Navigating the complexities of pediatric care

Safe and effective care for the pediatric and neonatal population involves addressing the inherent complexities and risks, especially around medication management and patient, parent and caregiver education. What strategies can be used for navigating these challenges and for successfully engaging children and families for better outcomes?

A patient ‘s journey through the healthcare system can be complex, whether for acute illness, wellness check-ups, or management of chronic conditions. For pediatric patients the same journey can present even more complexity. Preterm babies, neonates, infants, children, and adolescents each present their individual characteristics and challenges.

Whether it's the emergency room, the hospital setting, or during a routine check-up, pediatric patients will be seen in various venues of care by a variety of different practitioners. For those who require drug therapy as part of their healthcare journey, an added layer of complexity arises. Understanding age-related safety concerns and dosing, and the need for evidence-based drug information that includes guidance for off-label use is key. Additionally, consideration for patient and caregiver preferences and assuring understanding of their condition and medications is essential for appropriate patient care.

These complexities necessitate teamwork and a careful focus on safety from physicians, advanced practitioners, nurses, pharmacists, and all those participating in the pediatric patient’s healthcare journey.

Treatment and medication complexity

Factors affecting drug effectiveness and safety can vary greatly in the pediatric population, necessitating individualized therapy for each child, with careful consideration of the condition being treated, and the specific drugs being used.1

The use of age and weight to inform drug dosing calculations carries a high risk of serious errors2 which can cause patient harm. This is especially critical when considering neonates, infants and young children, as their weight, developmental stage, and the way they metabolize medications changes rapidly as they grow. Patient-specific considerations are imperative to ensure safe and effective drug therapy. This is where the unique expertise of pharmacists who are experienced in pediatric care can play a significant role, providing clinical and informational services to the wider care team.

Information on appropriate use of medications for pediatric patients can be limited due to the lack of published literature and the difficulty in conducting drug studies in such a unique and vulnerable patient population. This means off-label use of a drug for a specific indication is common in pediatric care,3 and there are certain actions that should be considered to support safety in this practice.

Before prescribing off-label for pediatric patients, clinicians should reference trusted clinical decision support tools that include information on off-label use, authorized drug formularies or drug information in Summary of Product Characteristics (SmPC). Consideration of alternative administration instructions, routes, and dosage form availability is also imperative.

After administration, they must ensure the patient is closely monitored and that the whole care team is aware of goals for therapy effectiveness and the potential for adverse effects.4 It is also essential to ensure that the risks and benefits of off-label use are clearly discussed with the patient (when possible), and the patient’s parents or caregivers.

Patient and caregiver education

The collaboration between healthcare professionals and parents and guardians does not end at the clinic or hospital. Health literacy is incredibly important for better outcomes,5 and research shows that engaged patients have more positive care experiences.6 Continuing care and better outcomes depend on education – not only of the caregiver but also of the patient.

Caregivers need to understand the condition of their child and how to best manage it, the medications they have been prescribed, and how to monitor for adverse effects. Those caring for children experiencing acute conditions for the first time not only need to respond to the current event, but then manage medications and treatments afterwards. And parents and guardians of medically complex children require additional health literacy to coordinate care. Additionally, the child themselves needs an understanding of what they are experiencing, why, and how to communicate how they are feeling.

Patient and caregiver educational materials are incredibly important in improving patient outcomes and reducing the complexity inherent in pediatric care. Particularly when it comes to understanding a condition, or what’s involved in a medical procedure, and becoming more knowledgeable about the medication treatment plan. Evidence-based education tools that provide consistent information across care settings, written in clear, plain language to support family understanding can help with this, providing clarity around how to talk to children about what they’re experiencing.


Throughout a pediatric patient’s care journey, collaboration, communication, and a focus on safety are incredibly important to help manage complexity. Also critical is the unique expertise of clinicians experienced in pediatric care, as well as access to a trusted, evidence-based source of knowledge for condition and medication management that includes a population-specific focus, off-label information, as well as reliable materials for patient education and engagement. Combined, these elements can lead to better health outcomes and a smoother care journey from the neonatal period through adolescence.



  1. Reider, M. (2019). Pharmacy and pediatric drug therapy: The key to safe and effective treatment for children. American Journal of Health-system Pharmacy, 76(19):1452-1453. Retrieved on May 30, 2024 from
  2. Jenkins, M. E. (1978, October 1). Drug therapy in children. PubMed Central (PMC). Retrieved on May 30, 2024 from
  3. Allen, H. C., Garbe, M. C., Lees, J., Aziz, N., Chaaban, H., Miller, J. L., Johnson, P., & DeLeon, S. (2018, October 1). Off-Label Medication use in Children, More Common than We Think: A Systematic Review of the Literature. PubMed Central (PMC). Retrieved on May 30, 2024 from
  4. Petkova, V., Georgieva, D., Dimitrov, M., & Nikolova, I. (2023). Off-Label Prescribing in Pediatric Population—Literature Review for 2012–2022. Pharmaceutics, 15(12), 2652. Retrieved on May 30, 2024 from
  5. Morrison, A. K., Glick, A., & Yin, H. S. (2019). Health Literacy: Implications for Child Health. Pediatrics in Review, 40(6), 263–277. Retrieved on May 30, 2024 from
  6. Greene, J., Hibbard, J. H., Sacks, R., & Overton, V. (2013). When seeing the same physician, highly activated patients have better care experiences than less activated patients. Health Affairs, 32(7), 1299–1305. Retrieved on May 30, 2024 from