Section 8 - Pediatric Decontamination/Prophylaxis

  • DVD Resource:The Agency for Health Care Research and Quality (AHRQ) has made available for free, upon individual request, a DVD entitled The Decontamination of Children: Preparedness and Response for Hospital Emergency Departments. The information in this DVD outlines the key differences between treating children and adults, describes the important steps necessary for decontamination, and provides an overview of the process and systems needed to respond to this need. The DVD can be ordered at: http://www.ahrq.gov/research/decontam.htm - AHRQ Publication No. 050036-DVD, August 2005.

Purpose: These recommendations are intended to assist in planning for the needs of all children requiring decontamination that present to the hospital during a disaster or terrorist attack. Children require special considerations that may not be addressed in the general Hospital Decontamination Plan. These guidelines will assist hospitals to decontaminate properly infants and children in a timely manner.

Section Contents

General Guidelines1-10

Infants and children have unique needs that require special considerations during the process of hospital-based decontamination.

  • Separation of families during decontamination should be avoided, especially under conditions of large number of patients in a chaotic situation; however, medical issues take priority.
  • Older children may resist or be difficult to handle out of fear, peer pressure, and modesty issues, even in front of their parents or caregivers.
  • If the water temperature is below 98° F, the risk of inducing hypothermia increases proportionately with the smaller, younger child.
  • Attention to airway management is a priority throughout decontamination showers.
  • It cannot be assumed that the parents or caregivers will be able to decontaminate both themselves and their children at the same time. "Hot zone" personnel should recognize the need to assist them.
  • A large volume, low-pressure water delivery system (e.g., handheld hose sprayers that are 'child-friendly') should be incorporated into the hospital decontamination showers.
  • Regarding considerations such as hypothermia, airway management, separation of families and the ability to effectively decontaminate a child: the smaller the child, the bigger the problem.

Decontamination Recommendations Based on Age of Child1-10

  • Children should be divided into three groups by age: Less than 2 years old (infants and toddlers), ages 2 to 8 years old (pre-school/young children), and ages 8 to 18 years old (school age).
  • The recommendations are based on the child's estimated age, since asking children's ages may be impractical due to the limitations of the PPE worn by decontamination team members or to a large influx of patients.
  • The recommendations are meant as general guidelines.

Children Less Than 2 Years of Age (Infants and Toddlers)

Infants and toddlers represent the most challenging group to safely decontaminate due to their developmental stage, their dependent nature and their physical characteristics.

These special needs and considerations are the most important:

  • All infants and toddlers should be placed on a stretcher and disrobed by either the child's caregiver or 'hot zone' personnel. (Use trauma shears, if necessary, to speed the disrobing process.)
  • A hand should be kept on the infant or toddler at all times, even when bedrails are raised. (Small children can fall through.) Some have found plastic laundry baskets to be useful in moving infants through the decontamination area.
  • It is not recommended that the child be carried due to the possibility of injury resulting from a fall, or from dropping a slippery and squirming child.
  • All clothes and items that cannot be decontaminated should be placed in appropriate containers or bags as provided by the hospital and labeled.
  • Ensure the temperature of the shower does not present a danger to the infant/toddler.
  • Each infant and toddler should then be accompanied through the decontamination shower by either his or her caregiver or 'hot zone' personnel to ensure the entire patient is properly decontaminated.
  • Special attention must be given to the child's airway while in the shower.
  • Children and their families (parents or caregivers) should not be separated unless critical medical issues take priority.
  • Once through the shower, the infant's or toddler's caregiver or 'cold zone' personnel escort should be given a towel and sheets to dry off the child, and a hospital gown to dress the child. Immediately, the child should be given a unique identification number on a wristband and then triaged to an appropriate area for medical evaluation.
  • Remember that temperature regulation is a major issue for infants and toddlers. If necessary, cover the child with a blanket.

Children 2 to <8 Years of Age (Preschool and Young Children)

From age, two up to eight, children should be able to walk and speak, yet will still look like a child with considerable variations in physiology and anatomy.

  • Ambulatory children should be assisted in disrobing by either the child's caregiver or 'hot zone' personnel.
  • All clothes and items that cannot be decontaminated should be placed in appropriate containers or bags as provided by the hospital and labeled.
  • Each child should be directly accompanied through the shower by either the child's caregiver or 'hot zone' personnel to ensure the entire patient is properly decontaminated.
  • It is recommended that the child not be separated from family member(s) or the adult caregiver unless serious medical conditions dictate otherwise.
  • Once through the shower, each child should be given a towel and sheets to dry, and a hospital gown. Immediately, the child should be given a unique identification number on a wristband and then triaged to an appropriate area for medical evaluation. Ask if they would like a blanket.

In the case of children with special health care needs or injured children who are non-ambulatory:

  • Non-ambulatory children should be placed on a stretcher by 'hot zone' personnel and disrobed (using trauma shears if necessary). Again, all clothes and items that cannot be decontaminated should be placed in appropriate containers or bags as provided by the hospital and labeled.
    • Each non-ambulatory child on a stretcher is escorted through the decontamination shower and assisted with decontamination to ensure the entire patient is properly decontaminated.
    • Children of this age may be averse to the showering of their face. Care should be taken to keep their airway open during the showering procedure.

