Medication Administration and Pharmacological Management
Core concepts
Pediatric dosing is weight-based (mg/kg), sometimes body surface area for chemotherapy; always verify the safe dose range and maximum. Use the "rights" of medication administration and double-check high-alert drugs (insulin, opioids, heparin, chemotherapy). Calculate carefully and round per policy, not convenience.
Administration techniques: oral syringes for infants (never household spoons), avoid aspiration by positioning, and use distraction. For ear drops in children under 3, pull the pinna down and back; over 3, up and back. IM sites: vastus lateralis in infants, ventrogluteal in older children. IV therapy requires a pump and volume control to prevent fluid overload.
Understand pharmacokinetics: immature hepatic and renal function in neonates prolongs drug half-life; gastric pH and emptying differ. Know common pediatric drug classes, adverse effects, and monitoring (e.g., therapeutic drug levels, renal function).
Traps
- Using adult fixed doses rather than weight-based calculations.
- Failing to check the maximum dose-overdose risk in larger children.
- Using household spoons or mixing medication into a full bottle of formula.
- Wrong ear-drop direction technique by age.
- Missing the need for a pump/volume-control device in small children.
Rule of thumb
Always calculate the safe dose range before giving. If the ordered dose falls outside the range, hold and clarify-never "give what's ordered" without verification.
Worked example
Order: acetaminophen 15 mg/kg/dose for a 12 kg child = 180 mg. If the available suspension is 160 mg/5 mL, give 5.6 mL (rounded per policy). Verify 180 mg is within the safe range (10–15 mg/kg) and below the maximum single dose.