From Neuropathy to Burns, Exploring the Use of Lidocaine in Pediatrics and the Role of Pharmacists
Lidocaine has always been a trusted and reliable medication—so reliable, in fact, that there’s no question regarding its use in vulnerable children. Children’s hospitals recommend it for peripheral neuropathy, not to mention its obvious use as an anesthetic and to relieve everyday rashes and bug bites, but recent studies point to other vital uses for this versatile compound. Pharmacists take on a critical role for protecting the health of these young patients. Medication review and parent counseling are essential to ensure appropriate dosing and to teach parents how to properly apply the medicine.
Diabetic Neuropathy in Children
Clinical diabetic neuropathy is rare in children, but subclinical neuropathy is quite common. About half of all children whose type 1 diabetes has lasted five years or longer, and up to 25 percent of those with newly diagnosed diabetes, have subclinical neuropathy.1 Diabetic Neuropathy in Children published a small study in which 45 children who had type 1 diabetes for an average of seven years received neurological examinations, nerve conduction tests and quantitative sensory testing. The results offer interesting details:2
- Mechanical hypoesthesia was found in 38 percent of the children.
- Thermal hypoesthesia occurred in 25 percent.
- Mechanical and thermal hypoesthesia were associated with a heightened sense of pain in 47 percent of the subjects.
- Tactile hypoesthesia occurred in 33 percent of subjects.
- Tactile hypoesthesia was the most predictive for neuropathies found following nerve conduction tests.
- Nerve conduction tests were abnormal in 31 percent of the children.
Even though the American Diabetes Association recommends annual screenings for neuropathy beginning around puberty, the healthcare community faces a lack of scientific data to guide decisions. Screening methods frequently being used aren’t the most reliable, but they’re the best option available to pediatricians, according to an April 2014 study published in Pediatrics.3
Pharmacist counseling: When you counsel parents filling prescriptions for antidiabetic agents, talk to them about subclinical diabetic neuropathy. Ask whether their children are being screened and encourage them to consult a pediatric endocrinologist, who is more likely to have better diagnostic tools. These key points should be part of the conversation:
- Children may not complain about pain, yet have subclinical neuropathy.
- Symptoms such as numbness, tingling, aching, loss of balance, and dysfunction in extremities should be evaluated.
- Subclinical neuropathy increases the risk of severe complications such as foot ulcers.
- Parents should ask their pediatrician to use a 10-g monofilament instead of the more common 1-g monofilament.
- Biothesiometry is the gold standard for testing pediatric diabetic neuropathy.
- Topical lidocaine is recommended for pain relief in the pediatric population.
Benefits of Lidocaine for Other Pediatric Uses
Topical lidocaine 5 percent is a first-line choice for the treatment of neuropathic pain from many causes. Although research in children is sparse, a study published in Pain Medicine reported positive results when children with peripheral neuropathy from burn sequelae, such as hypertrophic scarring, keloids, contractures and pruritus, were treated with a 5 percent lidocaine plaster.  While the study was small—only 12 children were treated—they all experienced rapid pain relief. Within one week, the mean FACES Pain Scale scores were reduced by half. After three months of treatment, their overall functioning and quality of life improved. Topical lidocaine treatments allowed them to become more active, they slept better and they could tolerate touching the affected area. Even better, no systemic or local adverse effects were reported.4
While lidocaine should never be used for teething pain, lidocaine gel is safe and effective in over 97 percent of children with oral cavity pain.5 Most studies on pediatric uses of lidocaine relate to the hospital setting, determining efficacy in various medical procedures. One interesting example is its use for status epilepticus, a medical emergency estimated to strike 18 to 23 per 100,000 children.6 These prolonged and recurrent seizures cause death in two to seven percent of these kids, so prompt administration of the appropriate anti-seizure medication is life-saving. In pediatric patients already receiving phenytoin, seizures stopped in 60 percent after intravenous lidocaine was introduced.7
Tips for Pharmacist Outreach
In addition to neuropathy, topical lidocaine is a good treatment option for children needing relief from sunburn, insect bites, dermatitis, pruritus, minor cuts or a sore throat. Some children find it helpful in overcoming their fear of needles, with an area being numbed before a planned blood draw or immunization. Sometimes your job is to help parents choose the best OTC product. Other times, it’s essential to educate parents about adherence and using the drug, or you may need to recommend consulting their doctor for a different dose or form.
- Delivery form: Parents may be considering an OTC cream, but younger children will find better results with a patch or plaster, which ensures the proper dose compared to the risk of over- or under-application of a lotion or cream. You may want to recommend specialized delivery vehicles, like the OTC topical liposomal formulation, LMX-4, which is rapidly absorbed and has a longer anesthetic effect.
- Monitor doses: When lidocaine is prescribed for children, the dose is individualized. Monitor prescriptions for your young patients, verifying that the dose is accurate for their body weight—four percent creams and five percent ointments should not exceed 4.5 mg per kg of weight.8 Also make sure that the delivery base and dose prescribed are appropriate for the skin thickness in the area where it will be applied.
- Mix multiple meds: Ask parents about how well the medication is working and discuss with them ways to boost efficacy. Their physician may need to prescribe other pharmaceuticals to be included with the lidocaine, such as amitriptyline.
Pharmacist Counseling Yields Optimal Results
Lidocaine’s versatility makes it the treatment of choice for a variety of medical conditions, which subsequently gives pharmacists multiple opportunities to interact with all patients. But when your patients are children, it’s vital to be proactively involved to know they receive the appropriate dose in the best form to ensure optimal results. Whether the lidocaine is OTC or prescription, develop and implement a protocol that establishes medication management for these young, susceptible patients.
Pharmaceutica North America provides Lidocaine Ointment USP, 5 percent PAK in convenient two, four and eight unit packages. We also offer high-quality lidocaine as a Bulk Active Pharmaceutical Ingredient. Contact us today to talk about how we can support the pharmaceutical needs of your patients.
- “Diabetic Neuropathy in Children,” 2014, http://www.ncbi.nlm.nih.gov/pubmed/25410219 ↩
- “Childhood Diabetic Neuropathy: Functional Impairment and Non-invasive Screening Assessment,” November 2012, http://www.ncbi.nlm.nih.gov/pubmed/22507184 ↩
- “Common Tests May Miss Pediatric Diabetic Neuropathy,” April 2014, http://www.medscape.com/viewarticle/823521 ↩
- “Five Percent Lidocaine Medicated Plaster Use in Children with Neuropathic Pain from Burn Sequelae,” March 2013, http://painmedicine.oxfordjournals.org/content/14/3/422.long ↩
- “Efficacy and Safety of a Lidocaine Gel in Patients from 6 Months up to 8 Years with Acute Painful sites in the Oral Cavity: A Randomized, Placebo-Controlled, Double-Blind, Comparative Study,” November 2015, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677000/ ↩
- “Management of Status Epilepticus in Children,” April 2016, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4850470/ ↩
- “Lidocaine for Status Epilepticus in Pediatrics,” November 2015, http://www.ncbi.nlm.nih.gov/pubmed/26303341 ↩
- “Lidocaine, Topical,” accessed July 2016, https://www.drugs.com/dosage/lidocaine-topical.html ↩