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what not to do

In the care of minors there are practices that are not appropriate, do not contribute anything or can even be harmful, such as prescribing medicines in spoonfuls and not in milligrams and without checking the patient’s weight. A guide with recommendations for pediatricians sheds light on what not to do.

Prepared by the Spanish Association of Paediatrics (AEP), the guide, which has just been published, includes a list of recommendations for pediatricians on what not to do in the different areas of pediatric care such as primary, emergency, during hospital admission, intensive care and home care.

Although the societies of pediatric specialties have made recommendations related to their area, in the project they have been drawn up from a more transversal point of view, as explained by the coordinator of the Care Quality and Patient Safety Committee of the AEP, Aurora Madrid in a statement. The aim is that “they can be useful” for professionals.

Among the examples of what pediatricians should not do is, for example, prescribing without checking the patient’s current weight, allergies or contraindications; or giving antibiotics when there is an uncomplicated viral respiratory infection; or fail to report any suspected mistreatment or abuse.

Here are the tips on what not to do issued by the different societies of pediatricians included in the guide:

Medicines Committee of the AEP and Spanish Group of Pediatric Pharmacy of the Spanish Society of Hospital Pharmacy ()

  • Don’t keep them medicines in the sight and reach of children or in a container different from the original.
  • to provide written information about medication to parents/caregiverswithout the relevant oral explanations and without verifying that they understand it.
  • Prescribe in spoonfuls or prescribe exclusively in milliliters without using units of mass (such as milligrams), concentration, or specific presentation.
  • Prescribe without checking the current patient weight, allergies, contraindications and possible interactions.
  • Store high-risk medications without identifying them together with the rest of the medicines in the pharmacies of the health centers.

Spanish Society of Pediatric Emergencies (SEUP)

  • Do not start an antibiotic treatment a patient with suspected urinary tract infection without having previously collected a urine culture using a sterile method.
  • administer antibiotic to a patient with an uncomplicated viral respiratory infection (upper airway catarrh, laryngitis, bronchitis, bronchiolitis).
  • Delay the start of the empiric antibiotic therapy to obtain cultures (blood and/or cerebrospinal fluid) in a patient with clinical suspicion of sepsis.
  • Stop reporting any suspicion of mistreatment and/or abuse.
  • Administer water, milk or activated charcoal after ingestion of household or industrial products. In exceptional cases, careful evaluation may modify this recommendation regarding the use of activated carbon.

Spanish Society of Internal Hospital Paediatrics (SEPIH)

  • Perform the hospital admission without checking the identification bracelet, the allergy history or the treatment sheet.
  • Employ hypotonic fluids as maintenance fluid therapy.
  • administer medicines that are not correctly identified.
  • Hide, cover up and take punitive attitudes against adverse events linked to hospitalization.
  • Perform any transfer of care between professionals on a delegated basis, without any of the persons responsible for assistance being present.
pediatricians what not to do
Pediatric ICU at the Nen Jesús Children’s Hospital in Madrid. Photo provided

Spanish Society of Pediatric Intensive Care (SECIP)

  • Prolong the duration of antibiotic treatment longer than recommended.
  • Delay the start of enteral feeding without being contraindicated. Prolong the duration of antibiotic treatment longer than recommended.
  • Register without health care supervision to a patient who has received sedation for a procedure prior to the restoration of the previous basal situation.
  • Delaying the placement of an intraosseous access in a patient in cardiorespiratory arrest or imminent danger of arrest to cannulate a central venous line.
  • Transfer a pediatric patient before its stabilization in the best possible conditions in the issuing hospital.

Spanish Association of Primary Care Paediatrics (AEPAP)

  • Remove the gluten of the diet without justified cause.
  • Treat pharyngotonsillitis with antibiotic without confirming the bacterial etiology (by rapid antigen detection test or culture).
  • Use drugs of low therapeutic utility in the treatment of the acute nasopharyngitis (as mucolytics, expectorants, antitussives, antihistamines, decongestants, antibiotics or corticosteroids).
  • Prescribe to asthma inhaled drugs without educating the child and the family in the appropriate technique for each age.
  • Delay administration of adrenaline intramuscularly in anaphylaxis.

Spanish Society of Neonatology (SENEO)

  • Make one invasive technique in the newborn without having evaluated and managed the pain with pharmacological and/or non-pharmacological measures.
  • keep empiric antibiotic therapy without clinical or microbiological justification.
  • Do dressing changes of central roads daily on a routine basis.
  • Separate the binomial mother and child as long as there is a possible alternative.
  • Early clamping of the umbilical cord in term or late preterm infants who do not require resuscitation.
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