Children 8 to 18 Years of Age (School-Aged Children)

At the age of 8 years and upward, the airway anatomy approximates that of an adult. Although it is tempting to regard this age group as 'small adults', there are special needs unique to this age group.

First, privacy is likely to be a bigger issue with this age group than with younger children, so steps should be taken to protect modesty of the patient and limit the number of people to which the child appears to be exposed.

Second, this group will be more likely to want explanations about procedures. The child is likely to be more cooperative if age-appropriate explanations are given.

  • Ambulatory children should be instructed to disrobe by 'hot zone' personnel.
  • All clothes and items that cannot be decontaminated should be labeled and placed in appropriate containers or bags as provided by the hospital. Children of this age should able to accomplish this themselves.
  • Each ambulatory child should then walk through the decontamination shower, preferably in succession with their parent or caregiver, and essentially decontaminate him/herself.
  • Non-ambulatory children should be placed on a stretcher by 'hot zone' personnel and disrobed (using trauma shears if necessary). This may include children with mobility impairments, children with special healthcare needs or injured children. Clothing should be placed in appropriate containers or bags provided and labeled. Then, each non-ambulatory child should be escorted through the decontamination shower and assisted with decontamination to ensure the entire patient is properly decontaminated.
  • Once through the shower, each child should be given a towel and sheets to dry, and a hospital gown. Immediately, the child should be given a unique identification number on a wristband and then triaged to an appropriate area for medical evaluation. Ask if they would like a blanket.
  • Children and their families (parents or caregivers) should not be separated unless critical medical issues take priority.

Pharmaceutical Needs11

General Needs: There are resources for clinicians who are unfamiliar with pediatric dosing. The listing below is not intended to be all-inclusive, nor should it be considered an endorsement of any particular product.

  • Color Coding Kids/Broselow Pediatric Emergency Tape - This system uses a color-coded measuring tool based on height-weight correlations to determine the proper pediatric dose to administer. The color measurement system allows near instantaneous weight determination. The color-coded cardboard measuring tape is laid down alongside a supine pediatric patient. The color zone used to measure the child lists the proper amount of medication dosages, proper equipment sizes, IV infusion information, and other pertinent information specific to that size patient. The full system includes a 'smart cart' with color-coded drawers, containing medications that relate to the measuring tool. For more information, go to: www.colorcodingkids.com.
  • Pedi-Wheel - This is a pocket reference tool with vital information related to pediatric emergencies where the patient is aged preemie to age 16. On one side, the clinician can dial the patient's age and windows reveal average weight, blood pressure, heart rate, respiratory rate, and sizes for ET tube and laryngoscope blades. The other side can be used to dial the patient's weight to calculate doses of 14 emergency medications. Information conforms to ACLS and PALS guidelines for fluid resuscitation, defibrillation and cardioversion. It can also accurately calculate percentage of body surface burned.
  • Freeware for PDAs - There are several websites that make available downloadable freeware. Information can be loaded onto PDAs for reference use. Among the websites are Drexel University's library site (http://www.library.drexel.edu/resources/guides/healthpda.html#Pediatrics) and Softpedia (http://www.softpedia.com/).

Prophylaxis Using Adult Doses: The following documents, developed by the Oklahoma University College of Pharmacy and the Oklahoma City - County Public Health Department, provide explanations of how to prepare emergency dosages of the following medications which can be printed and given to patients and family members.

English versions of the following appear in this section of the toolkit: (Spanish and Vietnamese versions are available upon request.)

  • Doxycycline for anthrax, brucellosis, plague and tularemia prophylaxis
  • Ciprofloxacin for anthrax, plague and tularemia prophylaxis
  • Co-trimoxazole suspension or tablet for brucellosis prophylaxis
  • Rifampin for brucellosis prophylaxis
  • Oseltamivir (Tamiflu®) for influenza exposure

Note: The sample documents that follow assume a specific formulation of each drug. Prior to copying and distributing the instruction sheets, please determine whether the instructions need to be altered based on a different formulation/dosage of the drug.

Home Preparation for Emergency Doses of Doxycycline for Infants and Children Exposed to Anthrax

Once you have been notified by your federal, state, or local authorities that you have been exposed to anthrax, you may need to prepare emergency doses of doxycycline for infants and children using doxycycline tablets.

You will need:
One (1) 100-milligram (mg) doxycycline tablet One of these foods:
  • chocolate syrup
  • maple syrup
  • caramel syrup
  • applesauce
  • unsweetened applesauce
  • jarred pureed baby fruit
Metal teaspoon
One (1) teaspoon (tsp) and one-half (½) tsp measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions:

  1. Put one (1) 100-mg doxycycline tablet into a small bowl.
    Crush the tablet with the back of the metal spoon until no large pieces are seen.
  2. Add four (4) level tsp of a food to the crushed doxycycline.
    Stir them together until the drug looks evenly mixed with the food.
  3. Use the chart that follows to find out how much of the mixture to give the child.

