Manipulation of drugs to achieve the required dose is intrinsic to paediatric practice but is not supported by guidelines or evidence

Table 1 Definitions of manipulations for each dosage form

Drug dosage form	Manipulation for dose accuracy includes
Tablet	• split/broken/cut and a segment given
	• crushed and a proportion of the powder given
	• dispersed in liquid and a portion of the liquid given
Capsule	• opened, dispersed in liquid and a proportion of the liquid given
Capsule	• opened and a portion of the powder given
Sachet (powder)	• opened, dispersed in liquid and a portion of the liquid given
Sachet (powder)	• opened and a proportion of the powder given
Oral liquid	• diluted and a proportion given (to make the measurement of a small dose volume easier)
Suppository	• cut/split and a segment given
Nebuliser solution	• portion given
Nebuliser solution	• diluted and a proportion given
Enema/bladder irrigation	• proportion of sachet/unit given (the remainder then discarded)
Enema/bladder irrigation	• portion of contents removed and the remainder given
Transdermal patch	• patch cut and a portion applied
Transdermal patch	• portion of patch uncovered and applied
Intravenous injection	• reconstituted or ready prepared solution, further diluted to allow a smaller dose to be measured,
Intravenous injection	• volume of fluid removed from IV container, drug added (to obtain accurate concentration for infusion)
	• drug added to infusion bag, portion with smaller dose removed and infused

ISSN: 1471-2431