Children's medicines

In partnership with organisations representing health professionals, children and young people, and parents and carers, the College manages and supports projects in paediatric medicines. 

Row of babies sitting

On this page:

Programmes of the Medicines Committee

The Medicines Committee is a unique collaborative standing committee with membership split between the RCPCH and Neonatal and Paediatric Pharmacists Group (NPPG). The Committee's key work areas are:

  • British National Formulary For Children (BNFC) - Input into policy issues and support production of future editions
  • Consultation - Respond to consultation documents from the Government and outside agencies, including the National Institute of Clinical Excellence (NICE)
  • Lobbying - Advise and support external agencies and parental bodies about licensing, availability, use and surveillance of medicines in paediatric populations, including medicines used outside of the license, newly licensed products, unlicensed medicines for rare conditions and adverse reactions to medicines
  • Medicines for Children information for parents and carers - provides practical and reliable information on, with leaflets covering more than 100 medicines, instructional films on giving medicines to children and latest news
  • Medicines for Children Research Network (MCRN) - supporting research opportunities and implications for practice to improve the coordination, speed and quality of randomised controlled trials and other well-designed studies of medicines for children and young people; the MCRN is one of six research networks managed by the UK Clinical Research Network (UKCRN)
  • Education and training resources 

For more information about the Committee, email

MEDUSA: Injectable Medicines Guide

September 2017

RCPCH-endorsement-logo-WEB.gifThe injectable medicines guide (IMG) multidisciplinary advisory group led by Imperial College Healthcare Trust have developed an Injectable Medicines Guide, a web-based resource, also known as Medusa. It is hosted by the NHS Wales Informatics Service and can be accessed via the internet or downloaded and made available through an organisation’s intranet.

Medusa provides guidance on the preparation and administration of injectable medicines, in adult and paediatric clinical areas with links, if appropriate, to local practice guidelines. It currently contains over 400 monographs for medicines given by the intravenous (IV) route.

Since 2013, the Neonatal and Paediatric Pharmacist Group (NPPG) provided funding to review all monographs for medicines used in children and/or neonates to ensure content reflects good practice in this clinical area. All monographs are checked for accuracy and for consistency with IMG Writing Guidelines by a regional Medicines Information (UKMI) centre. In organisations where Medusa is used a paediatric pharmacist will be involved in reviewing and commenting on updated monographs before they are published.

The RCPCH endorses the use of Medusa and their monographs on the preparation and administration of injectable medicines for use in paediatrics.

Medusa is accessible via

N NNNPPG update on ENFit syringes

Enfit connectors have been introduced around the world to help prevent wrong route administration. If used correctly the low dose syringes are more accurate than the current syringes. For doses less than 1ml it is important to ensure the hub at the end of the syringe is empty before administration to prevent significant dosing errors.

ENFit is the name assigned to the connectors for enteral application as outlined in the newly released ISO standard 80369-3. The aim of this standard was to reduce the risk of misconnections of incompatible routes of infusion such as IV to enteral, breathing gases to IV, neuraxial to enteral, etc. 

Each connector that falls under the ISO specification must not be compatible with another connector design within the series, and any proprietary connectors developed by manufacturers must not be compatible with any of the connectors in the series.
The low dose tip – LDT – design was introduced following performance and accuracy testing carried out by the Global Enteral Device Supplier Association (GEDSA), which demonstrated that volumes of 0.2ml or less administered via 1ml syringe could deliver accuracy within ± 10% which is in line with the requirements of ISO 7886-1 complaint (male luer) syringes when used in accordance with the manufacturer’s instructions. The ± 10% target was given by clinicians and pharmacists. 

It is important to note that this performance is an advancement on the performance of the reverse luer sequencing (female luer syringes) which have been in use for enteral application in the UK prior to July 2016. 
You may also find info on the PENG (The Parenteral and Enteral Nutrition Group) website helpful: links to support resources for ENFit implementation.

See the accompanying document: NPPG Newsletter. (PDF, 228KB, 4 Pages)

Use of domperidoneGroup of children kneeling

Following guidance from MHRA, NICE and recommendations included in the BNF-C, NPPG has produced a statement on the use of domperidone in infants and children.

The statement can be viewed via the NPPG homepage under 'What's new'

Use of codeine

As of June 2013, the MHRA advise that codeine should not be used in any child with a history of sleep apnoea who is undergoing tonsillectomy or adenoidectomy and that codeine should only be used in children over the age of 12 years. This guidance outlines potential alternatives.

Codeine statement - RCPCH, NPPG, RCoA and APAGBI (PDF, 112KB, 5 pages) - updated May 2014

Major trauma and the use of tranexamic acid in children

This statement produced jointly by members of the RCPCH/NPPG Medicines Committee and the Clinical Standards Committee is intended to provide guidance on the dose of tranexamic acid (TXA) in major trauma to ensure consistency with adult trauma. The statement should not preclude the development of suitable robust research studies in this area to improve knowledge.

Major trauma and the use of tranexamic acid in children (PDF, 53KB, 4 pages) - November 2012

Improving practice and reducing the risks of using parenteral nutrition for children

This report will help practitioners from all professions improve practice and reduce the risks in the provision of parenteral nutrition (PN) for children and neonates.

The chief pharmacists from specialist children’s hospitals and the Paediatric Chief Pharmacists Group along with input from the RCPCH, scoped current practice across the UK and made recommendations to improve practice and reduce risks in the provision of PN for neonates and children.

View report on the Royal Pharmaceutical Society website - November 2011 

Use of unlicensed medicines

Children's medicines are regularly provided off-licence (where the medicine does not have a license for use in children) or off-label (where the medicine is used in a different way than that described in the license).

This statement, produced by the Medicines Committee, informs and guides health professionals, health service managers, and parents and carers who prescribe, dispense, administer or have responsibility for medicines for children.

Unlicensed medicines statement (PDF, 38KB, 4 pages) - December 2013

Paediatric prescribing tool

This training tool was developed by a small working group from RCPCH and NPPG as a rapid response to critical incidents of gross prescribing errors affecting children.

Tested by about 40 practitioners, it is based on best practice and similar tools in use. The tool alerts supervising consultants when a staff member needs extra support for paediatric prescribing.

More information and download tool - including scenarios, assessor's sheet and teaching presentation

SCRIPT safe prescribing toolkit

SCRIPT is an innovative eLearning toolkit designed to support newly qualified doctors to encourage safe, effective and appropriate prescribing practice across a wide range of crucial therapeutic areas.

More information

For more information, contact the Research Projects Team.