How Much of the Doxycycline Mixture to Give a Child

  • The number of teaspoons of the doxycycline mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart below tells you how much to give a child for one (1) dose.
  • You should give the child two (2) doses each day for ten (10) days.
    One (1) dose is given in the morning and one (1) dose is given in the evening.
If the child weighs: Give the child:
4 to 11 pounds (lb) One-half (½) teaspoon (tsp) (2.5 mL) of the doxycycline mixture
12 to 22 lb One (1) tsp (5 mL) of the doxycycline mixture
23 to 33 lb One and one-half (1½) tsp (7.5 mL) of the doxycycline mixture
34 to 45 lb Two (2) tsp (10 mL) of the doxycycline mixture
46 to 55 lb Two and one-half (2½) tsp (12.5 mL) of the doxycycline mixture
56 to 65 lb Three (3) tsp (15 mL) of the doxycycline mixture
66 to 77 lb Three and one-half (3½) tsp (17.5 mL) of the doxycycline mixture
78 to 88 lb Four (4) tsp (20 mL) of the doxycycline mixture [or one (1) 100-mg tablet]
>88 lb Children heavier than 88 lb who are exposed to anthrax should take 1 100-mg tablet of doxycycline two (2) times a day (at the same time each day if possible) for ten (10) days. If the child cannot swallow tablets, use the directions for preparing a mixture and give four (4) teaspoons twice a day.

How Already Prepared Doxycycline Mixture Should be Stored

  • Prepare the doxycycline mixture daily.
  • Store the mixture in a covered container and refrigerate.
  • Mixture will keep for at least 24 hours.
  • After 24 hours, throw away any unused portions.

Home Preparation for Emergency Dosages of Ciprofloxacin for Infants and Children Exposed to Anthrax

Once you have been notified by your federal, state, or local authorities that you have been exposed to anthrax, it may be necessary to prepare emergency doses of ciprofloxacin for infants and children using ciprofloxacin tablets.

You will need:
One (1) 500-milligram (mg) ciprofloxacin tablet One of these foods:
  • chocolate syrup
  • maple syrup
  • caramel syrup
  • unsweetened applesauce
  • jarred pureed baby fruit
  • ketchup
Metal teaspoon
One (1) teaspoon (tsp) and one-half (½) tsp measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions:

  1. Put one (1) 500-mg ciprofloxacin tablet into a small bowl.
    Crush the tablet with the back of the metal spoon until no large pieces are seen.
  2. Add six (6) level teaspoons of a food to the crushed ciprofloxacin. Stir them together until the drug looks evenly mixed with the food.
  3. Use the chart that follows to find out how much of the mixture to give the child.

How Much of the Ciprofloxacin Mixture to Give a Child

  • The number of teaspoons of the ciprofloxacin mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart tells you how much to give a child for one (1) dose.
  • You should give the child two (2) doses each day for ten (10) days.
    Give one (1) dose in the morning and one (1) dose in the evening.
If the child weighs: Give the child:
4-6.5 pounds (lb) One-half (½) tsp (2.5 mL) of the ciprofloxacin mixture
7-12.5 lb One (1) tsp (5 mL) of the ciprofloxacin mixture
13-18 lb One and one-half (1½) tsp (7.5 mL) of the ciprofloxacin mixture
19-24 lb Two (2) tsp (10 mL) of the ciprofloxacin mixture
25-30 lb Two and one-half (2½) tsp (12.5 mL) of the ciprofloxacin mixture
31-37 lb Three (3) tsp (15mL) of the ciprofloxacin mixture
38-43 lb Three and one-half (3½) tsp (17.5 mL) of the ciprofloxacin mixture
44-49 lb Four (4) tsp (20 mL) of the ciprofloxacin mixture
50-55 lb Four and one-half (4½) tsp (22.5 mL) of the ciprofloxacin mixture
56-61 lb Five (5) tsp (25 mL) of the ciprofloxacin mixture
62-67 lb Five and one-half (5½) tsp (27.5 mL) of the ciprofloxacin mixture
68-73 lb Six (6) tsp (30 mL) of the ciprofloxacin mixture [or one (1) 500-mg tablet]
>73 lb Children heavier than 73 pounds who are exposed to anthrax should take one (1) 500-mg tablet of ciprofloxacin two (2) times a day (at the same time each day if possible) for ten (10) days. If the child cannot swallow tablets, use the directions for preparing a mixture and give six (6) teaspoons twice a day.

How Already Prepared Ciprofloxacin Mixture Should be Stored

  • Prepare the ciprofloxacin mixture daily.
  • Store the mixture in a covered container and refrigerate.
  • Mixture will keep for at least 24 hours refrigerated.
  • After 24 hours, throw away any unused portions.

