Education

Patient Education - Children

Pediatrics

Children pose many challenges when it comes to medication: they may resist having to take a medication, dislike the taste or texture, have difficulty swallowing solid dosage forms, and are fearful of injections.

The limited pediatric market for most drugs may be the leading reason for the lack of investment in drug development for this population by the pharmaceutical industry. Most medications are not labeled for pediatric populations, and when a medication is not approved for use in infants and children, it usually is not available in a suitable pediatric dosage form. Fortunately, our compounding pharmacy is able to help. We can compound oral medications into pleasantly flavored suspensions, solutions, concentrates, freezerpops, "gummy bears" or lozenges, in colors that entice the child to take the medication. A palatable formulation is more likely to improve compliance and minimize spillage or waste during administration. Lollipops are an ideal alternative to "swish and swallow" medications that need to be retained in the mouth for a prolonged period of time. Most drugs can be compounded into transdermal gels that can easily be applied to an appropriate site, such as the child's wrist, for absorption through the skin.

Professional compounding is not just diluting existing medications, or mixing powders with bases. We must consider physical and chemical properties of each active and inactive ingredient in order to prepare an effective and safe customized medication with the desired taste, color, fragrance, viscosity, uniformity, texture, and stability. The efficacy of any compounded medication is influenced by the technique and equipment used in preparing the formulation, the purity and quality of the ingredients, choice of vehicle (base), and proper use of additives such as penetration enhancers.

How To Guides and Tips

How to Give Ear Drops
How to Give Eye Drops
How to Apply Eye Ointment
How to Give Insulin to a Child
Tips for Giving Oral Liquid Medications to an Infant
How to Use an Oral Inhaler, Nebulizer or Spacer
How to Use a Nasal Inhaler
How to Use a Nasal Spray
How to Give Nose Drops to Children
How to Use Nose Drops in Infants
How to Apply a Rectal Ointment
How to Apply Topical Medications
How to Give a Rectal Suppository
Safety & Storage of Medications
How to Give Tablets to a Child

How to Give Ear Drops

The following list of instructions will help you to properly administer ear drops to your child:

Always wash your hands before giving medication.
Warm the medicine to body temperature by holding the bottle between your hands for several minutes. A medicine that is cold and placed in the ear could cause dizziness or nausea.
Place child on his side so the affected ear is on top.
Straighten the ear canal by: Child younger than 3 years old: Hold ear lobe and pull down and back. Child 3 years and older: Hold upper part of ear and pull up and back.
Drop the correct number of drops into the ear. Do not touch the dropper to the ear. Try to place the drops onto the side of the ear canal and not dropped directly down the ear canal.
Keep child on his side for 5 minutes. Repeat steps 3 to 6 on other ear if necessary.

How to Give Eye Drops

The following list of instructions will help you properly administer eye drops to your child:

Always wash your hands before giving medication.
Be sure the eye drops are at room temperature before using.
Clean your child's eye of all secretions and/or old medication. This can be done by gently wiping the eye with a damp gauze or cotton pad.
Have your child stand or sit with his head tilted back.
Do not touch the dropper bottle to the eye
Have the child look upward toward the ceiling. Use your index finger and thumb to gently pinch and pull down the lower lid to create a pouch. Drop the prescribed number of drops into the pouch and not directly in the eye.
Have child close eyes for 1-2 minutes.
If a second type of eye drop is also prescribed, wait at least 5 minutes before giving second drops.

How to Apply Eye Ointment

The following list of instructions will help you properly administer eye ointment to your child:

Always wash your hands before giving the medicine to your child.
Be sure the ointment is at room temperature before using.
Clean your child's eye of all secretions and/or old medication. This can be done by gently wiping the eye with a damp gauze or cotton pad.
Tell the child that the ointment may cause blurred vision. This is normal and will go away rather quickly.
Have child lie on his back or sit with his head tilted back.
Do not touch the tip of the tube to the eye, eyelashes or eyelids
Pull lower lid down while your child looks up. Squeeze out a line of ointment along the lower lid from inner to outer eye. By rotating the tube when you reach the outer eye, you will help detach the ointment from the tube.
Keep eyes closed for 1-2 minutes.
Gently wipe any excess ointment from the eye while it is closed.

