Although pediatricians usually take great care in accurately calculating medication for their patients, the important processes of measuring and administering the dose are often overlooked. Many of the problems encountered in the administration of tablets and capsules to small children have been overcome by the production of medications in liquid form. However, the advantage gained in the administration of liquid products is often lost because of the inaccuracy of the devices used to measure and administer them.
Liquid doses may be inaccurate for several reasons. The measuring devices commonly used today include household spoons, cups, and specific devices provided by pharmaceutical manufacturers to be used with their products. Teaspoons are particularly poor measuring and administering devices. The measured capacity of the teaspoon has been shown to be within the range of 2.5 to 7.8 ml.1,2 In addition, teaspoons are a poor delivery device because they tip easily. Furthermore, the same spoon, when used by different persons, may deliver from 3 to 7 ml.3 Such variations may be related to factors such as pouring the liquids from different-sized bottles, the color of the liquids, and the adequacy of available light. Perhaps the most important factor in measurement is related to the care practiced by the person doing the measuring.
Although the American Pharmaceutical Association (in 1902) and the American Medical Association (in 1903) defined the "standard teaspoonful" as 5 ml, this recommendation has not been universally adopted.4 The practice of some pharmaceutical manufacturers of establishing doses in 4-ml and other fractions of a "teaspoon" tends to confuse the prescribing physician when it comes to instructing patients.
The testillg of drugs for use ill cilildren is difficult to accomplish, and it is even difficult to write about. Anything that smacks of "experimentation" on a child or even the use of a placebo given to a sick child is an emotionally charged subject. To carry out procedures that cannot be considered as essential to therapy, especially when they are painful or tiresome, seems abhorrent.
However, it is recognized that the effects of many drugs on children may vary considerably from the effects on adults even when careful calculation is made to arrive at a dosage proportional to the body weight or estimated body surface area. Pharmacologically, children cannot be regarded as little adults. Intensified, or toxic effects of drugs administered to children, especially infants, may reflect immaturity in enzymatic mechanisms for drug metabolism, as well as other detoxification and excretory functions.
In view of these circumstances, there is need for special caution in prescribing medication in the treatment of childhood disorders, particularly when the medication is used for an extended period of time or when a newly marketed drug is employed. Even greater caution is needed with the use of a new drug under investigation, in advance of approval for marketing. Known serious adverse effects of drugs in children include the effects of sex hormones on growth, steroids on genital development, and antibiotics on tooth enamel.
According to the regulations of the Food and Drug Administration, a drug which has not been subjected to investigation in children may not be labeled for use in pediatric therapy.
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