Coming to terms with children’s health

When it comes to children’s health pharmacists can not only help alleviate some of the key concerns for parents, they can ensure their pharmacy is a child-friendly space, writes Leanne Philpott

Michelle Barraclough, director of Child Friendly Solutions says, “91% of parents who shop with their children will leave the store because they are distracted by their kids, which might lead you to consider what impact this is having on your pharmacy sales and how you can create a more child-friendly environment.

“A safe, child-friendly pharmacy has the potential to keep customers in the store for longer and enable you to provide a superior level of customer service.”

“Child Friendly Solutions has installed Play Panels in a number of pharmacies and other businesses, which has enabled parents, and in particular mums, to stay longer in the store and made picking up a prescription or discussing a healthcare matter much easier,” says Barraclough.

Samantha Bowen, pharmacist at Chemmart Winmalee, NSW, installed a wall-mounted play panel in her store. She says, “A large part of our customer demographic is young families with small children so we thought the play panel would be a good way to keep the children happy and make visiting the pharmacy less difficult for the parents.

“It has facilitated better conversation between the pharmacists and parents, which is really important when you’re talking about people’s health concerns or medication needs.

“The play panel is mounted on the wall so it doesn’t take up much room, but it has certainly been well received by customers, especially the little ones.”

Chemistworks Wetherill Park, NSW, has had a play area in store for over nine years.  Retail manager Malake Bronger explains, “The playground has a slide with an interactive noughts and crosses game on the side. Parents are required to keep an eye on their children, but it’s definitely a draw card that keeps the kids happy.”

“Having the playground located at the front of shop (FOS) allows more discussion about retail purchases and product choices.”

Barraclough adds, “Many staff, particularly younger people, haven’t had exposure to small children and may be uncertain how to deal with a customer who brings kids into the store. Empowering staff to feel more confident can help ensure the customer gets a great experience in your pharmacy.”

She provides the following tips on teaching staff how to deal with children.

  • A friendly greeting to both parent and child goes a long way and doesn’t take much effort.
  • Get down to the child’s level to say hi with a big smile, without getting too close. Children respond to a smile but shy away or get upset if you get ‘in their face’.
  • If it’s within your scope, keep a jar of little gifts you can give away to kids. They are the customers of the future so you want them to associate your pharmacy with pleasant memories. Parents don’t always appreciate lollies, but I’m sure they wouldn’t mind you offering their child some fun stickers.

“Becoming a child-friendly pharmacy is a tool you can use in your marketing plan to differentiate and promote your store within the local community.”


Parent education

As part of its mission to help Australians be more medicine wise, NPS MedicineWise encourages pharmacists to educate parents and carers about safe use of medicines in children. Spokesperson and pharmacist Sarah Spagnardi says, “It is important for parents to know how to safely and effectively help their child feel better when they are unwell. We encourage parents and carers to be prepared: don’t wait until the middle of the night when your child is sick to work out what dose to give them.

“Correct dosing is important for anyone taking a medicine, but it is even more important when giving medicines to children. Pharmacists can help parents with dosage calculations based on ideal body weight if a child is particularly large or small for their age.

“For anyone caring for a small child, it’s important to weigh children regularly, know how to interpret medicine dosage information on labels about age and weight, know how to use measuring devices and have the proper measuring tools handy, and know when and where to seek advice from a healthcare professional.

“In a recent study looking at the types of errors parents make when giving liquid medicine to a child, more errors were made with dose amounts of 2.5 ml or 7.5 ml compared with 5 ml doses.  These results outline the important role of the pharmacist in demonstrating to parents and carers how to measure medicine correctly using an appropriate oral syringe or cup. A kitchen spoon should never be used, as this is not an accurate way to measure the correct dose.

“By assisting parents in identifying the active ingredients in medicines pharmacists can help prevent dosing errors and double dosing,” says Spagnardi.


Paracetamol perplexity

An analysis of callers to Australia’s National Prescribing Service Medicines Line between September 2002 and June 2010 identified that dosing, adverse reaction and interactions are the most common concerns about children’s medicines, with paracetamol identified as the primary medication of interest across all age groups (infants, young children and adolescents).

Significantly more paracetamol-related calls were made for a child (23.7%) compared with ‘rest of calls’ (12.7%), with questions about administration being most frequent.

Similarly, research into how much adults know about children’s paracetamol, carried out by the Faculty of Science, Medication and Health at the University of Wollongong, revealed some big gaps in knowledge.

