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Medicines for Children Paediatric Palliative Care For Home Based Carers Funded by British High Commission, Pretoria Small Grant Scheme Children with HIV Need to prevent infections Need to treat infections Need to manage symptoms May need to manage side effects of drugs

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medicines for children

Medicines for Children

Paediatric Palliative Care

For Home Based Carers

Funded by

British High Commission, Pretoria

Small Grant Scheme

children with hiv
Children with HIV
  • Need to prevent infections
  • Need to treat infections
  • Need to manage symptoms
  • May need to manage side effects of drugs
  • So, they usually need lots of medicines
types of medicines
Types of Medicines

Preventing Infections

  • Bactrim, Vitamins, Immunisations, ARVs

Treatment for infections

  • Antibiotics, Antifungals

Symptom Management

  • Analgesia, Anti-pyretics,

Anti-diarrhoeals, Anti-emetics,

Management of Side Effects

  • Antihistamine, Anti-diarrhoeals,

Anti-emetics

other types of medicine
Other Types of Medicine

Home Remedies

  • ?

Traditional Medicines

  • ?

Herbal Remedies

  • ?

©TALC

medicine chain
Medicine Chain

Prescription

  • Certain medicines can be prescribed by Doctor only
  • Some Professional nurses may prescribe with special training

Dispensing

  • Prescription is prepared by a pharmacist
  • Ensures correct drugs, dosage and timing of doses is in a labelled container for patient

Administering

  • Professional nurses may administer drugs to patient
  • Care givers may only do this under supervision of Professional Nurse
scope of practice
Scope of Practice

Your scope of practice means you will not usually be

administering pharmaceutical medicines, but you have a vital role!

  • Children MUST get the medicines they are prescribed
  • If they don’t they can’t work!

Check the child has access to and is getting the drugs

Assess whether carer knows how to give them correctly

Refer any concerns to the Professional Nurse

Ensure any side effects are reported immediately

Reinforce the importance of completing the course to the carer

Support the carer in giving the medicines

caution
Caution
  • Medicines which are not used correctly can be dangerous
  • The sale, prescription and dispensing of medicines is controlled by law
  • All medicines which are sold to the public must be tested and registered with the Medicines Control Council
medicines control council
Medicines Control Council

Schedule 1 and 2

  • Aspirin, Vitamins, Milk of Magnesia
  • Can be bought at supermarkets and cafes

Schedule 3

  • Can only be bought by an adult from a pharmacy

Schedule 4

  • Can only be obtained on the prescription of a doctor from a pharmacy

Schedule 5,6 and 7

  • Must be prescribed by a doctor, dispensed by a pharmacist and prescription renewed every time

(Department of Health, 1997)

side effects
Side Effects

Be aware of the more common side effects of medicines

You need to be able to:

  • Recognise them if a child experiences them
  • Refer the child for appropriate management
  • Teach the carer about common side effects of the medicines
  • Teach her when to seek advice
  • Ensure the side effects have been managed appropriately
  • Refer again if they have not
expiry date
Expiry Date
  • Medicines are all marked with a date
  • They MUST be used before that time or they may be harmful or of no use

04Jul06

adherence
Adherence

If the medicines are to work, they must be taken

All medicines must be taken in exactly the way they have been

prescribed

This is known as adherence

You have a vital role in assessing:

  • Assessing whether the child is adherent to the medication
  • Identifying any causes of non-adherence
  • Supporting the carer
  • Referring any concerns
causes of non adherence
Causes of Non-adherence

A child is dependent on the carer. If the carer:

  • Does not understand the importance of the medicines
  • Does not know which medicines to give to the child and when
  • Does not know how to give the medicines to the child
  • Is unable to remember to give the medicines
  • Does not believe the child should have them
  • Is unable to collect the medicines
  • Is unable to get the child to take the medicines
  • Thinks the child is better now so stops the medicines

The child may be non-adherent!

5 golden rules
5 Golden Rules
  • The right patient
  • The right medicine
  • The right dose
  • The right route
  • The right time

These apply to everybody but…

They are even more important

when giving medicines to children!

