Chapter 38: Medication Administration and Safety for Infants and Children

The foundation rests on understanding pediatric pharmacokinetics and pharmacodynamics, where physiological immaturity in neonates and children—including differences in gastric acidity, gastrointestinal motility, body fluid composition, protein binding capacity, and blood-brain barrier development—fundamentally alters drug absorption, distribution, metabolism, and excretion compared to adults. These developmental variations increase susceptibility to adverse drug events and complicate dosing when standardized pediatric protocols remain unavailable. Safety mechanisms form a central focus, encompassing the Six Rights of medication administration, medication reconciliation during transitions of care, and technological safeguards such as barcode verification systems and smart infusion pumps. Dosage calculation receives extensive coverage, including weight-based formulas expressed in milligrams per kilogram and surface area calculations using nomograms, with particular emphasis on verifying high-alert medications like insulin and digoxin through double-checking protocols. The chapter integrates developmental psychology into administration strategies, recommending therapeutic play for preschoolers, offering autonomy to school-age children, and employing specialized comfort positioning techniques to reduce psychological distress. Multiple administration routes are systematically addressed: oral delivery using calibrated measurement devices, optic and otic instillations with age-specific pinna positioning, and rectal administration. Parenteral therapy selection focuses on intramuscular injection site anatomy, advocating the vastus lateralis muscle for infants and toddlers while reserving the deltoid for older children, alongside guidelines for needle gauge selection and maximum volume limits per injection site. Intravenous access management covers site selection across scalp, hand, and foot locations, topical anesthetics including EMLA cream for insertion pain reduction, and maintenance protocols for central venous devices such as peripherally inserted central catheters and implanted vascular access ports. The chapter concludes with blood product administration safety and parent education strategies to promote medication adherence and prevent accidental overdosing in home settings.