Home Preparation for Emergency Dosages of Doxycycline for Children Over 8 Years of Age Exposed to Brucellosis

Once you have been notified by your federal, state, or local authorities that you have been exposed to brucellosis, it may be necessary to prepare emergency doses of doxycycline for infants and children using doxycycline tablets.

You will need:
One (1) 100-milligram (mg) doxycycline tablet One of these foods:
  • chocolate syrup
  • maple syrup
  • caramel syrup
  • applesauce
  • unsweetened applesauce
  • jarred pureed baby fruit
Metal teaspoon
One (1) teaspoon (tsp) and one-half (½) tsp measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions

  1. Put one (1) 100-mg doxycycline tablet into a small bowl.
    Crush the tablet with the back of the metal spoon until no large pieces are seen.
  2. Add four (4) level teaspoons of a food or drink to the crushed doxycycline.
    Stir them together until the drug looks evenly mixed with the food or drink.
  3. Use the chart that follows to find out how much of the mixture to give the child.

How Much of the Doxycycline Mixture to Give a Child

  • The number of teaspoons of the doxycycline mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart tells you how much to give a child for one (1) dose.
  • You should give the child two (2) doses each day for ten (10) days. One (1) dose is given in the morning and one (1) dose is given in the evening.
If the child weighs: Give the child:
4-11 pounds (lb) One-half (½) tsp (2.5 mL) of the doxycycline mixture
12-22 lb One (1) tsp (5 mL) of the doxycycline mixture
23-33 lb One and one-half (1½) tsp (7.5 mL) of the doxycycline mixture
34-45 lb Two (2) tsp (10mL) of the doxycycline mixture
46-55 lb Two and one-half (2½) tsp (12.5 mL) of the doxycycline mixture
56-65 lb Three (3) tsp (15 mL) of the doxycycline mixture
66-77 lb Three and one-half (3½) tsp (17.5 mL) of the doxycycline mixture
78-88 lb Four (4) tsp (20 mL) of the doxycycline mixture [or one (1) 100-mg tablet]
>88 lb Children heavier than 88 pounds who are exposed to brucellosis should take one (1) 100-mg tablet of doxycycline two (2) times a day (at the same time each day if possible) for 3-6 weeks. If the child cannot swallow tablets, use the directions for preparing a mixture and give four (4) teaspoons twice a day.

How Already Prepared Doxycycline Mixture Should be Stored

  • Prepare the doxycycline mixture daily.
  • Store the mixture in a covered container and refrigerate.
  • Mixture will keep for at least 24 hours refrigerated.
  • After 24 hours, throw away any unused portions.

Note: Children receiving doxycycline for brucellosis prophylaxis should also receive rifampin. See rifampin instructions for dosing.

Home Preparation for Emergency Dosages of Co-trimoxazole for Children Less Than 8 Years of Age Exposed to Brucellosis

Once you have been notified by your federal, state, or local authorities that you have been exposed to brucellosis, it may be necessary to prepare emergency doses of co-trimoxazole for infants and children using co-trimoxazole tablets.

You will need:
One (1) 800/160-milligram (mg) co-trimoxazole tablet One of these foods:
  • chocolate syrup
  • maple syrup
  • caramel syrup
  • applesauce
  • unsweetened applesauce
  • jarred pureed baby fruit
Metal teaspoon
One (1) teaspoon (tsp) and one-half (½) teaspoon (tsp) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions:

  1. Put one (1) 800/160-mg co-trimoxazole tablet into a small bowl. Crush the tablet with the back of the metal spoon until no large pieces are seen.
  2. Add five (5) level teaspoons of a food or drink to the crushed co-trimoxazole.
    Stir them together until the drug looks evenly mixed with the food or drink.
  3. Use the chart that follows to find out how much of the mixture to give the child.

How Much of the Co-trimoxazole Mixture to Give a Child

  • The number of teaspoons of the co-trimoxazole mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart tells you how much to give a child for one (1) dose.
  • You should give the child two (2) doses each day. Give one (1) in the morning and one (1) in the evening.
If the child weighs: Give the child:
4-7 pounds (lb) One-half (½) tsp (2.5 mL) of the co-trimoxazole mixture
8-15 lb One (1) tsp (5 mL) of the co-trimoxazole mixture
16-20 lb One and one-half (1½) tsp (7.5 mL) of the co-trimoxazole mixture
21-25 lb Two (2) tsp (10 mL) of the co-trimoxazole mixture
26-30 lb Two and one-half (2½) tsp (12.5 mL) of the co-trimoxazole mixture
31-36 lb Three (3) tsp (15 mL) of the co-trimoxazole mixture
37-45 lb Three and one-half (3½) tsp (17.5 mL) of the co-trimoxazole mixture
46-55 lb Four (4) tsp (20 mL) of the co-trimoxazole mixture
56-63 lb Four and one-half (4½) tsp (22.5 mL) of the co-trimoxazole mixture
64-75 lb Five (5) tsp (25 mL) of the co-trimoxazole mixture [or one (1) 800/160-mg tablet]
>75 lb Children heavier than 75 pounds and less than 8 years old, who are exposed to brucellosis should take one and one-half (1½) 400/160-mg tablets of co-trimoxazole two (2) times a day (at the same time each day if possible) for 3-6 weeks.

