Aims The need to manipulate some dosage forms to deliver a suitable dose of a drug to infants and children is well recognised and established in paediatric practice.^{1 2} The aim of this project was to produce best practice guidance on how healthcare professionals, working in neonatal and paediatric in-patient clinical areas, can obtain a required dose, where no suitable formulation or alternative product exists.

Methods The guidelines were informed by a number of work streams, undertaken under the umbrella of the MODRIC (Manipulating Drugs in Children) project. The evidence from a systematic review of the literature, an observational study of manipulations in clinical practice and a national survey of the experience of paediatric nurses in manipulating medicines, was reviewed and supplemented with the expertise of a guideline development group to develop an acceptable guideline.

Results This guideline describes situations where medicines should not be manipulated and has recommendations on avoiding manipulation (such as by procuring the appropriate dosage forms or using dose rounding where appropriate). Where a manipulation is considered necessary, recommendations have been developed for different dosage forms. In addition recommendations to the regulator, to industry and to inform further research have been included.

Conclusions The use of this guideline will raise awareness about drug manipulation in paediatric and neonatal care settings and offer guidance for undertaking manipulations if they cannot be avoided. It is intended that the guideline will be used to inform hospital Medicines Management Policy on manipulation of medicines.