Preventing Medication Errors in Paediatrics: A Narrative Review

Paediatric medication errors remain a major and preventable cause of patient harm worldwide. Children are particularly vulnerable to medication-related adverse events because of weight-based dosing requirements, age-dependent pharmacokinetics, off-label medication use, communication limitations, and the need for complex drug preparation and administration processes. High-risk settings such as neonatal intensive care units, emergency departments, oncology services, and transitions of care are associated with particularly high rates of prescribing and administration errors. This narrative review examines the epidemiology, causes, and prevention of paediatric medication errors, with a focus on system-level contributors and evidence-based safety strategies. Common sources of error include dosing miscalculations, interruptions during medication administration, inadequate communication, insufficient paediatric-specific decision support, and caregiver-related challenges such as low health literacy and language barriers. The review highlights the role of technological interventions, including computerised physician order entry, clinical decision support systems, barcode medication administration, and smart infusion pumps in reducing prescribing and administration errors. Additional effective strategies include standardised dosing protocols, structured communication tools, pharmacist integration into multidisciplinary teams, independent double-checking processes, and family-centred education using teach-back methods and pictorial instructions. Although significant progress has been made in high-resource settings, important gaps remain in low- and middle-income countries where access to paediatric formulations, trained personnel, and electronic safety systems may be limited. Emerging technologies such as artificial intelligence-based dosing support may offer future benefits but also introduce ethical and governance challenges. Improving paediatric medication safety requires coordinated system-level approaches that combine technology, standardisation, workforce training, human-factors design, and active caregiver engagement to achieve sustained reductions in preventable harm.