How to Give Insulin to a Child

The following list of instructions will help you to properly administor insulin to your child

Be sure you have the correct type of insulin before beginning. Giving the wrong type of insulin could result in blood sugar levels that are too high or too low.
Roll the insulin vial between your hands to mix. Do not shake the vial.
Clean the top of the vial with an alcohol wipe.
Clean the skin at the site where the injection is to be given with another alcohol wipe.
Remove the protective cap from the insulin syringe. Pull back on the plunger until the black rubber stopper is at the same number as the dose (number of units) that is to be given. This is done so that the same amount of air is put into the vial as volume of insulin that will be taken out.
Insert the needle through the rubber stopper on top of the vial and turn the vial upside down.
Push on the plunger until all the air is out, and pull it back to the prescribed dose of insulin to be injected.
Turn vial over and pull needle out of the vial.
Examine the insulin in the syringe. If there are anyair bubbles, gently tap on the syringe with your finger to move the bubbles up to the needle.
Once all the air bubbles are in the needle, carefully push up the plunger until the liquid just starts to come out of the top of the needle. This removes all air bubbles from the syringe and needle.
Pinch the skin at the injection site and hold it. Quickly insert the needle into the skin at a 90 degree angle.
Push down on the plunger to inject the insulin. Withdraw the syringe and dispose of it properly.

Tips for Giving Oral Liquid Medications to an Infant

Chill the medication if this won't affect its potency (ask the pharmacist). The taste may be less pronounced when it's cold.
Use a dropper or oral syringe to squirt the medication between the molars or the rear gum and the cheek. Do this slowly, do not squirt more than a baby can swallow at one time. Never aim directly down the baby's throat as this can cause the baby to aspirate (inhale) the medication.
Unless instructed to give the medication with or after meals, plan on giving it just before feeding. First because the baby is more likely to accept it when hungry, and second because if baby does vomit it right back up, less food will be lost.
Enlist help when you can. Holding a wriggling, uncooperative baby and giving medicine can be next to impossible. Ask your physician, a nurse or a pharmacist about techniques to use to get the baby to cooperate.
As a last resort, mix the medication with a small amount of strained fruit or fruit juice (check with your pharmacist to make sure that the medication won't react with the food or juice).
Be confident! If your baby knows that you are anticipating a battle, you're sure to get one.

How to Use an Oral Inhaler, Nebulizer or Spacer

The following list of instructions will help you properly administer a medication with an oral inhaler:

Shake the inhaler well before use.
Remove the cap from the inhaler.
Ask your child to exhale completely (blow all the air from lungs).
Position inhaler about an inch away from the mouth.
While child breathes in, press on the top of the inhaler to release a puff of medicine.
After child has inhaled completely, have the child hold his breath for 10 seconds or as long as he can hold it.
Have the child breathe out slowly.
If more than one puff is to be given: wait at least one minute after first puff to give second puff
If several different medicines from different inhalers are to be given: It is best to give the bronchodilator before any other. Examples of bronchodilators include albuterol or metoproterenol.

To check if your child is taking a bronchodilator ask your pharmacist or physician or contact us at Kids'n Cures (330-629-9714). New, dry powder inhalers are becoming available. Contact your physician or pharmacist for instructions on their use.

There are three different types of popular spacers. They are the Aerochamber with mask, the Aerochamber with mouthpiece, and the Inspirease spacer. The following list of instructions for each type will allow you to properly help your child use a spacer.

The following list of instructions will allow you to help your child properly use an Aerochamber with mask:

Shake the inhaler well before use.
Place the whole inhaler unit onto the end of the spacer.
Place the masked end of the spacer up to the child's face.
4. Be sure the mask fits tightly over both the child's mouth and nose. If it isn't a snug fit, you may have the wrong size. The masks come in several different sizes. Check with your pediatrician or pharmacist if you think you need a different size mask.
Press on top of the inhaler to release medicine into the spacer.
Instruct the child to breathe in and out slowly several times, taking deep breaths and holding for several seconds.
If the spacer squeaks or whistles while the child is inhaling or exhaling, then the child is breathing too fast. Instruct the child to take slower breaths.
If more than 1 puff is necessary: wait at least one minute after first puff.
If several different medicines from different inhalers are to be given: It is best to give the bronchodilator before any other. Examples of bronchodilators include albuterol or metoproterenol.

