Pediatrics Presentation PDF

Pediatrics E L L I E TA B A R , P H A R M D FEB 11,2025 PHAR 840/ IPC I M M U N O LO G I C CO NDI TI ON S AN D SPE CIA L P O P U L AT I O N S  Learn pediatric medication complexities Understand differences in pediatric drug absorption...

Pediatrics E L L I E TA B A R , P H A R M D FEB 11,2025 PHAR 840/ IPC I M M U N O LO G I C CO NDI TI ON S AN D SPE CIA L P O P U L AT I O N S  Learn pediatric medication complexities Understand differences in pediatric drug absorption Follow pediatric dosing guidelines Objectives Calculate common pediatric doses Choose the right treatment for common pediatric conditions  Premature Neonate: Born < 37 weeks Neonate: First 28 days of life Infant: 1–12 months old Toddler: 1–2 years old Age Classification Preschooler: 3–4 years old School-age: 5–12 years old Adolescent: 13–18 years old  Pediatric Growth & Development Growth Velocity Change in weight or height over time Multiple points compared over time (more than one measurement) Measured at each “well-child” care appointment using standardized growth charts https://www.cdc.gov/growthcharts/index.htm Weight Term neonates commonly lose up to 10% of body weight during the first few days of life Should regain birth weight by 10–14 days of age Infants should gain approximately 20–30 grams per day in the first three months Infants should double birth weight by 4 months Infants should triple birth weight by 1 year  Pediatric Nutrition Proper Nutrition is Necessary for Optimal Growth During the first 6 months, exclusive breastfeeding is recommended. From 6 to 23 months, continue breastfeeding alongside the introduction of complementary foods. Complementary Feeding Initiate at 6 months of age. Ensure the diet is diverse, including: Animal-source foods (meat, fish, poultry, dairy) Fruits and vegetables Legumes and nuts  Vitamin Supplementation Vitamin D Recommendation: All infants, including those who are exclusively breastfed, should receive a daily supplement of 400 IU (10 mcg) of vitamin D, starting within the first few days after birth. Duration: Continue supplementation until the infant consumes at least 1 liter (approximately 34 ounces) of vitamin D-fortified formula or milk daily. Iron Breastfed Infants: Starting at 4 months of age, exclusively breastfed infants should receive an iron supplement of 1 mg/kg per day until iron-rich complementary foods are introduced. Formula-Fed Infants: Typically do not require additional iron supplementation, as formula is iron-fortified. Vitamin B12 At-Risk Populations: Infants and children on strict vegan diets are at risk for vitamin B12 deficiency. Supplementation should be considered, with dosages determined in consultation with a pediatrician. Pediatric Pharmacokinetics Absorption: Slower oral, avoid IM, increased topical absorption Distribution: Higher water %, lower protein binding, lower fat Metabolism: Neonates = slow, children = fast Elimination: Slower kidney function → Adjust dosing Final Tip: Always adjust drug dosing based on age & organ function! Obesity & Pharmacokinetics BMI Classification Overweight: 85th–94th percentile Obese: ≥95th percentile Pharmacokinetics in Obese Children Dosing Considerations Absorption: No major effect Use IBW for hydrophilic drugs (e.g., aminoglycosides, Distribution: vancomycin) Hydrophilic drugs: ↓ Vd → Use IBW, Use IBW for benzodiazepines / opioids Lipophilic drugs: ↑ Vd → May require adjustments (varies by drug)->TBW Use TBW for lipophilic drugs that distribute into fat Metabolism: Liver enzyme activity may increase → Some drugs (e.g., some anesthetics) metabolized faster Consider Adjusted Body Weight (ABW) for certain Elimination: Renal clearance may be increased → Adjust dosing for renally excreted drugs cases Do not exceed adult doses Pediatric Dosing Guidelines Essential Considerations: Always calculate each dose individually Use reliable dosing handbooks Key Points to Remember: Dosing units vary: Can be reported as mg/kg/dose or mg/kg/day (divided doses) Always use kg for weight-based dosing -Convert: Weight (lb) ÷ 2.2 = Weight (kg) Dosing Adjustments: Select the correct indication – Doses vary based on disease severity Choose the appropriate age group: Neonatal vs. Pediatric vs. Adolescent dosing Safety Warning: Always verify calculations and avoid exceeding maximum doses DOSING By Weight (mg/kg) Used for most drugs By BSA (Body Surface Area) Formula: √[(Height (cm) × Weight (kg)] / 3600] Used for chemotherapy and some other medications Round Dose (Up to 10%) Adjust to the appropriate tablet size Ensure a safely measurable volume dose Important Note: Do not exceed adult doses!  