Drugs not controlling child pain

Drug doses are tested on adults

Some children being treated in hospital might not be having their pain adequately controlled, research suggests.

The problem is that many drugs are not tested on children before they are made available.

Children are not merely little adults

Professor James McElnay

Instead, standard doses are determined by testing drugs on adults, and doctors are left to estimate what dose would be effective for children.

The study, led by Professor James McElnay, of Queen's University of Belfast, examined the use of 10 commonly prescribed drugs on nearly 500 children.

It found that most doctors selected doses that were appropriate and safe.

However, he did find evidence that in some cases doctors were giving children doses that were too low to control their symptoms - particularly when administering painkillers.

Some 42% of young patients still suffered moderate pain after being given the drug Diclofenac following surgery.

In a small number of cases (1.3%) the pain was recorded as severe.

Professor McElnay said: "This could mean doctors are erring on the side of caution.

"Whilst any new drug must undergo extensive testing before being used in adults, there is currently no obligation for separate trials for children, which I would argue is a violation of their basic human rights.

"The time has come for doctors to be armed with the confidence of evidence-based guidelines. Children are not merely little adults."

Difficult measurement

Mr Tony Nunn, from Alder Hey Children's Hospital in Liverpool, which also took part in the study, said it was possible that doctors were more prone to under-use painkillers because measuring pain levels was difficult, and tended to be subjective.

James Baker's drug does cannot be increased

He said: "There is a need to research drugs in children better than is done currently and to submit the findings to the scrutiny of the licensing process."

There are ethical problems in conducting drug trials in children, but Mr Nunn said part of the problem was that, as children made up a small section of the potential market, drug companies might not consider specific testing on children commercial viable.

He said it might be necessary to follow the US system of offering commercial incentives to pharmaceutical companies.

Children and babies differ from adults in the way that they handle and absorb drugs because their liver and kidneys are less developed, putting them at risk of potential over-dosing.

Yet figures estimate that as many as 90% of babies, and 66% of children being treated in hospital are prescribed drugs that are unlicensed or licensed only for use in adults.

Too much pain

James Baker is among those who has suffered from the lack of information about appropriate doses of painkillers to give children.

He has problems with his heart and immune system, and cannot go to school because, even though he is taking medication, the pain is still too severe.

His mother Susan said: "He has weeks when he is in an awful lot of pain, and we cannot increase the painkillers because we don't know the risk to him."

The charity Action Research, which financed the study, has also commissioned a poll of 2,065 adults which suggests that there is ignorance about the issues among the general public.

More than six in ten (63%) adults believe that medicines are thoroughly tested for use in children and babies before they are used in this country.