How Already Prepared Co-trimoxazole Mixture Should be Stored

  • Prepare the co-trimoxazole mixture daily.
  • Store the mixture in a covered container and refrigerate.
  • Mixture will keep for at least 24 hours refrigerated.
  • After 24 hours, throw away any unused portions.

Note: Children receiving co-trimoxazole for brucellosis prophylaxis should also receive rifampin. See rifampin instructions for dosing.

Home Preparation for Emergency Dosages of Rifampin for Children and Adults Exposed to Brucellosis

Once you have been notified by your federal, state, or local authorities that you have been exposed to brucellosis, it may be necessary to prepare emergency doses of rifampin for infants and children using rifampin capsules.

You will need:
Two (2) 300-milligram (mg) rifampin capsules One of these foods:
  • chocolate syrup
  • unsweetened applesauce
  • maple syrup
  • jarred pureed baby fruit
  • caramel syrup
  • ketchup
Metal teaspoon
One (1) teaspoon (tsp) and one-half (½) tsp measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions:

  1. Open two (2) 300-mg rifampin capsules into a small bowl.
    Put the contents of the capsules into a small bowl and discard the empty capsule.
    Crush the contents with the back of the metal spoon until no large pieces are seen.
  2. Add six (6) level teaspoons (tsp) of a food to the crushed rifampin.
    Stir them together until the drug looks evenly mixed with the food.
  3. Use the chart on the following page to find out how much of the mixture to give the child.

How Much of the Rifampin Mixture to Give a Child

  • The number of teaspoons of the rifampin mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart tells you how much to give the child for one (1) dose.
  • You should give the child one (1) dose each day for 3-6 weeks.
If the child weighs: Give the child:
<10 pounds (lb) One-half (½) tsp (2.5 mL) of the rifampin mixture
10-17 lb One (1) tsp (5 mL) of the rifampin mixture
18-30 lb Two (2) tsp (10 mL) of the rifampin mixture
31-44 lb Three (3) tsp (15 mL) of the rifampin mixture
45-55 lb Four (4) tsp (20 mL) of the rifampin mixture
56-70 lb Five (5) tsp (25 mL) of the rifampin mixture
71-88 lb Six (6) tsp (30 mL) of the rifampin mixture
>88 lb Children heavier than 88 pounds who are exposed to brucellosis should take two (2) 300-mg rifampin capsules once a day (at the same time each day if possible) for 3-6 weeks. If the child cannot swallow capsules, use the directions for preparing a mixture and give six (6) teaspoons once a day.

How Already Prepared Rifampin Mixture Should be Stored

  • Prepare the rifampin mixture daily.
  • Store the mixture in a covered container and refrigerate.
  • Mixture will keep for at least 24 hours refrigerated.
  • After 24 hours, throw away any unused portions.

Note: Children 8 years or older should also receive doxycycline. Children less than 8 years old should also receive co-trimoxazole. Please see additional sheets for directions and dosing of those drugs.

Home Preparation for Emergency Dosages of Oseltamivir (Tamiflu®) for Infants and Children Exposed to Influenza

Once you have been notified by your federal, state, or local authorities that you have been exposed to influenza, it may be necessary to prepare emergency doses of oseltamivir for infants and children using oseltamivir capsules.

You will need:
One (1) 75-milligram (mg) oseltamivir capsule One of these foods:
  • chocolate syrup
  • maple syrup
  • caramel syrup
  • applesauce
  • jarred pureed baby fruit
  • apple juice
  • strawberry jam
Metal teaspoon
One (1) teaspoon (tsp) measuring spoon [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions

  1. Put the contents of one (1) 75-mg oseltamivir capsule into a small bowl, discarding the empty capsule. Add two (2) level teaspoons of water. Stir the water and capsule contents for one (1) minute.
  2. Add three (3) level teaspoons of a food or drink to the oseltamivir and water mixture.
    Stir them together until the drug looks evenly mixed with the food or drink.
    The final concentration is 3 mg/ml (2 tsp = 30 mg).
  3. Use the following chart to find out how much of the mixture to give the child.

How Much of the Oseltamivir (Tamiflu®) Mixture to Give a Child

  • The number of teaspoons of the oseltamivir mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart tells you how much to give a child for one (1) dose.
  • You should give the child one (1) dose each day (once in the morning).
If the child weighs: Give the child:
<33 pounds (lb) Two (2) tsp (30 mg) of the oseltamivir solution
33-51 lb Three (3) tsp (45 mg) of the oseltamivir solution
51-88 lb Four (4) tsp (60 mg) of the oseltamivir solution
>88 lb Five (5) tsp (75 mg) of the oseltamivir solution
Adults and adolescents 13 years and older The recommended oral dose of oseltamivir prophylaxis of influenza in adults and adolescents 13 years of age and older is 75 mg once daily for ten (10) days. Treatment should begin within two (2) days of exposure.