The following list of instructions will allow you to help your child properly use an Aerochamber with mouthpiece:

Shake the inhaler well before use.
Place the whole inhaler unit onto the end of the spacer.
Place the other end of the spacer (mouthpiece) in the child's mouth.
Press on top of the inhaler to release medicine into the spacer
Instruct the child to breathe in and out slowly several times, taking deep breaths and holding for several seconds.
If the spacer squeaks or whistles while the child is inhaling or exhaling, then the child is breathing too fast. Instruct the child to take slower breaths.
If more than 1 puff is necessary: wait at least one minute after
If several different medicines from different inhalers are to be given: It is best to give the bronchodilator before any other. Examples of bronchodilators include albuterol or metoproterenol.

How to Use a Nasal Inhaler

The following list of instructions will help you to properly utilize a nasal inhaler with your child:

Have the child gently blow his nose if able. An infant suction bulb can be used for infants.
Shake the inhaler well and remove the protective cap.
Place the tip of the inhaler inside the child's nostril.
While the child holds his breath, firmly press down on the top of the inhaler and then release.
Have the child hold his breath for at least 3 more seconds.
Remove the inhaler from the child's nose and have him exhale through his mouth.
Repeat the above steps if more sprays are prescribed or if the other nostril needs medicine.
Instruct child not to blow his nose for at least 2 minutes after the last spray.

How to Use a Nasal Spray

The following list of instructions will help you to properly utilize a nasal inhaler with your child:

Have the child gently blow his nose if able. An infant suction bulb can be used for infants.
Shake the inhaler well and remove the protective cap.
Place the tip of the inhaler inside the child's nostril.
While the child holds his breath, firmly press down on the top of the inhaler and then release.
Have the child hold his breath for at least 3 more seconds.
Remove the inhaler from the child's nose and have him exhale through his mouth.
Repeat the above steps if more sprays are prescribed or if the other nostril needs medicine.
Instruct child not to blow his nose for at least 2 minutes after the last spray.

How to Give Nose Drops to Children

The following list of instructions will help you to properly administer nasal drops to an older child:

Wash your hands before giving the medicine.
Have the child gently blow his nose if he is able.
Smaller children (toddler age) should lie on their back with a small pillow between their shoulders. Tilt head back over top of the pillow. Older children can sit in an upright position with their heads tilted back.
Warn the child that he may taste the medicine drops.
Warm the medicine to room temperature if it is cold.
Draw up enough medicine into the dropper so the correct number of drops can be given.
Push up gently on the tip of the child's nose.
Without touching the dropper to the nose, insert the dropper slightly into the nostril (about one-third of an inch).
Instruct the child to breathe through his mouth while the medicine is being placed into the nose.
Aim the dropper toward the back of the nostril and squeeze out the prescribed number of drops
Repeat the above steps if the other nostril needs medicine.
Tell the child to keep his head tilted back for 5 minutes. Allow him to spit out any medicine that runs down his throat.
If the child coughs, place him upright and watch for any problems with breathing or excessive coughing. If either of these should occur, call the pediatrician immediately!

How to Use Nose Drops in Infants

The following list of instructions will help you properly administer nasal drops to an infant:

Wash your hands before giving the medicine.
Using a suction bulb, clear the baby's nose. Ask your pharmacist or pediatrician on the proper method for suctioning an infant's nose.
Warm the medicine to room temperature if it is cold.
Place the infant lying down in your arms with his head tilted back.
Draw up enough medicine into the dropper so the correct number of drops can be given.
Without touching the dropper to the nose, insert the dropper slightly (about one-third of an inch) into the nostril.
Aim dropper toward the back of the nostril and squeeze the prescribed number of drops from the dropper.
Repeat on the other side if the other nostril needs medicine.
After the drops have been given, tell the child to keep his head tilted back for 5 minutes. Allow the child to spit out any medicine that runs down his throat.
If the child coughs, place him upright. Keep him upright and watch for any problems with breathing or excessive coughing. If this occurs, call the pediatrician immediately.

How to Apply a Rectal Ointment

The following list of instructions will help you to properly administer a rectal ointment to your child:

Wash your hands and put on a pair of medical gloves.
Have the child lie on his left side. The left leg should be straight and the right leg bent up toward his chest.
Place the applicator that comes with the ointment onto the end of the tube. Place a small amount of Vaseline or KY Jelly onto the tip of the applicator.
With one hand, gently separate the child's buttocks so you can see the anal opening.
With the other hand, gently insert the applicator into the anal opening.
Once the applicator is inside, squeeze the tube to insert the prescribed amount of ointment.
Remove the applicator from the rectum. Detach the applicator from the tube and clean applicator with soap and warm water.
Have the child remain in the same position for about 20 minutes. If this becomes a problem, the child should at least sit or lie down for this amount of time without going to the bathroom.

