Optimizing Outcomes for Pediatric Infusion Therapy

Pediatric patients in need of infusion therapy face the same access barriers as their adult counterparts. But they also deal with the added challenges of finding sites of care and infusion providers that are accustomed to caring for children.

Robert Dracker, MD, MHA, MBA, CPI, medical director of Summerwood Pediatrics & Infusacare Medical Services in Liverpool, New York, spoke on these issues at the 2022 National Infusion Center Association (NICA) Annual Conference, held June 17 and 18, 2022, in New Orleans, Louisiana.¹

Dracker discussed considerations and developmentally appropriate interventions to promote high-quality, patient-centered pediatric infusion care. Dracker started with a question: “What is infusion medicine?” There is no standard definition, he said, so he crafted his own, drawing on his decades of experience in the field. Dracker defined this growing sector as, “the health care specialty involved with the clinical science and practice of administering parenteral fluids, medications, biologic, and cellular therapies to adults and children.”

Dracker also touched on the unique needs of children who will be receiving intravenous (IV) or parenteral medications. Compared with an emergency department visit or for a hospitalized child, outpatient infusion therapy is semielective and scheduled, allowing time to prepare the child for the therapy.

“This is a very difficult thing to do for a child in general,” he said. “A [provider] should explain the need for the therapy and obtain an informed consent in some cases, particularly with regards to some of the newer biologic therapies for diagnoses like eczema and psoriasis.”

He compared general therapy considerations with important concerns specific to dealing with pediatric patients, reminding health care professionals that children are not just tiny adults. Things to know and factor into the care include the age of the child and any developmental issues, how ill the child is (acute vs chronic), who is with the child at the visit, any preexisting conditions that could complicate the therapeutic intervention, and the child’s understanding of the treatment and informed consent.

Dracker spoke about the importance of establishing a relationship between a provider and the infusion site team; there must be open communication between both to address issues such as special needs of a particular patient, who will be monitoring the response and follow up labs, and how to partner medically with regards to new emerging therapies.

Dracker also noted that treating a child may raise the anxiety of the medical team, so a collaborative approach is helpful, especially at the start of the therapy. He stressed that an open, interactive relationship between the provider's practice and the therapy site is critical for care.

“There should obviously be communication between both regarding currently available and emerging therapies, the needs for prior authorization, follow-up lab work required, and the fact that the infusion center staff will commonly see the patient during treatment more often than the dermatologist, which means that the response to treatment, or lack thereof, should also be conveyed back to the referring office,” he said.

Providers can take steps to prepare children for treatment in this environment by familiarizing the child with the environment, explaining each step of the process, and surrounding them with love, affection, and even “bribes” such as cartoons, books, and snacks.

In general, parents are fairly motivated to ensure that their child receives their therapy on a scheduled basis. It is important to provide a reminder to parents for an upcoming appointment with regards to date and time. Dracker also urged infusion providers to make an attempt to accommodate a child’s needs, especially related to school and activities.

Dracker also touched on vascular access issues in pediatric patients, the importance of being honest with children, and steps the FDA is taking to ensure access to safe and effective medical products for children.

At the conclusion of his talk, Dracker shared his hope that attendees could walk away with the understanding that children have special needs when it comes to infusion therapy treatments and that in many ways, these providers are treating a whole family—an experience that can be positive or negative depending upon the efforts made and the accommodations provided.

Reference

1. Dracker R. Not just tiny adults: considerations for a pediatric population. Presented at: 2022 National Infusion Center Association Annual Conference; June 17-18, 2022; New Orleans, LA.