Infant Motrin? I think Not

This week I read an article by Novak and Allen: “Prescribing Medications in Pediatrics: Concerns regarding FDA approval and Pharmacokinetics”. The pediatric population is one that I am familiar with and enjoy working with the most. That being said this weekend I was exposed to some other than stellar medical care which made me think about what I would do if the tables where changed.



Brief story: I was working as an agency nurse this weekend in an ED and was asked to give a 10 week old Motrin (weight based dose 5o mg po) due to fever. Motrin is a drug that I have been taught not to give under 6 months of age. So I decided to one assess the patient myself then make a decision on the order. I went into the triage area to find a 10 wk old baby wrapped in numerous blankets. I asked the parents to unwrap the child and have only a light blanket to hold the infant with. I then passed by the triage nurse (engrossed in her computer, charting I am sure) and spoke with the ED MD who had written the order without assessing the child. I asked if he knew that the patient was a 10 wk old child. And he said yes and he felt comfortable giving the medication. I handed him the drug and asked if he wanted to administer it. To which he replied he never does. I explained that the child was wrapped in many blankets and suggested rechecking the temp after being unwrapped and doing a physical assessment and history. I then informed the busy triage engrossed in the computer (still charting I am sure, although she had no patients to triage) that I was not comfortable giving the drug nor would I. I then tried to pull up information regarding Motrin use and infants. As I suspected the FDA has not approved its use for those under age 6 months.

Fast forward to this article. Several key points where discussed. One of the first statements included that “Off-label” use of medications still required rationale scientific theory, sound medical judgment or data from controlled trails. This is of key importance to me. I highly doubt a nurse who is engrossed in her computer did a sound history enough to understand when the patient actually last had Tylenol or thought to unwrap the infant from the many blankets before urging the MD to give her a verbal order, to which she felt too busy to administer herself.

Novak and Allen also point out that although the Harriet Lane book is often differed to for appropriate children dosing, although  some medications described are also not approved by the FDA.

I reviewed my own pediatric dosage handbook by Lexi-comp and again it stated the safety and efficacy had not been established for infants younger than 6 months. Not that this information alone would stop me, but say the infant had an undiagnosed Patent Ductous Arteriousus. The lack of assessment and random administration of a drug without complete history and assessment puts the patient at risk.
At the end of the article this simple statement was made: "prescribing medication to children is one of the most complex and potentially dangerous functions pediatric advance practice nurses perform” (Novak& Allen, 2007, pp.69). I realize that my time on the ED floor is coming to an end, and that I will eventually be on the other side of care. But what seems most important to me is actually assessing the patient and determining the efficacy of treatment. In addition I think referring to professional colleges who have more sage knowledge in specific areas is also important. Never forget your resources. As far as my role currently as an ED nurse, I will continue to question orders I feel where written without precedence and hope that I can teach other nurses who may not be as vocal as I to also use sound judgment and assessment.


Novak, E. & Allen, P.J. (2007). Primary care approaches: prescribing medications in pediatrics: concerns    regarding FDA approval and pharmacokinetics. Pediatric Nursing, 33 (1), 64-70.

Taketomo, C., Hodding, J. & Kraus, D. (2009) Ibuprofen . In Taketomo, C., Hodding, J. & Kraus, D. (Eds.), Pediatric Dosage Handbook (pp. 899-902) Hudson OH: Lexi-comp.