How Prepared Oseltamivir (Tamiflu®) Solution Should be Stored

  • Prepare the oseltamivir mixture daily.
  • If mixed with food, store the mixture in a covered container and refrigerate.
  • Mixtures made with juice can be stored at room temperature.
  • Mixture will keep for at least 24 hours.
  • After 24 hours, throw away any unused portions.

Home Preparation for Emergency Dosages of Doxycycline for Infants and Children Exposed to Plague

Once you have been notified by your federal, state, or local authorities that you have been exposed to plague, it may be necessary to prepare emergency doses of doxycycline for infants and children using doxycycline tablets.

You will need:
One (1) 100-milligram (mg) doxycycline tablet One of these foods:
  • chocolate syrup
  • maple syrup
  • caramel syrup
  • applesauce
  • unsweetened applesauce
  • jarred pureed baby fruit
Metal teaspoon
One (1) teaspoon (tsp) and one-half (½) teaspoon (tsp) measuring spoons
[NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions:

  1. Put one (1) 100-mg doxycycline tablet into a small bowl.
    Crush the tablet with the back of the metal spoon until no large pieces are seen.
  2. Add four (4) level teaspoons of a food to the crushed doxycycline.
    Stir them together until the drug looks evenly mixed with the food.
  3. Use the chart on the following page to find out how much of the mixture to give the child.

How Much of the Doxycycline Mixture to Give a Child

  • The number of teaspoons of the doxycycline mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart tells you how much to give the child for one (1) dose.
  • You should give the child two (2) doses each day. Give one (1) dose in the morning and one (1) dose in the evening for seven (7) days.
If the child weighs: Give the child:
4-11 pounds (lb) One-half (½) tsp (2.5 mL) of the doxycycline mixture
12-22 lb One (1) tsp (5 mL) of the doxycycline mixture
23-33 lb One and one-half (1½) tsp (7.5 mL) of the doxycycline mixture
34-45 lb Two (2) tsp (10 mL) of the doxycycline mixture
46-55 lb Two and one-half (2½) tsp (12.5 mL) of the doxycycline mixture
56-65 lb Three (3) tsp (15 mL) of the doxycycline mixture
66-77 lb Three and one-half (3½) tsp (17.5 mL) of the doxycycline mixture
78-88 lb Four (4) tsp (20 mL) of the doxycycline mixture [or one (1) 100-mg tablet]
>88 lb Children heavier than 88 pounds who are exposed to plague should take one (1) 100-mg tablet of doxycycline two (2) times a day (at the same time each day if possible) for seven (7) days. If the child cannot swallow tablets, use the directions for preparing a mixture and give four (4) teaspoons twice a day.

How Prepared Doxycycline Mixture Should be Stored

  • Prepare the doxycycline mixture daily.
  • Store the mixture in a covered container and refrigerate.
  • Mixture will keep for at least 24 hours refrigerated.
  • After 24 hours, throw away any unused portions.

Home Preparation for Emergency Dosages of Ciprofloxacin for Infants and Children Exposed to Plague

Once you have been notified by your federal, state, or local authorities that you have been exposed to plague, it may be necessary to prepare emergency doses of ciprofloxacin for infants and children using ciprofloxacin tablets.

You will need:
One (1) 500-milligram (mg) ciprofloxacin tablet One of these foods:
  • chocolate syrup
  • maple syrup
  • caramel syrup
  • unsweetened applesauce
  • jarred pureed baby fruit
  • ketchup
Metal teaspoon
One (1) teaspoon (tsp) and one-half (½) teaspoon (tsp) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions

  1. Put one (1) 500-mg ciprofloxacin tablet into a small bowl.
    Crush the tablet with the back of the metal spoon until no large pieces are seen.
  2. Add six (6) level teaspoons (tsp) of a food to the crushed ciprofloxacin.
    Stir them together until the drug looks evenly mixed with the food.
  3. Use the chart on the following page to find out how much of the mixture to give the child.

How Much of the Ciprofloxacin Mixture to Give a Child

  • The number of teaspoons of the ciprofloxacin mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart tells you how much to give a child for one (1) dose.
  • You should give the child two (2) doses each day. Give one (1) dose in the morning and one (1) dose in the evening for seven (7) days.
If the child weighs: Give the child:
4-5 pounds (lb) One-half (½) tsp (2.5 mL) of the ciprofloxacin mixture
5.5-10 lb One (1) tsp (5 mL) of the ciprofloxacin mixture
11-15 lb One and one-half (1½) tsp (7.5 mL) of the ciprofloxacin mixture
16-20 lb Two (2) tsp (10 mL) of the ciprofloxacin mixture
21-25 lb Two and one-half (2½) tsp (12.5 mL) of the ciprofloxacin mixture
26-30 lb Three (3) tsp (15 mL) of the ciprofloxacin mixture
31-35 lb Three and one-half (3½) tsp (17.5 mL) of the ciprofloxacin mixture
36-40 lb Four (4) tsp (20 mL) of the ciprofloxacin mixture
41-45 lb Four and one-half (4½) tsp (22.5 mL) of the ciprofloxacin mixture
46-50 lb Five (5) tsp (25 mL) of the ciprofloxacin mixture
51-55 lb Five and one-half (5½) tsp (27.5 mL) of the ciprofloxacin mixture
56-60 lb Six (6) tsp (30 mL) of the ciprofloxacin mixture [or one (1) tablet]
>60 lb Children heavier than 60 pounds who are exposed to plague should take one (1) 500-mg tablet of ciprofloxacin two (2) times a day (at the same time each day if possible) for seven (7) days. If the child cannot swallow tablets, use the directions for preparing a mixture and give six (6) teaspoons twice a day.