COMMON CALCULATION Mg/kg Dosing Patient’s weight (kg) × dose (mg/kg) = dose (mg) Example: Acetaminophen 10 mg/kg/dose × 8 kg = 80 mg/dose BSA Dosing Patient’s BSA (m²) × dose (mg/m²) = dose (mg) Example: Acyclovir IV 1500 mg/m²/day × 0.79 m² = 1185 mg/day Divided into three doses → ~395 mg per dose Rounded to 400 mg IV Q8H Volume Calculation Dose (mg) ÷ concentration (mg/mL) = volume (mL) Volume Calculation Patient needs 250 mg of Medication X Medication X concentration: 400 mg/5 mL What volume should the parent administer? A. 0.63 mL B. 3.125 mL C. 3 mL D. 5 mL Dose Check Calculation Step 1: Divide the mg dosage by the patient’s weight (kg) to get mg/kg Step 2: Check if the mg/kg dose is within the dosing range for the drug Step 3: If yes, proceed to verify/fill the order If no, call the prescriber to discuss the dose 2/9/2 02 5 13 Case: Noah (5 kg) A 2-month-old 5 kg infant, Noah, presents to the ED with: Fever Decreased PO intake Bulging fontanelle One episode of seizure The team suspects meningitis and wants to start IV antibiotics. They ask for advice on dosing for the following medications: Ceftazidime Vancomycin Acyclovir (for HSV meningitis) Pointers for Dosing: Since the patient is >1 month old, use infant dosing, not neonatal dosing. Since this is meningitis, use the higher end of the dosing range for better penetration into the CNS.  Fluid Maintenance Rate: Since Noah is critically ill, the team wants to admit him and start IV fluids. What maintenance rate would you recommend? Pediatric Conditions: Diagnosis & Treatment  Acute Constipation in Children Common Occurrences of Acute Constipation Dietary Changes (e.g., switching from breast milk/formula to solid foods) Toilet Training Periods School Entry (change in routine, less water intake) Prevention Strategies 1.Dietary Recommendations High-fiber foods (recommended intake: age + 5g/day) Adequate hydration (water + age-appropriate fluids) 2.Toilet Habits Encourage regular toilet sitting (5–10 minutes, 2–3 times daily, preferably after meals) Use a footstool to support proper posture Fiber Supplements for Constipation Helps absorb water in stool, increasing bulk and movement Available as powders & gummies Best for mild constipation & long-term gut health Ensure proper hydration for effectiveness Gummies look like candy—risk of overuse! 2/9/2 02 5 18 Docusate (Colace) - Stool Softener Reduces surface tension of stool, allowing more water incorporation Best for children with hard, dry stools Comes in multiple products/concentrations—double-check dosing Avoid with mineral oil (reduces absorption of fat-soluble vitamins) Common side effect: Throat irritation (take with water) Osmotic Laxatives for Constipation MOA: Osmotic laxatives work by drawing water into the intestines, softening stool, and making bowel movements easier. They are commonly used for both acute and chronic constipation. Polyethylene Glycol 3350 (Miralax) - Most common Best for chronic constipation & first-line treatment in pediatrics Magnesium Hydroxide (Milk of Magnesia) - Avoid in kidney disease Lactulose & Sorbitol - Alternative options, may cause bloating Monitor electrolytes, especially with prolonged use 2/9/2 02 5 20  Lubricant Laxatives (Mineral Oil) MOA: Lubricates stool, decreasing water absorption from intestines Forms: Oral or enema Oral Onset: 6-8 hours Rectal Onset: 2-15 minutes Avoid in: Young children (aspiration risk) Reduces absorption of: Fat-soluble vitamins (A, D, E, K) Messy option! Avoid homemade enemas (soap suds, herbal) Use **normal saline enemas** in healthcare settings if needed Stimulant Laxatives: Bisacodyl & Senna MOA: Directly stimulate bowel contractions for fast relief Used for **occasional constipation**, not first-line for chronic use Use sparingly to **prevent dependency** Bisacodyl (Dulcolax): Tablet, suppository, enema Onset: Oral (6-12 hrs), Suppository (15-60 min), Enema (5-20 min) Do not crush/chew tablets, avoid with antacids/dairy Senna (Senokot): Derived from natural plant sources. 6-24 hours 2/9/2 02 5 22 Case: Noah You receive a question from the parent of Noah, a 3-year-old toddler. The parent is concerned because Noah has not had a bowel movement in 4 days and seems to be straining when trying to go. Upon further questioning, the parent tells you that Noah has recently been potty training and often refuses to sit on the toilet. They also mention that Noah’s diet consists mostly of chicken nuggets, white bread, and milk, with very few fruits or vegetables. What recommendations can we make for Noah and his family? 2/9/2 02 5 23 Constipation in Infants Dietary Modifications: - Prune juice, baby food , Fiber-rich vegetable purees, High-fiber cereal Glycerin Suppositories (Safe to use ): -MOA: Local osmotic agent - Onset: 15-60 minutes - Dose: 1 suppository PR QD or BID PRN Avoid: - Mineral oil (Aspiration risk ) - Saline agents in children