Introduction and purpose One in ten prescriptions for children in primary care is for an unlicensed or off-label medicine which can lead to an unsuitable formulation. Manufacture of “specials” is a major issue with significant cost implications. Doctors and health care professionals at all levels of training are often unaware of the licensing requirements for paediatric drugs and the implications of these, but there is little information assessing their knowledge.

Method Health care professionals attending a paediatric continuing professional development afternoon were invited to complete a questionnaire at the start of the session. The participants were asked to provide five definitions related to the prescribing of children’s medicines: 1) Off-licence, 2) Off-label 3) Specials, 4) NICE approved and 5) Marketing authorisation. The answers were analysed as to whether they were correct, partly correct or incorrect/unknown according to standard definitions. Ethics approval was not necessary.

Results 36 questionnaires were distributed and 32 (89%) were returned from 12 paediatric consultants, 9 paediatric trainee doctors, 4 senior paediatric nurses and 7 pharmacists. Participants were asked to provide 5 definitions each, giving a total of 160 potentially correct answers.

There were also differences in the ability to define the definitions. There was particularly poor understanding of the term “special”. 50% of consultants were able to define it adequately, yet no doctors in training were. The pharmacists had the best understanding.

Conclusion There is limited knowledge regarding paediatric prescribing amongst all levels of doctors, but most worryingly the junior doctors who do not understand when they are prescribing off -label or off-licence drugs. They are unlikely to be aware when they are prescribing a “special” and therefore unaware of the problems the child and family may have obtaining it, the variations in the formulations’ pharmacokinetics, and the cost. The paediatric consultants fared a little better, but have gaps in understanding. Doctors’ lack of knowledge regarding paediatric prescribing needs to be addressed. The strength of paediatric pharmacists’ knowledge could be utilised more to guide doctors in prescribing the most suitable and cost-effective formulations for children.