How Prepared Ciprofloxacin Mixture Should be Stored

  • Prepare the ciprofloxacin mixture daily.
  • Store the mixture in a covered container and refrigerate.
  • Mixture will keep for at least 24 hours refrigerated.
  • After 24 hours, throw away any unused portions.

Home Preparation for Emergency Doses of Doxycycline for Infants and Children Exposed to Tularemia

Once you have been notified by your federal, state, or local authorities that you have been exposed to tularemia, it may be necessary to prepare emergency doses of doxycycline for infants and children using doxycycline tablets.

You will need:
One (1) 100-milligram (mg) doxycycline tablet One of these foods:
  • chocolate syrup
  • maple syrup
  • caramel syrup
  • applesauce
  • unsweetened applesauce
  • jarred pureed baby fruit
Metal teaspoon
One (1) teaspoon (tsp) and one-half (½) teaspoon (tsp) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions:

  1. Put one (1) 100-mg doxycycline tablet into a small bowl.
    Crush the tablet with the back of the metal spoon until no large pieces are seen.
  2. Add four (4) level teaspoons of a food to the crushed doxycycline.
    Stir them together until the drug looks evenly mixed with the food.
  3. Use the chart on the following page to find out how much of the mixture to give the child.

How Much of the Doxycycline Mixture to Give a Child

  • The number of teaspoons of the doxycycline mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart tells you how much to give the child for one (1) dose.
  • You should give the child two (2) doses each day. Give one (1) dose in the morning and one (1) dose in the evening for 14 days.
If the child weighs: Give the child:
4-11 pounds (lb) One-half (½) tsp (2.5 mL) of the doxycycline mixture
12-22 lb One (1) tsp (5 mL) of the doxycycline mixture
23-33 lb One and one-half (1½) tsp (7.5 mL) of the doxycycline mixture
34-45 lb Two (2) tsp (10 mL) of the doxycycline mixture
46-55 lb Two and one-half (2½) tsp (12.5 mL) of the doxycycline mixture
56-65 lb Three (3) tsp (15 mL) of the doxycycline mixture
66-77 lb) Three and one-half (3½) tsp (17.5 mL) of the doxycycline mixture
78-88 lb Four (4) tsp (20 mL) of the doxycycline mixture [or one (1) 100-mg doxycycline tablet]
>88 lb Children heavier than 88 lb who are exposed to tularemia should take one (1) 100-mg doxycycline tablet two (2) times a day (at the same time each day if possible) for 14 days. If the child cannot swallow tablets, use the directions for preparing a mixture and give four (4) teaspoons twice a day.

How Prepared Doxycycline Mixture Should be Stored

  • Prepare the doxycycline mixture daily.
  • Store in a covered container and refrigerate.
  • Mixture will keep for at least 24 hours.
  • After 24 hours, throw away any unused portions.

Home Preparation for Emergency Dosages of Ciprofloxacin for Infants and Children Exposed to Tularemia

Once you have been notified by your federal, state, or local authorities that you have been exposed to tularemia, it may be necessary to prepare emergency doses of ciprofloxacin for infants and children using ciprofloxacin tablets.

You will need:
One (1) 500-milligram (mg) ciprofloxacin tablet One of these foods:
  • chocolate syrup
  • maple syrup
  • caramel syrup
  • unsweetened applesauce
  • jarred pureed baby fruit
  • ketchup
Metal teaspoon
One (1) teaspoon (tsp) and one-half (½) teaspoon (tsp) measuring spoons [NOTE: Measuring spoons are preferred, however if they are not available, use the metal spoon to grind, measure and give the medicine.]
One (1) small bowl

Directions

  1. Put one (1) 500-mg ciprofloxacin tablet into a small bowl.
    Crush the tablet with the back of the metal spoon until no large pieces are seen.
  2. Add six (6) level teaspoons of a food to the crushed ciprofloxacin.
    Stir them together until the drug looks evenly mixed with the food.
  3. Use the chart on the following page to find out how much of the mixture to give the child.

