Adverse reactions in children. Special considerations in prevention and management

Adverse reactions occur in only 2 to 5% of children for whom drugs are prescribed. Most of those which do occur are mild and transient in nature. Practitioners who treat children should be familiar with the adverse effects of every drug they use and be certain that every drug prescribed is strictly necessary. Antimicrobials and antipyretic/analgesics are the drugs most commonly prescribed for children. Serious adverse reactions such as aplastic anaemia (with chloramphenicol) are fortunately rare. Erythromycin prescribed for intercurrent infection may precipitate signs of toxicity in children receiving carbamazepine or theophylline. Anticonvulsants impair cognitive function and thereby affect school performance. Phenothiazines and metoclopramide prescribed as antiemetics may cause spectacular dystonic posturings, although this adverse reaction is rapidly reversed with intravenous biperiden. The duration of drug therapy in paediatric practice should be limited to the minimum time compatible with full recovery. The management of adverse reactions in childhood hinges on early recognition and prompt withholding of the offending drug. Urgent resuscitation is essential when anaphylactic collapse occurs, but in most instances of adverse reaction symptomatic treatment of discomfort is all that is necessary. It is important that parents of a child who has suffered an adverse reaction be aware of this and know the name of the drug responsible. Practitioners who encounter an unreported adverse reaction have an obligation to notify the appropriate drug monitoring authority.