Problems of medication with the pediatric patient

During the course of dental treatment, when it is necessary to prescribe pharmacologic agents for the pediatric patient, a drug should be selected that is not only effective but also available in a readily acceptable form. Dosages should be considered carefully. Rather than attempting to adjust adult recommendations, established guidelines for children should be utilized. Manufacturer's doses should be followed when available. If a child frustrates efforts toward treatment and does not respond to nonpharmacotherapeutic management approaches, premedication should be considered. The practitioner should have a thorough medical history before deciding to employ outpatient sedation. This history can be helpful in selecting the most appropriate regimen. Very young children and severely compromised patients are not good candidates for sedation and are best treated under general anesthesia. Narcotic analgesics are rarely indicated for control of pain following dental treatment in children. Nonnarcotic preparations are very effective and will suffice for most procedures. Because prolonged bleeding has been demonstrated, aspirin should be used with caution in surgical cases. Oral administration is recommended for most dental infections requiring antibiotics. In instances when severe infection is encountered, the parenteral route is suggested. A narrow-spectrum, bactericidal agent is preferred; barring allergy, penicillin is the usual drug of choice. When antibiotic prophylaxis is indicated, adherence to American Heart Association guidelines is strongly encouraged.