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Not just small adults…

Paediatrics is a unique and fulfilling area of pharmacy practice but challenges in overcoming the gaps in pharmaceutical care for these patients remain

A well-worn adage used in paediatrics is: “children are not just small adults”. Having paediatric-specific diseases (for example, neuroblastoma, congenital heart diseases and juvenile onset diabetes) and often requiring specific testing and special techniques or individualised frameworks for many procedures, we cannot deny that children are a very specific category of patients. 

From a pharmacological point of view, paediatrics embraces a heterogenous group of patients under the age of 18 years. Monitoring and adjustment of therapy requires a detailed knowledge of variations in pharmacokinetics (PK) and pharmacodynamics (PD) as well as other factors that influence efficacy, such as absorption, formulation and administration.

It is well known that PK processes, metabolism and excretion undergo changes during growth and development, while PD vary substantially within different age groups and disease states. Apart from being a heterogenous population, paediatrics embraces a constellation of different medical disciplines, many in constant evolution in terms of drug development and drug research (such as in paediatric oncology, where numerous clinical trials with new drugs and cellular therapies are ongoing). 

Paediatric pharmacy is different, not only in terms of PK, PD and drug development, but also in other domains. Our colleagues involved in medical materials and devices know that even the size of the surgical equipment for children highlights the fact that they are a special group of patients.

Children are particularly at high-risk for medication errors and drug-related problems. Hospital pharmacists must be trained to ensure safe, effective and rational drug use to optimise treatment in different age groups. These factors add to the challenge of becoming a specialist in paediatric pharmacy. Apart from training, it is important for to stay up to date with current literature and participate in ongoing education, to develop a thorough knowledge of important developments in the field of paediatric pharmacology and pharmaceutical care. 

As part of the multidisciplinary team, the benefit of having one or more pharmacists on the paediatric ward and (especially) in the compounding units of the hospital pharmacy is invaluable. By providing age-appropriate formulations (to overcome any hesitancy and reluctance children might have to take their medications), they play a pivotal role in the safe and optimal use of drugs and improve quality and pharmacotherapeutic outcomes in paediatric units. 

In recent years, there has been a growing interest in understanding patients’ pharmacogenomic information. Genotype-based dosing recommendations are being developed and updated, so the need for paediatric pharmacists trained in this discipline has become essential.

From a hospital’s perspective, paediatric clinical pharmacists often serve on P&T committees working closely with other healthcare professionals. In this capacity, they are well positioned to develop and implement clinical decision support tools, guidelines and recommendations within the institution and tailor-made for specific paediatric disciplines. They boost collaboration by assisting prescribers, physician assistants (especially in university centres), and nurses as well as other members of the multidisciplinary team. 

Finally, when looking at the number of ongoing clinical trials in paediatrics, the role of clinical pharmacists has certainly been well established, but there are still great opportunities for pharmacists specialising in this patient population. 

So please don’t forget about the children! Paediatrics is a unique and fulfilling area of pharmacy practice but challenges in overcoming the gaps in pharmaceutical care  for these patients remain. To overcome these, let’s ensure that the required knowledge, skills and support is available to all pharmacists to allow them to develop innovative solutions and to reap the professional rewards of a gratifying career in improving pharmaceutical care for a special patient group.

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