A–Z of prescribing for children
This series focuses on aspects of prescribing for neonates, children and young people, from A–Z. Aspects of pharmacokinetics will be considered, alongside legal considerations, consent and medications in schools
The British National Formulary (BNF) was first published in 1949 as a result of war-time formularies, with new editions being published every 3 years until the mid-1970s (Wade, 1993). Then, the pharmaceutical industry began to publish the Monthly Index of Medical Specialities (MIMS) every month, providing more up-to-date information for doctors – no non-medical prescribers then! However, the BNF format was re-evaluated and re-formed, and new editions have been published every 6 months since 1981. This new format included drug monographs for all licensed medications, as well as some unlicensed drugs and, since 1999, NICE (then the National Institute of Clinical Excellence) has been using the BNF to create guidelines alongside evidence-based practice (Ogden, 2017).
In 2005, the British National Formulary for Children (BNFc) (Paediatric Formulary Committee, 2023) was launched. Paediatric health professionals know that caring for children is challenging in a variety of ways, and that they are not just ‘little adults’. Children – especially neonates – differ greatly to adults in their response to drugs. In the neonatal period, for example, the risks of toxicity are increased by a reduced drug clearance, so a working knowledge of differing pharmacokinetic changes as children grow and develop is paramount. Yet, most children's doses of medications are still extrapolated from adult drug studies (O'Hara, 2016).
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