Children’s medicines: resources to support clinical decisions

SPS resources

SPS has a variety of resources on paediatrics which we recommend you check first.

Using solid oral dosage form antibiotics in children (SPS page) provides advice on administration of antibiotic capsules and tablets for children, including ‘off-label’ crushing tablets and opening capsules.

For information on vaccines in children, see Vaccines and immunisation: useful resources to support answering questions (SPS page).

For information on excipients and children, see the paediatrics section of Understanding excipients in medicines (SPS page).

Other useful SPS resources include:

• Assessing suitability of medicines in a ketogenic diet
• Managing the risks of using effervescent tablets in children
• Using Standardised Strengths of Unlicensed Liquid Medicines in Children

Other resources

In addition to our own resources, we recommend the following. They are free to access unless otherwise indicated.

Local formulary or guidelines

Your local Area Prescribing Committee, Medicines Management Group or similar body may have relevant guidelines or documents on their website. For example, prescribing guidelines and shared care protocols.

In secondary care, consult Trust policies and guidance.

Local children’s health services

If your question relates to the care of a specific patient, under the care of a specialist children’s hospital, it can be helpful to contact them directly.

For issues relating to mental health, your local Children and Young People’s Mental Health Service (CYPMHS) or Children and Adolescent Mental Health Service (CAMHS) may be able to help. Contact details should be available on your local Mental Health Trust website.

BNF for Children

The BNF for Children (BNFC) is the standard UK resource for information on the use of medicines in children.

Guidance on prescribing provides useful information including definitions of preterm neonate, neonate, infant, child and adolescent. There is also advice on managing medicines in schools and advice on excipients.

Drug monographs include licensed and unlicensed doses of medicines. Look for a section called ‘unlicensed use’ in the monograph for details. A table showing mean weight and height for children by age and sex can be helpful when checking or calculating doses.

Clinical Knowledge Summaries

Clinical Knowledge Summaries (CKS) provide advice on child health for primary care practitioners. There are many guidelines relating to child health, including croup, constipation, fever and common childhood infections.

Many other guidelines are also applicable to children, such as asthma and epilepsy.

When using a CKS guideline, click on ‘Have I got the right topic?’ to check what ages the guideline applies to. Some guidelines cover people of all ages from birth to elderly, others cover narrower age ranges.

Summaries of Product Characteristics

Product information is available via electronic Medicines Compendium and MHRA. Useful SmPC sections include:

• 4.1 and 4.2 for licensed doses and age ranges
• 2 and 6.1 for information on excipients in liquid formulations

Prescribers need to know the licensed status of medicines they prescribe; using medicines outside of their licensed age ranges is considered ‘off-label’.

Medicines for Children

Medicines for Children provides useful leaflets for patients and carers.

Medicines information section provides an A-Z list of medicine leaflets. Leaflets include information on side effects and advice on what to do if the child vomits or a dose is missed.

Advice and guides section includes

• How to give different types of medicines – practical tips for different dosage forms
• General information about medicines – such as travelling with medicines and information about unlicensed medicines and off-label use

The website is maintained by the Royal College of Paediatric and Child Health (RCPCH), the Neonatal and Paediatric Pharmacists Group (NPPG) and the national children’s charity ‘WellChild’.

NPPG

The Neonatal and Paediatric Pharmacy Group (NPPG) website provides information for pharmacists and pharmacy technicians. The ‘Resources’ section of the site contains freely accessible position statements, including:

• Choosing an oral liquid medicine for children – includes information on excipients
• Calcium, phosphate, potassium and zinc supplementation in neonates and children – provides practical advice on the off-label use of effervescent tablets to provide appropriate doses
• Liquid vitamin and iron supplements in neonates and children – links to a spreadsheet of multivitamin preparations with information on licensed age ranges and excipients
• Using standardised strengths of unlicensed liquid medicines in children – lists the recommended concentration for some liquid medicines

Paediatric Formulary

The Paediatric Formulary (previously the Guy’s Children’s Formulary book) is produced by four London hospitals. Healthcare professionals can access it on computers or mobile devices via the Clinibee app which they must install first (free registration required).

Clinical Drug Monographs are listed in alphabetical order and note the date they were updated. ‘Traffic light’ recommendations refer to the South East London Joint Formulary and may not reflect formularies elsewhere.

APPM formulary (palliative care)

The Association for Paediatric Palliative Medicine (APPM) formulary provides guidance on medicines use in paediatric palliative care. The formulary is a 276-page pdf document that can be downloaded or viewed online.

Information is presented as:

• drug monographs, which include dosage information and key practice points
• appendices, such as morphine equivalent doses, subcutaneous infusion drug compatibility and switching from gabapentin to pregabalin in children with neuropathic pain

Further advice

If the information is not available from the resources listed, or if your case is complex, our Medicines Advice service (SPS page) may be able to help. This service is available for healthcare professionals working in NHS primary care (including community pharmacy) in England. 

In secondary care, you may be able to seek advice from your hospital Medicines Information service or a directorate pharmacist. 

Training resources

If you would like more information on how to approach answering questions on medicines in children, we recommend: 

Medicines Learning Portal

The Medicines Learning Portal is aimed at trainee hospital pharmacists but the content is also relevant to clinical primary care healthcare professionals. The portal includes a tutorial on children which provides advice on:

• questions to ask when considering questions relating to children
• calculating doses
• reducing risk of medication errors in children

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