Oral medication administration in pediatrics requires precision, patience, and age-appropriate techniques to ensure safety, effectiveness, and cooperation from the child. It’s one of the most common routes for pediatric drug delivery, especially for antibiotics, antipyretics, and supplements.
Equipment Needed
- Medication chart
- Medication drug formulary to ensure correct dosage
- Manufacturer’s drug information (if required
- Medication tray containing:
- Prescribed medication
- Medicine cup (with measured volume)
- Tablet splitter mortar and pestle
- Sterile water (for dissolving medicine)
- Kidney tray
- Scissors
- Medication card
- Face towel
- Gauze pieces in a small bowl (for wiping the syrup bottle)
Pre procedure Assessment
- Follow the hospital policy for administration of medications as institutions may vary.
- Ensure that treatment doors are kept closed when preparing medications to avoid interruption.
- Never administer medications that you have not checked yourself.
- Obtain equipment needed for the procedure.
- Check the expiry date of all equipment.
- Check if the prescription is clearly and correctly written.
- Ensure that any preliminary observations have been carried out if necessary prior to administration (e.g., vital signs).
- Check if the child does not have any known
medication.
allergy or contraindication to the prescribed - Inform the prescribing practitioner if the child does have allergy and do not give medicine.
- Check if a recent and correct weight has been recorded and dated on the prescription chart.
- Check in an approved drug formulary that the dose, route, and frequency of prescribed medication are accurate.
- Check if the medication supplied is suitable for oral administration.
- If more than one medicine is prescribed, check for compatibilities and drug interactions.
- Check if it is necessary for the medication to be given before or after food/fluid.
- If administering more than one medication, ensure that the medications can be given together.
- Liaise with pharmacist or refer to manufacturer’s guidelines regarding mixing oral medications with food and fluid.
Procedure
- Follow the protocol for checking and preparing medications:
- Systematic check of chart, allergies, weight, age, five rights, sign of prescriber, drug commence date, expiry, double checking.
- Check if the child is available to take medications.
- Ensure that room door is closed.
- Wash hands.
- Remove the medication from the box and check the name, dose, and expiry date of the medication’s original container (e.g., bottle label, tablet strip).
- If using an unopened bottle of medicine, ensure that the date and time of opening are documented on the bottle.
- Dispense medication into the appropriate vessel without directly touching the medication with the hands.
- Take the medication with the prescription chart directly to the child for administration.
- Assist the child in repositioning for administration of medicines.
- Unless contraindicated, the child should be in an upright position. A baby can be positioned in a semireclined position with the head elevated on the parent’s lap.
- Allow time for the child to take the medicine.
- Oral syringe/spoon can be inserted into the side of the mouth between the cheek and the gum or can be placed on the tip of the tongue.
- Encourage older children to use a medicine cup or spoon to take medications.
- Ensure that the medication is given slowly and use spoon to retrieve any medicine that split or spat out; stroke baby’s cheek or under the chin.
- Unless contraindicated, offer the child a flavored drink/ice cube between and after the medicines.
- Provide positive reinforcement as appropriate during and after the procedure.
- Assist the child in repositioning if required after the procedure.
Don’ts
- Don’t leave the medication in a room for the parent to administer later.
- Don’t take medication that requires administration via different route into the room at the same time [i.e., oral, intravenous (IV) medication].
- Don’t attempt to administer oral medicine while the child is asleep/crying.
- Don’t force the vessel/medicine into the child’s mouth.
Post procedure Care
- If the child refuses or is unable to take the prescribed medicine, inform the responsible prescriber. Document the incident in the appropriate section of the prescription chart and nurse’s notes.
- Discard any unused medicine according to the institutional policy.
- Dispose the equipment.
- Wash and replace the articles.
- Wash hands.
- Sign for the administration of the medication on the child’s prescription chart once the administration is complete.
- If the process required “double checking” ensure both signatures are on the prescription chart.
- Monitor the effects of the medicine administered and document in the nursing records.
- Observe for and report immediately to the nurse in charge and responsible prescriber any adverse effects of the medication.
- Stabilize child’s condition.
Nurse’s Responsibility in Administration of Oral Medications
- Refer to the responsible practitioner if a child is nil by mouth.
- Ensure the child’s gag reflex is present.
- Postoperatively, ensure the child is sufficiently awake to take the medicine safely. If the volume of the suspension is large, consider using an alternative preparation.
- The pediatric nurse should understand whether the tablets are suitable for crushing or not. For example, soluble tablets/capsules should not be crushed but dissolved in water.
- Tablets should not be broken in half unless they are scored and an appropriate tablet cutter should be used.
- Consider the constant change of physical, metabolic, and physiological state of infants and children as this has an impact on the pharmacokinetics.
- Liquid medications, primarily suspensions, may be less concentrated at the top of the bottle than at the bottom. Always shake the liquid to ensure even drug distribution.
- Never mix the crushed tablets or the contents of a capsule with formula or other essential foods. Otherwise, the child may associate the bitter taste with the food and later refuse to eat.
- Always use calibrated equipment, such as a medicine cup, spoon, plastic oral syringe, or dropper for administering liquid forms.
- If a dropper is packaged with a certain medication, never use it to administer another medication, since the drop size may vary from one dropper to another.
- When using an oral syringe or dropper for infants and young children, direct the liquid toward the posterior side of the mouth.
- Give the drug slowly in small amounts (0.2-0.5 mL) and allow the child to swallow before more medication is placed in the mouth.
- As the children adapt to swallowing tablets or capsules, administration is similar to that of adults.
- When helping the younger child learn how to swallow medication, the tablet or capsule can be placed at the back of the tongue or in a small amount of food such as ice cream or applesauce. Always tell the children if there is medicine in the food; otherwise, they may not trust you.
- Never force an oral medication into a child’s mouth or pinch the child’s nose. Doing so increases the risk for aspiration and interferes with the development of a trusting relationship.
- When the child has nasogastric, gastrostomy, or Naso jejunal tubes, oral medications may be given via these devices. The tube allows for the medication to be placed directly into the stomach or jejunal area.
- Medication for administration via a tube may be supplied in a liquid form, or a crushed tablet or opened capsule can be mixed with a liquid.
- Always check the tube placement before administering the medication.
- After administration, flush the tube to maintain patency.
Role of Nurse in Medication Management
- Administering medication safely and efficiently
- Assessing and monitoring the effects of medication
- Establishing interdisciplinary collaboration
- Evaluating desired and undesired effects of medication
Precautions for Oral Administration
- Digestive tract trauma/illness
- Post gastrointestinal surgery
- Nil by mouth
- Nausea
- Diarrhea
Guidelines for Administering Medication via Gastrostomy or Jejunostomy Tubes
- Give liquid medication directly into the tube.
- Draw appropriate amount into syringe and clear air.
- Mix powdered medication well with warm water first.
- If medication is in pill form, verify if it is ok to crush.
- Then, crush tablets and mix in warm water to prevent tube occlusion.
- Open capsules and mix the contents in warm water to dissolve the contents and prevent tube occlusion.
- Label each syringe appropriately.
- Flush the tube with water after administering medications to ensure that the entire amount of medication has been given and to prevent tube occlusion.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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