Pediatric Medication Safety

Nursing Knowledge

Pediatric Medication Safety

Children are not just “small adults.” There are significant risks and variations compared to adults in how medications affect children’s bodies. To ensure safe pharmacological treatment of children, nurses need to know how to calculate doses for children, which medications to avoid, and how pharmacokinetics are different in children’s bodies.
Last updated: December 4, 2023

Table of contents

What makes giving medications to children challenging? 

Research in pediatric populations is limited given the ethical considerations involved in conducting medical research on children.

The research we do have reveals wide variation in the pediatric response to medications compared to adults. Immature organ systems put pediatric clients at increased risk for adverse drug reactions. Response to drugs varies by age group and stage of development within the pediatric population, with the youngest clients being most sensitive to medications and most at risk of adverse effects.

What are the pediatric age groups? 


  • < 36 weeks gestational age: premature infants
  • 36–40 weeks gestational age: full-term infants


  • First 4 weeks postnatal: neonates
  • Weeks 5–12: infants
  • Year 1–12: children
  • Year 12–16: adolescents 

Which medications should be avoided in children? 

The following medications should be avoided in children: 

  • Aspirin (can cause Reye’s syndrome)
  • Glucocorticoids (lead to growth suppression) 
  • Certain antibiotics:
    • Chloramphenicol (risk of Gray syndrome in neonates and infants)
    • Tetracyclines (can stain teeth)
    • Fluoroquinolones (can cause tendon rupture) 

Medication safety tips for nurses 

  • Pediatric drug doses are typically individualized based on weight.
  • Calculate dosage carefully and validate calculations with a second nurse per facility protocol.
  • Be aware of fluid volume balance and risk of volume overload when administering IV medications to pediatric clients.
  • Be aware of choking hazards when administering oral medications to children.
  • Build trust with clients and family.
  • Educate family members on safe home medication administration.

Pediatric pharmacokinetic variations

Limited protein-binding capacity

Children’s bodies’ limited protein-binding capacity leads to a high free drug concentration.

Immature liver

Neonates and infants have a reduced hepatic metabolism; while children have a faster metabolism compared to adults. 

Immature kidneys

Renal excretion is reduced in immature kidneys. 

Underdeveloped blood–brain barrier

Pediatric clients’ blood–brain barrier not being fully developed leads to increased sensitivity to CNS medications.  


Pediatric Medication Safety

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Nursing Cheat Sheet

Overview of pharmacologic considerations and risk factors in different pediatric age groups

Master the topic with a unique study combination of a concise summary paired with video lectures. 

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