(Department of Health, 1997)

the right patient
The Right Patient

The only person who should receive the medicines

prescribed by the doctor, dispensed by the pharmacist and administered by the professional nurse is

the child whose name is on the bottle/box/bag

the right medicine
The right medicine
  • If the wrong medicine is given to a child, this could also be very

dangerous

  • The wrong medicine may not treat or prevent infection, manage

symptoms or side effects

  • Some medicines should not be given to children
  • The child may be allergic to that drug
the right dose
The Right Dose
  • Children are much smaller than adults
  • Their bodies have different ways of coping with medicines
  • Drug doses are extremely carefully calculated for children so:

Drugs achieve their aim but do not harm the child

  • Doses are calculated by weight (and sometimes height)
  • Children grow quickly so need regular monitoring of weight
the dose
The Dose
  • You MUST give an accurate dose!
  • NEVER guess the amount to give
  • NEVER just pour syrup in to the child’s mouth
  • This could be dangerous for the child:

- He may get too much medicine

- He may get too little medicine

measuring the right dose
Measuring The Right Dose

Different methods may be used to measure accurate doses of syrups or liquids before giving them to the child

  • Droppers
  • Marked Medicine Cap
  • Medicine Cup
  • Syringe
  • Spoon
the right route
The Right Route

Medicines must always be given by the correct route

Medicines may be administered in the following ways:

  • By mouth
  • Under the tongue
  • On the skin
  • In to the eye
  • Into the nose
  • In to the rectum
  • By injection
  • By inhalation
the right route20
The Right Route
  • The route by which drugs are given to children is extremely

important

  • Children do not like medicines
  • May cause trauma and distress to both the child and the carer
  • If the child cannot/will not take the medicines, they cannot work
  • The way medicines are given can have a great impact on a child’s quality of life
medicines by mouth
Medicines By Mouth

Most medicines given to a child

will normally be given by mouth

They come in the form of:

  • Pills and tablets
  • Capsules
  • Suspensions/mixtures
  • Syrup
  • Drops
helping the child take medicine
Helping the Child Take Medicine
  • If the medicines are to work, the child must be able to swallow them
  • A child may have been dispensed medicine that he cannot swallow
  • This causes unnecessary distress for the child and the carer
  • The child will not get the medicines he needs
giving medicines to a child
Giving Medicines to a Child

If the medicines are to work, the child needs you to make regular

assessments

  • Does he like the taste of the medicine?
  • Is he able to swallow the tablets?
  • Can he tolerate the volume of syrup?
giving the medicine
Giving the Medicine
  • Medicine Cups
  • Syringes (1ml, 2.5ml, 5ml, 10ml)
  • Spoon
  • Plastic dropper

©TALC

giving the medicine25
Giving the Medicine

Need to prevent aspiration

  • Hold child in semi-reclining position
  • Place medicine in spoon, plastic cup, plastic dropper, plastic syringe (without needle!)
  • Place medicine along side of infant’s tongue
  • Administer slowly
  • Wait for child to swallow
handy hints
Handy Hints!

Some medicines are only available as tablets or

capsules

Handy Hints for Children!

  • Crush tablet if possible/allowed
  • Mix with jam, porridge
  • Divide tablet if scored
  • Empty capsule and sprinkle contents on jam

(only allowed for some drugs!)

handy hints27
Handy Hints!
  • Talking with the Child
  • Taking Medicines Together
  • Sticker Charts
  • Play Therapy
nasogastric administration
Nasogastric Administration
  • Oral medications may be given via NG tube
  • Removes distress of giving medicines
  • Does not disturb the child
  • Medicines in liquid form or safe to crush only
  • Risk of clogging the tube
  • Always flush tube with clean water
rectal administration
Rectal Administration
  • Useful for children unable to take anything by mouth
  • Sedatives, analgesia, anti-pyretic, anti-emetics, anti-convulsants
  • Often absorbed more quickly and quicker response
  • Faeces may delay absorption
  • Unsuitable for child with diarrhoea
eyes ears nose
Eyes, Ears & Nose
  • Not usually painful but drugs can cause unpleasant sensation
  • Usually distressing for a child
  • Difficult for carer to gain child’s cooperation
  • Infant and young child need to immobilise head
  • Older child needs explanation and direction
the right time
The Right Time

Medicines must be given at the right time or they will not be effective

Medicines may be ordered

  • 4 hourly (06h00, 10h00, 14h00, 18h00, 22h00)
  • 6 hourly (06h00, 12h00, 18h00, 24h00)
  • Daily (in the morning, after breakfast)
  • Every evening (at bed time)
  • Three times a day (usually after meals)
  • Twice a day (after breakfast and supper)

Medicines must never be given more often than prescribed as this

could be dangerous for the child

the right time32
The Right Time

Note!

  • Some drugs must be taken on an empty stomach or with food
  • These instructions MUST be adhered to
  • Otherwise the drugs will not work or may be harmful to the child
  • The importance of this must be explained to the carer
  • This can cause difficulties for carers when children want to eat / do not want to eat
summary
Summary

Working within your scope of practice, you are not usually involved in administering of medicine

But

You have a vital role in ensuring the children are receiving their medicine, safely and accurately and that any problems are referred