Medication Administration: Oral

CLINICAL GUIDELINES

Medications are administered by a registered nurse (RN), licensed practical nurse (LPN), physician, or family member who is knowledgeable about the medication and techniques of administering oral medications to a child.
A healthcare prescriber orders medications.
Principles of pharmacologic management (see Chapter 6) are followed.
Use the oral route whenever possible because it is the least invasive method and less traumatic than intramuscular (IM) and intravenous (IV) routes. The gastrointestinal (GI) tract provides a vast absorptive area for medications. This absorption from the GI tract, as well as distribution, metabolism, and elimination, differs with maturation. Factors such as gastric pH, gastric emptying time, motility, absorptive area, enzyme activity, and dietary factors affect GI absorption.
Medications are administered within 1 hour of prescribed time.
When using syringes to measure and administer oral medications, use an oral syringe (has a smooth vs. Luer-lock tip). Do not use Luer-lock syringes to help prevent inadvertent IV or IM administration of medication because needles cannot be attached to oral syringes.
Administer oral medications in a manner consistent with the child’s age and developmental abilities. The following are guidelines for administration by age:
- Infancy
  - Up to 3 to 4 months of age: Liquid medication may be put in a nipple or oral syringe. The rooting and suck reflex stimulates the infant to suck the medication from the syringe and swallow it.
  - 5 to 11 months of age: Put liquid medication in an oral syringe and administer in small amounts toward the side of the mouth, not toward the throat. Place the syringe across the tongue to keep an older infant from spitting out the medication. Lightly stroking the throat in a downward motion may stimulate the infant to swallow.
  - Oral medicine can be placed on a spoon in a small amount of sweet-tasting food and fed to infant. Do not place medication in large amounts of fluid (e.g., a feeding) because the infant may not ingest it all.

Never give honey to an infant because of risk for botulism.

Early childhood
- Explain in simple terms the reason for the medication. The same techniques used with the infant, excluding the nipple, can be used. Offer choices of technique when possible, for example, “Do you want to suck from the syringe or drink from the medicine cup?” Include family in medication administration. Permit the expression of anger and spend time comforting and praising the child afterward.
- Offer choices on technique and fluids to drink afterward. Enlist the child’s cooperation.
Middle childhood
- Give concrete explanations of the purpose of the medications. Offer choices as often as possible concerning administration (e.g., liquid, chewable tablet, or pill). Children in middle childhood are collectors, so offer option of collecting washedout medication cups or medication labels. Allows independence from parents/family in the process if the child gets to choose.
Adolescence
- Depending on maturity, more abstract rationales for the medication may be given to the adolescent. Use approaches suggested for middle childhood.

CHILD AND FAMILY ASSESSMENT AND PREPARATION

Assess the child’s previous experience with oral medications. The family is a good source of information about their child; ask them how the child best takes oral medications.
Prepare the child, as appropriate to cognitive level, and family before administration.
Provide therapeutic play as indicated, or involve a child life specialist, to allow the child to work through his or her fears and master control of the situation.
Explain the medication’s actions and side effects.
Teach the family how to administer oral medications to the child if they have not done so in the past.
Assess for drug allergies; if present, notify healthcare prescriber. Label child’s record and apply identification band indicating allergies.

PROCEDURE
Administering Oral Medication

Steps	Rationale/Points of Emphasis
1 Verify the order with the child’s medical record and check for allergy to drug; if present, do not administer drug and notify prescriber.	Verifies correct drug, dose, route, time, and patient. Allergic reactions to medications may be life threatening.
2 Perform hand hygiene and don gloves.	Reduces transmission of microorganisms.
3 Obtain medication and read the label to verify with the order. Check for expiration date; if expired, do not administer.	Route, dose, frequency, and time to be administered must be verified each time a medication is given.
Some institutions automatically discontinue oral medications after surgery. Check policy.
4 Check medication form dispensed to ensure that it is appropriate for the child.	Many children are unable to swallow pills or capsules, and the medication may need to be modified. Contact pharmacy for alternate forms of the medication. Solid medications that are not sustained-release preparations may be crushed and mixed with a small amount of nonessential food, such as applesauce or pudding. Check with pharmacy before crushing tablets to ensure it is not contraindicated.
5 Prepare medication for administration. Measure all liquid medications using an oral syringe or medicine cup.	For amounts less than 1 mL or drops, use a small volume syringe. Household spoons are inaccurate. Medications must be measured accurately because a small error in amount could be dangerous for the child.
	caREminder
	If mixing the medication with food or a liquid, use a small amount so that the child will finish all the medication.
6 Verify the medication with the electronic record or take medication record and medication to child to administer. Verify the child’s identity by comparing name on medication (if verified electronically) or on medication record with child’s identification band and any other patient identifier required by the institution.	Ensures proper identification of the child.
7 Elevate the child’s head or pick up and hold an infant or small child before administering medication, unless such positioning is contraindicated (Figure 68-1). Figure 68-1 When giving oral medication, position the child upright with the head elevated.	An upright position aids swallowing and helps prevent choking and aspiration. KidKare Never call medicine candy or a treat to reduce the chance that the child will think it is a treat and then seek out and ingest large amounts. If the medication is mixed in food or liquid, tell the child that the food or liquid contains medication to promote trust between child and care provider.
8 Administer the medication. Deliver liquids in small amounts, placing the syringe to the side of the mouth and allow the child to swallow between amounts. For older children, based on developmental age and abilities, give child the medication and allow to self-administer.	Administration of 0.2 to 0.5 mL at a time helps prevent choking. Aiming the syringe to the side of the mouth helps prevent gagging and choking on the medication. KidKare If the medication is distasteful, offer a popsicle or iced fluid after swallowing to disguise the taste.
9 Stay with the child until the medication is taken. Never leave medication at the bedside.	Nurse is responsible to ensure that the child has received the medication. If left at the bedside, it could be forgotten or taken by another child.
	caREminder
	Have a family member administer the medication, if they are willing, under nursing supervision to optimize teaching opportunities and to evaluate administration technique.
10 Dispose of medicine cup, syringe, and other objects in appropriate receptacle.	Ensures equipment is not reused or used for other procedures (e.g., feeding).
11 Remove gloves and perform hand hygiene.	Reduces transmission of microorganisms.