Childrens National app reduces anxiety of dosing pediatric meds

Saif Usman MD

The pediatric quick reference app was developed by the pediatric emergency medicine department at Childrens National Medical Center in Washington DC for quick and easy access to pediatric vitals, dosages, and equipment guidelines during acute or life threatening emergencies. As a provider, dealing with pediatric emergencies can be daunting even for an experienced clinician, especially when deciding what dose of medication to use or what rate to administer IV fluids.

Much of this anxiety can be related to the critical weight based dosing that has to be applied in the pediatric population. Enter the Pediatric Quick reference app which is quick and easy to use albeit with slightly limited topics.

User Interface

When you start the app you will be asked to accept the terms and conditions and then identify the patient by either weight or age and gender. This will form the basis for all recommendations of medication dosages, vitals ranges and equipment sizes based on 50th percentile of CDC growth charts. Entering weight as the parameter to make calculations would generally be more advisable rather than age and gender.

Clicking submit brings you to the main menu page with easy tabs in a grid format for quick access to the various subheadings such as medications, clinical situations PALS as shown.

Clicking on clinical situations brings you to a list of 10-12 conditions likely to be encountered in the emergency department. While the topics are limited, each condition has commonly used medications with dosage recommendations based on the demographic information you entered on starting the app which definitely makes it easy to choose medications and correct dosages without calculations. In some cases common side effects and things to watch for are also mentioned.

The med list tab lists commonly used medications, again with dosage recommendations based on your weight or age selection earlier and, free app or not, this is an extensive list and very useful. You can search for the med you need or scroll down to the medication. Clicking the med brings up the recommended dosage based on age or weight and clicking on the more information tab brings up more important information on that drug. Again, physicians should be confirming the dosages and recommendations are accurate before following them.

The PALS tab provides quick and easy access to American Heart Association PALS charts for pediatric cardiac arrest, bradycardia and tachycardia in pdf format which has a small font and has no option to zoom so is difficult to read.

The equipment tab has age-related recommendations for appropriate sizes of commonly used equipment such as ET tubes, NG tubes, central lines etc and you can easily scroll up or down for different ages.

The Children’s National tab brings you to an information screen for the Childrens National Hospital Center with phones numbers to call for physician to physician consultations, referrals and transfers, and a link to their website. This would be very useful for physicians in the DC metropolitan area for quick access, but maybe not as useful outside this area.

Of note, in most screens there is a small tab on the upper right corner which will bring you right back to the main menu without having to go back through previous screens which is very useful when navigating between the different tabs.

Evidence and literature used to support app

• At the bottom of the weight and age page there is a tiny disclaimer stating that a patient’s age or weight is estimated based on 50th percentile according to CDC growth charts.  The app description on the Google Play store states it was developed by Children’s National Medical Center physicians in the divisions of emergency and transport medicine. While this lends the app some credibility, it does not list the actual sources of their information and with the app providing detailed drug reference information and calculations this is a definitive oversight.

Healthcare providers that would benefit from the app

• Physicians — In general the people who would benefit the most from this app would be Emergency department physicians, pediatricians, family physicians, fellows and residents.