Every year in the U.S., more than 5 million children become hospitalized and around 30 million children visit emergency departments. Most of these pediatric patients require some sort of medication. However, most medications do not have a standard dosing for children, and the way that a child's body responds to medications may change drastically with age and development. That’s where the role of a pediatric pharmacist is critical.
Pediatric pharmacy is one of the more than 100 career options available to PharmDs, and it’s what assistant professor, Luke Orth, PharmD, has dedicated his life to.
“What’s helpful in having a pediatric pharmacist involved [in the care of the patient], is navigating literature and figuring out what details of mediation use need to change in order to safely use medication with children,” Dr. Orth said.
The majority of pediatric medication use occurs in the hospital setting, and that is where most of the over 1,700 board-certified pediatric pharmacists in the U.S. interact with patients. Outside of the hospital, it is estimated that nearly 40% of children have at least one chronic health condition, and most require long-term medication use to manage their associated symptoms. In this outpatient setting, however, pediatric pharmacist presence is less common. That’s a reality that Dr. Orth is trying to change.
Managing Out-of-hospital Care
At Children's Hospital Colorado on the Anschutz Medical Campus, where Dr. Orth works, pediatricians, nurses, dietitians, psychologists, pharmacists, and other members of the healthcare team focus on the out-of-hospital care of children with medical complexity. According to the American Academy of Pediatrics, children with medical complexity have multiple significant health problems, functional limitations, high healthcare utilization, and often require medical technological devices to improve or sustain life and daily function. Polypharmacy, or the use of five or more medications on a regular basis, is often necessary. A 2021 study by researchers in the clinic found that enrolled children required a median of 31 daily medication doses in order to control their symptoms, and more complex medication regimens were associated with increased trips to acute care visits, including the emergency department and hospital setting.
“There are added challenges to using medications safely in this group of patients,” Dr. Orth said. “Many of the safety checks we use as healthcare providers are designed for adult patients. Weight-based dosing, immature organ function, suboptimal dosage forms for kids who may not swallow well or may require doses through a feeding tube… all of these can be barriers to safe or effective treatment in children. When you begin to layer in extensive polypharmacy, sometimes consisting of 30 or 40 drugs on a single patient’s medication list, there is a high potential for problems to occur.”
Guiding Providers, Patients and Families
As a part of his clinical practice, Dr. Orth works with providers in the clinic at Children's Hospital Colorado to account for these variables, drug-drug interactions, and other patient-specific factors to develop medication plans, including plans for safely stopping medications, or “de-prescribing” when they are no longer needed or may be causing unwanted effects.
“My job is to work with patients and their families to find the most effective medication from a bucket of sometimes less-than-ideal options,” Dr. Orth said. “I want my patients to be comfortable and healthy, so that they can live their best lives – whatever they may look like for each individual child.”
