Optimizing Outcomes in the Pediatric Patient

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An increasing number of childrenare being diagnosedwith conditions that requirethe use of pharmacologic agents aspart of the treatment plan (Table 1).More than 200 million prescriptionsare written for children and teenagersannually in the United States, andmore than 6 million children have achronic disease whose treatmentrequires the regular use of a prescriptiondrug.¹ Pharmacists are an essentialtool in ensuring that both parentsand the pediatric patients are adequatelycounseled on drug therapy,and they also can provide reinforcementand education with regard to athorough understanding of the specificdisease state.

Patient counseling is of courseimportant for all patient populationsto provide high-quality care, but certaincounseling techniques need to becustomized to meet the needs of specificpopulations, such as the pediatricpatient population. The AmericanAcademy of Pediatrics has definedthe various classes of the pediatricpopulation (Table 2).²

Addressing the Needs of thePediatric Patient

Making clinical assessments andproviding care to the pediatric patientinvolves special considerations. Certainchallenges in drug therapy canexist due to differences in physiologyand pharmacokinetics, lack of clinicaldata, insufficientdrug labeling,and problemsassociatedwith drugdosing and administration.³ Inaddition, studieshave shown that many pediatricpatients and their caregiversare nonadherent withmedications.^1,4For example, it is estimatedthat 75% of asthma patientsand 43% of epilepsy patientstake their medication therapyincorrectly. Some of the most prevalenttypes of medication adherenceissues that occur in the pediatricpatient population include¹:

• Discontinuing medication too soon
• Administering too little or too much medication
• Refusal to take medication due to unpleasant taste

Other barriers that may impede thecorrect use of medication therapymay include frequency of dosing,adverse effects associated with useof medication, lack of parental/caregiversupervision during medicationadministration, lack of clear instructionsregarding medication therapy,and parent or child's lack of understandingthe importance of adheringto the medication regimen.⁴

Tips for Optimizing Therapyin Pediatric Patients

• Address both the parent and thechild, and speak in terms thatmake it easy for the child to comprehendwithout being condescending
• Encourage the child to take anactive role in his or her care planby imparting a "can-do!" attitude
• Ensure that the parent and childunderstand the purpose of themedication
• Address any concerns or apprehensionsthe parent or child mighthave about the drug therapy
• Provide clear and thorough instructionson appropriate dose,administration, and storage conditions
• Describe how to identify potentialadverse drug reactions and whatto do if they should occur
• Explain what to do when a dose ismissed
• Add a flavoring agent or recommendliquid or chewable tabletdosage forms
• Advise parents to check with aphysician or pharmacist prior tousing any other medications toprevent possible drug interactions
• Reinforce the importance of completingthe entire course of therapyeven if the child feels better
• Recommend the use of medicationcompliance devices such aspillboxes or timers
• Encourage the use of calibratedmeasuring devices to ensureaccuracy of dosing

The American Academy of Pediatricshighly recommends the useof calibrated measuring devices forthe administration of liquid medications.³ Parents and patients should becounseled on the appropriate use ofthese devices. Parents should alwaysbe reminded to read all labels andconfirm the strength of all medicationprior to administration because manynonprescription products formulatedfor infants are in the concentratedform. Failure to read labels can resultin serious medication overdosages.Parents also should be reminded tocheck the expiration dates of medicationsprior to administration.

In addition to the many medicationsmanufactured specifically forthe pediatric population, the growingfield of compounding pharmacy canmeet some of the needs of the pediatricpopulation by providing alternativedosage forms when applicable.

Conclusion

Through effective pharmaceuticalcounseling, the pharmacist can optimizetherapy outcomes in the pediatricpatient population. Pharmacistsshould always be prepared to meetthe specific therapeutic needs of thepediatric patient population by makingappropriate clinical assessments. It isimperative that pharmacists beresponsible for thoroughly educatingboth the parent and child about theproper administration of the drug therapy.Patients also should be encouragedto adhere to the instructions providedto them to reduce the incidenceof drug errors. When pediatric patientsand their parents are equipped withthe essential knowledge about thecondition and the drug therapy, theybecome empowered and remaincommitted to being proactive withregard to their health.

Ms. Terrie is a clinical pharmacy writer based in Haymarket,Va.

For a list of references, send a stamped,self-addressed envelope to: ReferencesDepartment, Attn. A. Rybovic, PharmacyTimes, Ascend Media Healthcare, 103College Road East, Princeton, NJ 08540;or send an e-mail request to:arybovic@ascendmedia.com.