-in-1 pre-school booster (diphtheria, tetanus, pertussis, polio), HPV (Now offered to girls AND boys), 3-in-1 teenage booster (tetanus, diphtheria, polio) and Men W are listed (1 year-2-15 year inclusive) with dates and details.
Immunisation
- Immunisations are contraindicated in some cases; these include acute illness and previous severe reactions to the vaccine or its constituents.
- Live vaccines shouldn't be given to immunocompromised patients.
- Ensure complete vaccination details in the child's health record.
- Community pharmacies, clinics, and GPs provide details on immunisation schedules.
Rotavirus
- Rotavirus is a common cause of gastroenteritis in infants and young children, commonly causing significant numbers of hospital admissions.
- Rotavirus is highly contagious and is spread via the faecal-oral route.
- This virus is usually prevalent from January to March in the UK, affecting predominantly young children under 3.
- Symptoms last for 3-8 days.
Rotavirus administration
- Rotavirus vaccine is administered orally at 8 weeks.
- There are no restrictions related to food or drink before, during or after administration.
- Vaccination should be postponed if the child has diarrhoea but the first dose has to be received between 6-15 weeks of age.
Rotavirus administration
- The 2nd dose should be administered at or at least 4 weeks after the first dose, before the age of 24 weeks.
- Ideally, both doses should be completed before the age of 16 weeks to maximize vaccine effectiveness.
- Immunocompromised contacts need special consideration due to the way the vaccine is excreted in the child's stools. Caregivers should be advised regarding hand hygiene practices, to avoid transmission
- Vaccination outweighs risk of transmission to others.
Fluenz
- Fluenz is a nasal vaccine offered to children aged 2-16 years.
- The vaccine is made from genetically weakened strains of flu viruses.
- This method is designed to produce an immune response without causing clinical symptoms of flu.
- The vaccine's composition is designed to stimulate an immune response in the nose.
Fluenz
- During vaccination administration, the child should be able to breathe normally and is not required to inhale or sniff.
- Patients who have a blocked or runny nose at their appointments should receive the treatment once their symptoms are resolved.
Contraindications (Flu Vaccine)
- Immunocompromised children (e.g., leukaemia, lymphoma, patients with high dose steroids, and untreated HIV)
- Children under 2 years of age.
- Those allergic to aspirin or salicylates
- Those with an egg or gelatin allergy
- Pregnant patients (exceptions may apply).
- Children actively wheezing or with severe asthma
Men B Vaccine
- Added to the immunisation schedule in 2015.
- Administered via a single injection into the left thigh.
- Babies are at higher risk of fever if given concurrently with other vaccines.
- PHE guidelines recommend 3 doses of infant paracetamol following vaccinations, to prevent fever. This regimen exceeds current licensing terms for infant paracetamol (120mg/5ml), which states a maximum of two doses post-immunisation for 2-4 month-old infants.
Using Paracetamol after MenB Vaccination
- Providing clinical advice to parents on usage and guidelines.
- Providing guidance when the baby is teething and presents with vaccination fevers and how best to manage.
- Advice on what type of paracetamol should be used, dose amount and frequency.
- Dosage and timing should follow professional guidelines.
Case Studies
- Case studies presented for discussion of specific situations and potential treatment approaches for varying conditions.
- Medical history examined and potential vaccination recommendations were given based on the information provided in the case studies.
General Immunisation Issues
- Possible adverse reactions to immunisation- mostly minor, localised pain, swelling within 3-4 hours which resolves within 24 hours.
- Prolonged swelling should be referred.
- Fever - prophylactic paracetamol is not usually required unless administered concurrently with a vaccine that presents with fevers.
Immunisation - MMR
- Overview of the history of MMR and its safety record, which is considered exemplary by the WHO.
- Addressing the discredited research linking MMR vaccination to autism.
- The lack link between MMR and autism.
- Addressing concerns regarding increased autism diagnosis, with no increased risk for vaccinated children post-introduction of MMR vaccination.
- Discussing the 2013 Swansea measles outbreak as an example of the importance of vaccination compliance.
2013 Swansea Measles Epidemic
- Publicity and concerns regarding the MMR which saw the uptake rates decrease.
- Measles outbreak in Swansea in 2013, which stemmed from a holiday camp in south-west England.
- High number of confirmed cases in early 2013.
- Reported cases peaked at nearly 200 notifications in a week.
2023 - NHS England Update
- Presentation of recent updates concerning measles infections in London in 2023, which indicated that more than 32,000 children are at risk.
- The low uptake of the MMR vaccine of recent years and the rising rate of measles cases was reported.
- The WHO target for MMR vaccination uptake (95%) aims to create herd immunity, protecting vulnerable babies.
- Measles is highly contagious and can be transmitted up to four days before the rash appears.
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Description
This quiz covers the OSPAP programme focused on pediatric medicines, including vaccines and OTC medications. It addresses challenges in treating young patients, common ailments, and licensing issues regarding medication use in children. Gain insights into off-label usage and guidelines for safe medication administration to children.
