Safety of medicines in children

Unlicensed and off-label prescribing is common in children. This is likely to be due to a combination of the difficulty in carrying out reliable clinical trials in children and the lack of financial reward for the industry. The term 'paediatric' encompasses preterm babies to near adult-sized adolescents, and all aspects of drug handling differ over this age range, making extrapolation very problematic. Recently, adrenal failure with inhaled corticosteroid use in children has been highlighted. Examination reveals that this is due to a combination of factors common in paediatric prescribing; including the assumption that adult diseases are the same as paediatric diseases, the lack of good diagnostic tools in small children and lack of thought about problems of drug delivery. Although some steps are being taken to improve paediatric prescribing, much more needs to be done. One approach may be to offer incentives to the pharmaceutical industry. The present state of affairs is unsatisfactory and cannot be allowed to continue.