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Chapter 3: Pediatrics

Hanna Phan; Vinita B. Pai; Milap C. Nahata

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LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Define different age groups within the pediatric population.

  2. Identify factors that affect selection of safe and effective drug therapy in pediatric patients.

  3. Explain general pharmacokinetic and pharmacodynamic differences in pediatric versus adult patients.

  4. Develop strategies for appropriate and effective medication administration to infants and young children.

  5. Determine approaches to effectively communicate with patients and caregivers about appropriate medication use including expected outcomes, possible adverse effects, and appropriate administration.

INTRODUCTION

Pediatric clinical practice involves care of infants, children, and adolescents with the goal of optimizing health, growth, and development toward adulthood. Clinicians serve as advocates for this unique and vulnerable patient population to optimize their well-being. Care for pediatric patients is relevant in both inpatient and outpatient settings and requires additional considerations with regard to selection and monitoring of drug therapy.

image Despite the common misconception of pediatric patients as “smaller adults” where doses are scaled only for their smaller size, there are multiple factors to consider when selecting and providing drug therapy for patients in this specific population. Pediatric patients significantly differ within their age groups and from adults regarding drug administration, psychosocial development, and organ function development, which affect the efficacy and safety of pharmacotherapy.

FUNDAMENTALS OF PEDIATRIC PATIENTS

Classification of Pediatric Patients

Pediatric patients are those younger than 18 years, although some pediatric clinicians may care for patients up to age 21. Unlike an adult patient, whose age is commonly measured in years, a pediatric patient’s age can be expressed in days, weeks, months, and years. Patients are classified based on age and may be further described based on other factors, including birth weight and prematurity status (Table 3–1).1-3

Table 3–1Pediatric Age Groups, Age Terminology, and Weight Classification1–3
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Table 3–1 Pediatric Age Groups, Age Terminology, and Weight Classification1–3
Age Group Age
Neonate ≤ 28 days (4 weeks) of life
Infant 29 days to < 12 months
Child 1–12 years
Adolescent 13–17 years (most common definition)
Age Terminology Definition
Gestational age (GA) Age from date of mother’s first day of last menstrual period to date of birth
Full term Describes infants born at 37-weeks gestation or greater
Premature Describes infants born before 37-weeks gestation
Small for GA Neonates with birth weight below the 10th percentile among neonates of the same GA
Large for GA Neonates with birth weight above the 90th percentile among neonates of the same GA
Chronological or postnatal age Age from birth to present, measured in days, weeks, months, or years
Corrected or adjusted age May be used to describe the age of a ...

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