The pediatric patient

Abstract

The administration of drugs to the pediatric population should be safe and effective with minimum adverse events. Clinicians who are involved in their management should have bench knowledge of the pharmacokinetics and pharmacodynamics of drugs before application at the bedside. Unfortunately, the availability of evidence-based pharmaco-therapeutics in children lags behind the vast volume of clinical information that is published for drugs administered to adults. This lack of scientific basis for many drugs is particularly noted in the young infants, neonates and critically ill children. Doses for administration are derived from weight-based calculations from studies carried out in adults. This may not be suitable for all children as they belong to a heterogeneous group. The changes in the newborn as they grow into adults are seen as a dynamic spectrum in psychological, physiological and anatomical maturation. Understanding the physiological aspect in every child is especially important due to age-related differences in body components. This natural process of growth and development underlies the challenges in clinical pharmacology in children, requiring consideration of dose adjustment when drugs are given. Assessment of the child who is acutely ill will lead to diagnosis and decision-making for drug selection to manage pathophysiological states such as shock, hypoxia and poor perfusion. The further evaluation of the level of body organ function will guide clinicians to modify doses or choice of drugs. In acute care, many drugs may be given simultaneously and it is evident that interactions and toxicities may arise through inappropriate drug regimens. Therapeutic drug monitoring may be particularly useful in providing additional information for drugs with a low therapeutic index.