Consider raised intracranial pressure if the child shows evidence of:

• Confusion
• Drowsiness
• Vomiting
• Headache (especially on waking)
• Focal neurology
• Personality change

Management

General measures

• Investigation should be considered only if it will contribute to management decisions
• Reduction of tumour bulk may improve symptoms e.g. cranial irradiation and chemotherapy. Occasionally a ventricular shunt may be appropriate and this should be discussed with a neurologist or neurosurgeon
• Symptomatic management may include analgesia (see pain section), antiemetics and steroids.
  The antiemetic of choice is cyclizine

Medication

Dexamethasone

Form

Tablet: 500µg; 2mg
Oral solution: 2mg in 5mL. Other strengths available as ‘specials’.
Injection: 4mg in 1mL: 3.3mg in 1mL. Can be given orally

Dose (oral/ IV over 3-5 minutes)

For headache: 1 month -12yr : 250µg/kg b.d for 5 days then reduce or stop.

Antiemetic - by mouth or IV

< 1 year: initial dose 250µg 3 times daily. This dose may be increased as necessary and as tolerated up to 1 mg 3 times daily,
1–5 years: initial dose 1mg 3 times daily. This dose may be increased as necessary and as tolerated up to 2mg 3 times daily,
6–12 years: initial dose 2mg 3 times daily. This dose may be increased as necessary and as tolerated up to 4mg 3 times daily,
12–18 years: 4 mg3 times daily.

For other symptoms associated with brain tumour: e.g. spinal cord compression – seek specialist advice.

Co-prescribing: consider antacids and anti-thrush treatment.

Contraindications and warnings: caution if renal disease, cardiac disease or cystic fibrosis. Avoid in cardiac insufficiency.

Licence: licensed for use in children but not as antiemetic.

Cyclizine

Form

Tablet: 50mg
Injection: 50mg in 1mL
Suppositories: available as ‘specials’ 12.5mg, 25mg, 50mg, 100mg

Dose (oral/SC/IV)

1 month–6yr: 0.5–1mg/kg up to t.d.s. ( max. single dose 25mg)
6–12yr: 25mg up to t.d.s.
12–18yr: 50mg up to t.d.s.

Dose (rectal)

2–6yr: 12.5mg up to t.d.s.
6–12yr: 25mg up to t.d.s.
12-18yr: 50mg up to t.d.s.

Dose (SC / i/v continuous infusion)

1 month-5yr: 3mg/kg/24h ( Maximum 50mg/24hrs)
6-12yr: 75mg/24h
>12yr: 150mg/24h

Cyclizine is compatible with drugs most commonly used subcutaneously including diamorphine.

Licence: Tablets licensed in children >6yrs