Lecturer and researcher Dr Pippa Burns explains, “Despite a highly educated sample, over 70% had a tertiary education, there were surprising gaps in respondents’ knowledge regarding the administration of paracetamol containing products to children in their care.  A quarter of respondents didn’t know that only four doses should be administered within a 24 hour period (n=46, 26.4%); just under half thought that these products could be safely administered for more than two consecutive days (n=80, 46%) and over one-third didn’t know that liver toxicity could result from overdose (n=65, 37.4%).

“These findings suggest that adult caregivers administering paracetamol to children have gaps in their knowledge, which could potentially predispose children to adverse drug events.

“Pharmacists and pharmacy assistants should be reminded to talk to customers buying children’s paracetamol products about appropriate dosing regimens, regardless of how well educated the customer seems and how often they purchase the product.”

Dianne Crellin, a nurse practitioner and lecturer at The Royal Children’s Hospital, Melbourne and The University of Melbourne, says,People forget that paracetamol can cause significant problems when taken in large quantities. There’s the tendency to think that because you can buy it over the counter, without prescription, it must be safe.

“In my experience paracetamol, but more specifically fever management is a concern for many parents.”


Fever hysteria

Fever is amongst the most widespread complaints in children and the single most common non-trauma-related cause for a trip to the emergency department.

It is also a common fear amongst parents and as such, pharmacists could look for opportunities to discuss fever and help address and manage parent’s worry.

“Much of parent’s concerns stem from potential complications such as febrile convulsion and brain injury. What has become termed ‘fever phobia’ is thought to exist more so in those who have limited understanding of fever and its valuable role in diseases,” says Crellin.

“At the heart of fever management is parental education along with ensuring the child is comfortable and has fluids. Children lose more fluids when they’re hot so make sure they’re well hydrated and comfortable.

“None of the other measures that have been part of the traditional approach to managing fever, such as stripping them off, tepid sponging, putting a fan on – are effective at managing fever.

“All you’re doing is cooling the skin so that the body works harder to raise the temperature, which is counter-productive.

“The advice I believe pharmacists should be giving parents is to keep the child feeling comfortable. Treat them in the same way you would if they didn’t have a temperature. If they feel quite warm take a layer of clothing off, this doesn’t mean stripping them. If they feel cool, add a layer.

“By offering parents these practical tips pharmacists can help dampen down some of the fever hysteria. People are so terribly anxious about fever but in kids it’s such a common symptom and in most circumstances it goes hand in hand with a fairly benign illness.

“Pharmacists are certainly part of a team that can promote a better understanding of what should and shouldn’t alarm parents when it comes to the health of their children.

“Then the next step in the advice is to advise parents of the things that they should be concerned about – if they don’t know what’s causing the fever, if the child is particularly unwell, inactive, won’t drink, pale or the parent has a gut feeling. Don’t focus purely on the number (the temperature on the thermometer). The parent’s observation of their child, based on what they know about their child’s normal behaviour, is a much more meaningful piece of information than a temperature.”

Crellin says, “It’s also important to relay what constitutes a fever – anything ≥ 38°C is considered a fever. For those who are particularly anxious about a fever, concern over febrile convulsion is probably what’s underpinning their anxiety.

“It might be helpful for pharmacists to understand that many parents will be aware of this possibility and be alarmed by it and it’s driving their desire to treat the fever.

“Pharmacists can help alleviate some of these concerns by advising that only approximately 2% of children experience febrile convulsion as a result of fever and they’re harmless, albeit scary for the family, and don’t have lasting ramifications; they’re not responsible for brain damage. There’s also no evidence to suggest that giving regular Panadol or Nurofen will stop it from happening.”

Crellin tells The AJP she’d like to see more health professionals aggressively encourage treating discomfort rather than fever. It’s important to understand what’s causing the fever and address the underlying cause if necessary, bearing in mind the vast majority are viral in nature, which there’s no treatment for.

“If a large cohort of pharmacists were promoting a similar message to paediatric clinicians about fever, fever management and the use of antipyretics it would be fabulous.

“We’re swimming against the tide with respect to the use of paracetamol to treat fever as we have a long history of people saying you should treat fever because it’s dangerous. We need, clear and consistent messages.

“One of the big problems we see in healthcare is the inconsistency in information and it’s so unhelpful for parents to be told something by one clinician and something different by another.”

According to an article on fever management published in the World Journal of Paediatric Clinicians, health professionals should see parental education as a primary part of fever management.

General health checks can provide an opportune chance to educate parents on the best way to treat fever, as opposed to presenting facts when the child is sick as anxiety may impede their understanding. It states that ‘parents should be taught how simply to assess the child’s wellbeing (e.g. skin colour, activity levels, respiratory rate and hydration)’.


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