All pediatric dosing begins with an accurate weight in kilograms. Always weigh the child — never estimate from appearance or use a parent-reported weight for medication dosing. A 10 kg child given a 15 kg dose of a medication with a narrow therapeutic index can be lethal.
Step-by-step pediatric dose verification: (1) Get the ordered dose in mg/kg/dose or mg/kg/day. (2) Multiply by the child's weight in kg to get the total dose per administration. (3) Compare to the safe dose range from your drug reference. (4) Calculate the volume using the available concentration. (5) Independent double-check with another nurse for high-alert medications.
Example: Amoxicillin 40 mg/kg/day divided every 8 hours for a 22 kg child. Total daily dose = 40 × 22 = 880 mg/day. Per dose = 880 ÷ 3 = 293 mg per dose. Safe range for amoxicillin: 20–90 mg/kg/day — 40 mg/kg/day is within range. Available: 250 mg/5 mL suspension. Volume = 293/250 × 5 = 5.9 mL per dose.
| Medication | Typical Pediatric Dose | Maximum Single Dose | Key Nursing Notes |
|---|---|---|---|
| Acetaminophen (Tylenol) | 10–15 mg/kg every 4–6 hours | 75 mg/kg/day (max 5 doses/24hr) | Most common OD in children from caregiver overdosing; confirm weight-based dose; do not exceed 5 doses/day regardless of pain level |
| Ibuprofen (Motrin) | 5–10 mg/kg every 6–8 hours | 40 mg/kg/day; 400 mg/dose | Use only in children ≥6 months; give with food; avoid in dehydrated or renally impaired children |
| Amoxicillin | 40–90 mg/kg/day ÷ every 8–12 hours | 500 mg/dose (standard); 875 mg/dose (high-dose) | Higher end of range for S. pneumoniae coverage; confirm indication before using high-dose regimen |
| Ceftriaxone | 50–100 mg/kg/day ÷ every 12–24 hours | 4 g/day (meningitis); 2 g/day (other) | Never give with calcium-containing IV fluids in neonates (fatal precipitate); confirm no concurrent calcium infusion |
| Morphine | 0.05–0.1 mg/kg IV/SubQ every 2–4 hours PRN | 0.1–0.15 mg/kg per dose; titrate to effect | High-alert medication; independent double-check required; monitor respiratory rate and sedation; have naloxone at bedside |
| Ondansetron (Zofran) | 0.15 mg/kg IV over 15 min every 4 hours | 4 mg/dose (<40 kg); 8 mg/dose (≥40 kg) | QT prolongation risk; check ECG if other QT-prolonging medications are being given |
| Dexamethasone | 0.15–0.6 mg/kg depending on indication | 10 mg/dose for croup or post-extubation | Wide dose range by indication — confirm indication before verifying safe dose; croup dose differs from anti-emetic dose differs from anti-inflammatory dose |
| Age Group | HR (bpm) | RR (breaths/min) | SBP (mmHg) | Weight (kg approx) |
|---|---|---|---|---|
| Neonate (0–30 days) | 100–160 | 30–60 | 60–90 | 2.5–4 |
| Infant (1–12 months) | 100–160 | 25–50 | 70–100 | 4–10 |
| Toddler (1–3 years) | 90–150 | 20–40 | 80–110 | 10–14 |
| Preschool (3–5 years) | 80–140 | 20–30 | 80–110 | 14–20 |
| School age (6–12 years) | 70–120 | 15–25 | 85–120 | 20–40 |
| Adolescent (12–18 years) | 60–100 | 12–20 | 90–130 | 40–70+ |
Broselow Tape: The Broselow Pediatric Emergency Tape estimates weight from height and provides color-coded pre-calculated medication doses, equipment sizes, and defibrillation energy. It is the standard rapid-reference tool in pediatric emergencies when weight cannot be quickly obtained. Accuracy is good for patients between 3–34 kg. Always verify with actual weight as soon as possible.
The formula for minimum acceptable systolic blood pressure by age: 70 + (2 × age in years). A 4-year-old has a minimum acceptable SBP of 70 + (2×4) = 78 mmHg. Below this threshold, the child is in decompensated shock regardless of other clinical appearance. Hypotension in children is a late and ominous sign — tachycardia and poor perfusion precede hypotension by a significant margin.
Oral liquid medications for children must be measured using a calibrated oral syringe — never a household teaspoon (highly inaccurate) or a measuring cup. A "teaspoon" instruction on the bottle should be converted to mL for precise dosing (1 tsp = 5 mL). All liquid medication doses should be expressed in mL in the medication administration record and confirmed against a calibrated oral syringe.
Related guides: Pediatric nursing | Dosage calculations | Neonatal nursing | Medication routes
This article is general educational information for licensed clinicians and students, not medical advice or a substitute for your institution's protocols, pharmacy guidance, or a provider's orders. Always follow facility policy and verify doses independently.
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