For Quality, Essential, Generic Medicines
Chapter 1: About Drugs in General    

Infants and Children

Infants and children have frequent but not usually serious illnesses. A child's frequent illnesses in the early years are part of a natural process which develops his or her immature immune system. These generally mild infections help to build immunity against common diseases. Nutritious food, cleanliness and vaccinations are three important bodyguards that protect children against many diseases.

An important question which arises is that should children be given so many drugs for their illness? The answer is 'No'. However, the fact remains that too many drugs are being given to infants and children although most of them have very little or no value. Besides, subjecting children to lot of drugs means subjecting them to lot of adverse effects.

The main reason for children being more prone to adverse side effects of drugs is that children are not just small adults. The way a child's body deals with drugs in completely different from that of an adult body. The organs responsible for the breakdown and elimination of drugs, that is, the liver and the kidney respectively, are less efficient in a child's body than in a adult body. Hence if adult doses of a drug are given to children, drugs get accumulated in their body and produce harmful effects. This is why it is important that accurate doses be calculated for children taking into consideration both their age and weight.

Certain drugs are harmful to children even in therapeutic doses and should be completely avoided, for example, loperamide, tetracycline. Parents should always determine if a drug is really necessary for their child's condition and check if there is any non-drug alternative. They should avoid giving unnecessary drugs to their children who may grow up believing that medicines are solutions to many of life's health problems.

There are many drugs which are commonly misused in children. Some examples are:

* Antibacterials for viral upper respiratory infections.

    * Decongestants for colds, resulting in unacceptable adverse effects.  
    * Drugs to treat diarrhoea.  
    * Oral anti-emetics for vomiting.  
    * Antipyretic agents for fever.  
    * Tricyclic antidepressants for bed wetting.  

* Sedatives for sleepless children or those labelled hyperactive.


* Spasmolytics for abdominal pain.

    * Appetite stimulants, vitamins and tonics.  

Advice on use of individual drugs in children is given in this column wherever necessary.
Guidelines on the Use of Drugs in Children

While administering drugs to children, particularly neonates (first 30 days of life), special care is always needed because they differ from adults in their response to drugs. Doses should invariably be calculated on the basis of weight till 50 kg or puberty is reached. In the neonatal period, the risk of toxicity is higher due to inefficient renal clearance, relative deficiencies of various enzymes, heightened sensitivity and inadequate detoxifying mechanism.

If possible, painful intramuscular injections should be avoided. It is always a good practice to state the age of child patient while writing prescriptions. Even though liquid preparations are more easily accepted by children, many contain sucrose which can lead to dental decay.

Dosage: Children's doses are usually stated in the following age ranges: Neonate (first month), infant (upto 1 year), 1-5 years and 6-12 years. Where a single dose is given, it applies to the middle of the age range. Hence adjustment would need to be made for lower and upper limits of the stated range.

Dose Calculation: The dosage for children can be calculated from adult doses by using either age, or body-weight or body surface area or by a combination of these factors. Even though body-surface area provides the most reliable method of determining dosage, in practice it is exceedingly difficult.