How to Apply Topical Medications

The following list of instructions will help you apply topical medications to your child:

Always wash your hands before applying a topical medication.
Wash the affected area of the skin and pat dry with a towel. Do not wash the skin if a physician has directed you otherwise.
If no specific directions have been given, follow these general guidelines: i.creams, ointment, gels, solutions, lotions: Use only a thin layer of medicine and rub well into skin. ii.aerosol: Shake well; hold can 6 inches away from skin and spray for several seconds.
Be careful not to get any topical medication into your child's eyes, ears, or mouth.
Wash your hands after the topical medicine has been applied.

How to Give a Rectal Suppository

The following list of instructions will help you to properly administer a rectal suppository to your child:

Wash your hands before administering the medicine.
Have the child lie on his left side. The left leg should be straight and the right leg should be bent up towards his chest.
Before unwrapping the suppository, run it under cold water to make sure it is firm.
Put on a pair of medical gloves and remove the suppository from its wrapper.
With one hand, gently separate the child's buttocks so you can see the anal opening.
With the other hand, dip the suppository into some cold water or place a small amount of Vaseline or KY Jelly on the tip. Gently insert the smooth, rounded end of the suppository into the anal opening.
With one finger: Child under 3 years old: Use pinky finger. Child over 3 years old: Use index finger. gently push the suppository into the rectum until there is no resistance (maximum distance=2-3 inches). Check with your pediatrician on the proper distance for your child.
Remove your finger and check to make sure the suppository is still in the rectum. If it is inserted far enough, the suppository should stay in place. If it comes out, reinsert it again: slightly farther than before.
After the suppository has been inserted, hold the child's buttocks together until the immediate urge to go to the bathroom passes.
Have the child remain in the same position for about 20 minutes. If this becomes impossible, the child should at least sit or lie down for about 20 minutes without going to the bathroom.

Safety & Storage of Medications

Most importantly: KEEP ALL MEDICATIONS OUT OF THE REACH OF CHILDREN!

Safety Points to Remember:

Children are curious by nature!
Keep medication on a top shelf.
Store medication in child-proof containers. But remember, children are resourceful and can find a way to open most containers if given the opportunity.
Refrigerated medications should be kept on the top shelf hidden from the sight of children.
Grandparents please be aware that a large number of children's poisonings occur when in the care of grandparents or when visiting grandparent's homes.

In an emergency:If you think your child has accidently taken some medication, or you find them with an open bottle, do the following:

Remain calm.
Take the medication away from your child.
Keep your child with you.
The medication could make your child dizzy, fall or lose consciousness. Sit the child next to you. Call 911 or your local poison center (1-800-872-5111). Do not make your child vomit unless directed to do so by a trained professional.

Storage Points to Remember: Original Container:Keep all medications in the original container in which it was dispensed from the pharmacy.Protect from the elements:Some medications may lose their potency and become ineffective when exposed to moisture and sunlight. Store in a cool, dry place away from sunlight.

How to Give Tablets to a Child

Older Children
Tablets and capsules are usually swallowed whole and taken with water. Some tablets and capsules have a protective coating which prevents the stomach from getting upset. This coating may also keep the medicine from being destroyed by the acid in the stomach. Other tablets and capsules may be extended-release or have long-acting properties. If these tablets and capsules are cut open, crushed, or chewed, these properties may be destroyed. The medicine could then possibly harm your child. DO NOT crush, chew, or cut open these tablets or capsules unless advised to do so by a physician or pharmacist. This will ensure that the proper amount of medicine is delivered to your child.

Younger Children
Taking a tablet or capsule represents a problem when they are unable to swallow it. Certain medications are not available in liquid form. In this case, certain tablets can be crushed and certain capsules opened and mixed into ice cream or applesauce or other food. NOT ALL tablets and capsules can be crushed or opened and not all foods are compatible with certain medications -- you must first check with your child's pharmacist or physician, or you can contact us at Kids'n Cures (330-629-9714).Certain tablets and capsules can be converted into a liquid form. Kids'n Cures pharmacists may be able to make a liquid preparation, on the order of your physician, that can make it easier for your child to take.