Medicines used in childhood

NG80 Asthma: diagnosis, monitoring and chronic asthma management, noting the Treatment pathway for children under 5.

BTS/SIGN guideline for the management of asthma.

See the formulary link for the Respiratory System.

Most pre-pubertal boys only experience a single episode of balanitis.

See CKS Balanitis for further guidance on treatment.

[NG9] Bronchiolitis in children: diagnosis and management sets out management of bronchiolitis:

Do not use any of the following to treat bronchiolitis in babies or children:

• Antibiotics
• hypertonic saline
• adrenaline (nebulised)
• salbutamol
• montelukast
• ipratropium bromide
• systemic or inhaled corticosteroids
• a combination of systemic corticosteroids and nebulised adrenaline.

Give oxygen supplementation to babies and children with bronchiolitis if their oxygen saturation is:

• persistently less than 90%, for children aged 6 weeks and over
• persistently less than 92%, for babies under 6 weeks or children of any age with underlying health conditions

Please see our Infection Management page for more detail including managing coughs in children.

See UKMi Q&A Do NSAIDs increase the risk of severe skin reactions in children with chickenpox?

CG99 Constipation in children and young people: diagnosis and management. See point 1.4 for clinical management including disimpaction and maintenance therapy.

ERIC (the Children’s Bladder and Bowel Charity) have some useful resources for children and teens, parents/carers and education and health professionals.

CG57 Atopic eczema in under 12s: diagnosis and management

See our dermatology webpage and formulary for guidance and formulary choices.

Research has shown that online support improved eczema symptoms in children and young people. EczemaCareOnline provides an online toolkit with various useful resources to help manage eczema and is free to use without registration.

NICE [NG194] Neonatal infection: antibiotics for prevention and treatment point 1.8 discusses risk factors for clinical indicators of possible late-onset neonatal infection.

Refer to our Infection Management page for GP paediatric Sepsis decision support tools and prescribing advice.

‘When Should I Worry?’ is a booklet developed by researchers at PRIME Centre Wales, Division of Population Medicine, Cardiff University. It provides information for parents about the management of respiratory tract infections (coughs, colds, sore throats, and ear aches) in children, and has been designed to be used in primary care consultations.

Caring for children with coughs leaflet

NG1 Gastro-oesophageal reflux disease in children and young people: diagnosis and management, including ‘silent reflux’ also known as occult reflux.

Be aware that some symptoms of a non‑IgE‑mediated cows’ milk protein allergy can be similar to the symptoms of GORD, especially in infants with atopic symptoms, signs and/or a family history. If a non‑IgE‑mediated cows’ milk protein allergy is suspected, see the NICE guideline on CG116 Food allergy in under 19s: assessment and diagnosis.

See our infant feeding page and formulary links to suspected cow’s milk protein allergy for breastfed infants and formula fed infants.

Cow’s milk protein allergy should not be confused with Lactose intolerance.

CKS Oral Candidiasis. See also our Infection Management page.

Remember to treat the breastfeeding mum as well as baby when the child is diagnosed with oral candidiasis.

See the Breastfeeding Network factsheet on Thrush and Breastfeeding.

Babies, children, and teenagers need significantly more sleep than adults to support their rapid mental and physical development.

Sometimes sleep can be difficult to initiate or maintain and parents or carers will ask for advice.

Listed below are some Somerset based resources which may be helpful.

Somerset Children and Young People Health and Wellbeing

Special Educational Needs. Somerset Expertise (sen.se)

Please see the Traffic Light System for prescribing status of individual medications – Currently none are suitable for primary care prescribing.

Medicines are not always available in formulations that are suitable for patients, the alteration of medication formulations may therefore be necessary, such as crushing tablets or prescribing a ‘special’ liquid formulation. Access the specials guide for information and to avoid delay in treatment and unnecessary use of unlicensed options for children. See the Somerset Formulary for further information. Medications should only be given in an unlicensed manner when a licensed alternative is not available. Licensed routes of administration should be sought first. When prescribing alternatives (licensed/ unlicensed) it is important to consider:

• Dose adjustments that need to be made with alternative liquid/ injection preparations.
• Full dose directions need to be included on the prescription (if applicable) e.g. ’take one tablet, disperse in water and take once in the morning’.

See Managing the risks of using effervescent tablets in children from Specialist Pharmacy Service.

Before accepting a request for prescribing (including specials) from secondary care, a prescriber should consider if the condition is suitable for taking on in primary care, for example complex paediatrics under the care of a consultant.

The Department of Health recommends that:

• Babies from birth to 1 year of age who are being breastfed should be given a daily supplement containing 8.5 to 10 micrograms (µg) of vitamin D to make sure they get enough. This is whether or not you’re taking a supplement containing vitamin D yourself.
• Babies fed infant formula shouldn’t be given a vitamin D supplement if they’re having more than 500ml (about a pint) of infant formula a day, because infant formula is fortified with vitamin D and other nutrients.
• Children aged 1 to 4 years old should be given a daily supplement containing 10µg of vitamin D.

Healthy Start vitamins are available for families who qualify for free, see how to apply. Healthy Start women’s vitamin tablets contain folic acid and vitamins C and D (Children’s drops also available). FAQs. The application form must be signed by a midwife, health visitor, doctor or nurse. See Healthy Start for Healthcare Professionals for more information and resources.