Medication Administration: Infants and Children

Be honest. Do not bribe or threaten child to obtain cooperation.
When administering medication, do so in the least traumatic manner possible.
Describe any sensations child may expect to experience (e.g., "pinch" of needle during IM).
Explain how child can "help" nurse (e.g., "Lie as still as you can").
Tell child that it is OK to cry; provide privacy.
Offer support, praise, and encouragement during and after giving medication.
Allow child opportunity for age-appropriate therapeutic play to work through feelings and experiences, to clarify any misconceptions, and to teach child more effective coping strategies.

Be absolutely sure dose you are giving is both safe (check recommended mg/kg) and accurate (have another nurse check your calculations). Remember: dose should generally be smaller than adult dose.
Check identification band or ask parent or another nurse for child's first and last name.
Restrain child to avoid injury while giving medication; a second person is often required to help hold child.

Use syringe without needle to draw up medication.
Position: upright or semireclining.
Place tip of syringe along the side of infant's tongue, and give medication slowly, in small amounts, allowing infant to swallow. Medicine cups can be used for older infants and children. Never pinch infant or child's nostrils to force the child to open mouth.
When giving tablets or capsules (that are not enteric coated), crush and mix into smallest possible amount of food or liquid to ensure that child takes entire dose. Do not mix with essential food or liquid (e.g., milk); select an "optional" food, such as applesauce.

Position: supine or sitting with head extended.
For eyedrops: hold dropper 1 to 2 cm above middle of conjunctival sac.
For eye ointment: squeeze 2 cm of ointment from tube onto conjunctival sac.
After giving drops or ointment, encourage child to keep eyes closed briefly, to maximize contact with eyes. Child should be asked to look in all directions (with eyes closed) to enhance even distribution of medication.
Whenever possible, administer eye ointments at nap time or bedtime, due to possible blurred vision. Administer eyedrops prior to ointment (if both are ordered for the same time). Eyedrops may "roll off" the slick surface of the eye ointment.

Position: head to side so that affected ear is uppermost.
For child under 3 years of age: pull pinna gently down and back.
For child 3 years of age and over: pull pinna gently up and back.
After administering eardrops, encourage child to remain with head to side with affected ear uppermost, to maximize contact with entire external canal to reach eardrum. Gentle massage of area in front of ear will facilitate entry of eardrops into canal.
If eardrops are kept in refrigerator, allow to warm to room temperature before instilling.

Remember: young child's skin is more permeable; therefore, there is increased risk for medication absorption and resultant systemic effects. Monitor for systemic effects.
Apply thin layer of cream or ointment, and confine it to portions of skin where it is essential.

Prepare child emotionally and physically; rectal route is invasive and embarrassing, particularly for children.
Position: side-lying with upper leg flexed.
Lubricate rounded end of suppository and insert past anal sphincter with gloved fingertip (wear double gloves when inserting rectal medication).
Remove fingertip but hold child's buttocks gently together until child no longer strains or indicates urge to expel medication.

Because the infant or child is much smaller physically than an adult, the nurse should select a shorter needle, generally 5/8 inch (infant) to 1 inch (child).
Preferred injection sites in infants and young children include the vastus lateralis and ventrogluteal muscles. The deltoid muscle, though small, provides easy access and can be used in children over 12 months of age with adequate muscle mass.
Usually 1 mL is the maximum volume that should be administered in a single site to infants and children.
Because of vast differences in size, muscle mass, and subcutaneous tissue, it is especially important to note bony prominences as landmarks for intramuscular injections.
Have a second adult present to help restrain the child.
Once the nurse has told the child he or she is to receive an injection, the procedure should be carried out as quickly and skillfully as possible.