Doctors and health professionals now have access to what has been described as the most comprehensively researched source of information on paediatric medicines in the world. The British National Formulary for Children (BNF for Children) published in September 2005 covers all aspects of prescribing practice for children from birth up to the age of 18.
Those prescribing for children and babies have had a poor deal with reliable guidance on safe prescribing practice. For ethical reasons, children have rarely been involved in drug trials. But by protecting children from the risks of trials, many adult drugs have not been licensed for use in children. As a result, those prescribing for children have been left without manufacturers' guidance on drug use and without easily accessible published evidence. Decisions on how best to use drugs and to calculate doses for children have frequently had to be made with support from only scant research evidence that is often hard to find and the experience and accepted practice of peers.
The publication of the BNF for Children will transform doctors' prescribing for children by giving them immediate access to expert advice and guidance on all aspects of paediatric prescribing. The guide is a comprehensive information source and covers newborn babies to 18 year olds. It offers a range of advice, from choosing the best available drug to specific doses and formulations—information doctors and healthcare professionals usually have to research from many different sources. This means that instead of having to search the literature or rely on their own or colleagues' experience or judgment, doctors now have the very latest advice at their fingertips.
For children and their parents this can only be good news. GPs and specialists alike can refer to a standard work that confirms their prescribing practice or alerts them when their own prescribing practice is at odds with the advice of experts. It offers clarity on off license prescribing issues and insight into correct dosing.
The BNF for Children generally follows the standard layout style and size of the British National Formulary, but there are some important differences. Firstly, the general guidance section is in single columns rather than two; this makes it easier to read. The guidance includes a great deal of advice that goes beyond the product licence information. The general guidance includes prescription writing, supply of medicines and drug treatment in children and also incorporates prescribing in hepatic impairment, renal impairment, pregnancy and breast feeding, as well as palliative care. Each part covers relevant issues to be considered in the prescribing and supply of medicines for children. There is also a set of notes giving an overview of treatment of poisoning and recommends consultation with poisons information centres. Information on drugs is presented in the usual BNF chapter format and this helps the reader to find the dose information for each age group.
The BNF for Children contains a wealth of information on dosage, availability, clinically relevant excipients, kinetics, and toxicity of medicines in children which could otherwise be difficult for a prescriber to find.
The guidance on safe medication practice contained in the BNF for Children has brought together two main sources—the British National Formulary and the Royal College of Paediatric and Child Health's guidance Medicines for Children—with additional research conducted specifically for the publication of the formulary. These two sources have been validated against the emerging evidence base of medicines for children and with expert guidance on best practice from a wide ranging network of clinical experts led by Dr George Rylance of the Royal College of Paediatricians. The expert advisers in different specialties worked to create consensus on best prescribing practice. They paid particular attention to treatments of children suffering from rare conditions and who were being prescribed medicines off licence.
The compilation of this reference work also involved research input from an editorial team led by Ian Costello at the BNF, who searched for information about the use of medicines in children beyond standard sources. These sources included the literature, systematic reviews, consensus guidelines, reference works, statutory information, comments from readers, and comments from the industry.
The publication is part of a wider UK government strategy to develop a research network for medicines for children and will serve in the years to come to identify gaps where further research is needed. The BNF for Children will play a key part in a European initiative, led by the UK, to develop more treatments for children and expand research and information in the field.
The BNF for Children has been jointly published by the Royal Pharmaceutical Society, the British Medical Association, and the Royal College of Paediatrics and Child Health with the Neonatal and Paediatrics Pharmacists Group. It will be updated on an annual basis. It has been purchased by the four departments of health in the UK and will be distributed to all healthcare professionals involved in the care of children.