How Much of the Ciprofloxacin Mixture to Give a Child

  • The number of teaspoons of the ciprofloxacin mixture to give a child depends on the child's weight.
  • If the child's weight is unknown, weigh the child before giving the first dose.
  • The chart tells you how much to give a child for one (1) dose.
  • You should give the child two (2) doses each day. Give one (1) dose in the morning and one (1) dose in the evening for 14 days.
If the child weighs: Give the child:
4-6.5 pounds (lbs) One-half (½) tsp (2.5 mL) of the ciprofloxacin mixture
7-12.5 lb One (1) tsp (5 mL) of the ciprofloxacin mixture
13-18 lb One and one-half (1½) tsp (7.5 mL) of the ciprofloxacin mixture
19-24 lb Two (2) tsp (10 mL) of the ciprofloxacin mixture
25-30 lb Two and one-half (2½) tsp (12.5 mL) of the ciprofloxacin mixture
31-37 lb Three (3) tsp (15 mL) of the ciprofloxacin mixture
38-43 lb Three and one-half (3½) tsp (17.5 mL) of the ciprofloxacin mixture
44-49 lb Four (4) tsp (20 mL) of the ciprofloxacin mixture
50-55 lb Four and one-half (4½) tsp (22.5 mL) of the ciprofloxacin mixture
56-61 lb Five (5) tsp (25 mL) of the ciprofloxacin mixture
62-67 lb Five and one-half (5½) tsp (27.5 mL) of the ciprofloxacin mixture
68-73 lb Six (6) tsp (30 mL) of the ciprofloxacin mixture [or one (1) 500-mg ciprofloxacin tablet]
>73 lb Children heavier than 73 lb who are exposed to tularemia should take one (1) 500-mg ciprofloxacin tablet two (2) times a day (at the same time each day if possible) for 14 days. If the child cannot swallow tablets, use the directions for preparing a mixture and give six (6) teaspoons twice a day.

How Prepared Ciprofloxacin Mixture Should be Stored

  • Prepare the ciprofloxacin mixture daily.
  • Store the mixture in a covered container and refrigerate.
  • Mixture will keep for at least 24 hours refrigerated.
  • After 24 hours, throw away any unused portions.

References:

  1. Occupational Safety and Health Standards, 29 CFR 1910.120, Hazardous Materials, Hazardous Waste Operations and Emergency Response. United States Department of Labor-Occupational Safety and Health Administration Web site. April 3, 2006. Available at: http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9765. Accessed February 18, 2010.
  2. OSHA Best Practices for Hospital-based First Receivers of Victims from Mass Casualty Incidents Involving the Release of Hazardous Substances. OSHA Best Practices page. United States Department of Labor-Occupational Safety and Health Administration Web site. January 2005. Available at: http://www.osha.gov/dts/osta/bestpractices/html/hospital_firstreceivers.html. Accessed February 18, 2010.
  3. Concept of Operations Plan (CONOPS) for Public Health and Medical Emergencies. For Federal, State, and Local Planners page. U.S. Department of Health and Human Services Web site. March 2004. Available at: http://www.hhs.gov/disasters/discussion/planners/conops.html. Accessed February 18, 2010.
  4. Okumura T, Takasu N, Ishimatsu S, Miyanoki S, Mitsuhashi A, Kumada K, Tanaka K, Hinohara S. Report on 640 victims of the Tokyo subway Sarin attack. Ann Emerg Med. 1996;28(2):129-135.
  5. Macintyre AG, Christopher GW, Eitzen E Jr, Gum R, Weir S, DeAtley C, Tonat K, Barbera JA. Weapons of mass destruction events with contaminated casualties: effective planning for health care facilities. JAMA. 2000;283(2):242-249.
  6. Barbera JA, Macintyre AG. Jane's Mass Casualty Handbook: Hospital. Emergency Preparedness and Response. 1st ed. Surrey, UK: Jane's Information Group, Ltd; 2003.
  7. Hick JL, Hanfling D, Burstein JL, Markham J, Macintyre AG, Barbera JA. Protective equipment for health care facility decontamination personnel: regulations, risks, and recommendations. Ann Emerg Med. 2003;42(3):370-380.
  8. Hick JL, Penn P, Hanfling D, Lappe MA, O'Laughlin D, Burstein JL. Establishing and training health care facility decontamination teams. Ann Emerg Med. 2003;42(3):381-390.
  9. Markenson D, Redlener I. Pediatric Preparedness for Disasters and Terrorism: A National Consensus Conference-Executive Summary [Centers for Disease Control and Prevention Emergency Preparedness and Response Web site]. National Center for Disaster Preparedness. Columbia University, Mailman School of Public Health; 2003. Available at: http://www.bt.cdc.gov/children/pdf/working/execsumm03.pdf. Accessed February 18, 2010.
  10. Testimony Before the Children and Families Subcommittee of the Senate Committee on Health, Education, Labor, and Pensions, 107th Cong, 1st Sess (2001) (testimony of Joseph L. Wright, MD, MPH, FAAP on Behalf of the American Academy of Pediatrics). Available at: http://www.aap.org/advocacy/washing/Dr_Wright.htm. Accessed February 18, 2010.
  11. Oklahoma University College of Pharmacy and Oklahoma City-County Public Health Department. How to prepare medication for children.