Normal Length and Weight of Children
|Age||Length (cm)||Weight (kg)|
Normal Reference Values for Children
|Respiratory Rate||Blood Volume||Hgb-values
|Newborn||100-180||60/35 (MAP 40-45)||40-60||85 ml/kg||150-180|
|0-6 months||100-160||60-90/30-60||30-60||85 ml/kg||90-100|
|6-12 months||100-160||80-95/45-65||25-50||85 ml/kg||100|
|1-2 years old||100-150||85-105/55-65||25-35||80 ml/kg||100|
|School age (7-12)||65-110||95-115/55-70||18-30||75 ml/kg||110-120|
|Teen Age||60-90||110-130/65-80||12-16||75 ml/kg||120-130|
Target values for blood pressure in children in general anesthesia (MAP in mmHg)
|> 14 years||58-65||73|
This doses calculator was constructed by Carina Malmqvist Head Nurse of Intensive Care. Sahlgrenska University Hospital.
and Sara Eriksson Nurse of Intensive Care. Sahlgrenska University Hospital.
Enter the weight of the child and get recommended drug doses for anesthesia.
|HEADER||Patient data (date of birth - age)||EMPTY||EMPTY|
|SECTION||Drugs - Injections||EMPTY|
|HEADER||Name||Standard dosage||Concentration||Dose in mg||Dose in ml||Notes|
|CALC1||Adrenaline (Epinephrine)||0,01 mg/kg||0,1 mg/ml||In acute situations!|
|CALC1||Atropine||0,01 mg/kg||0,5 mg/ml|
|CALC1||Fentanyl||2 µg/kg||50 ug/ml||N.B.! dose in µg!|
|CALC1||Midazolam||0,1 mg/kg||1 mg/ml|
|CALC1||Morphine||0,1 mg/kg||1 mg/ml|
|CALC1||Naloxone||0,02 mg/kg||0,02 mg/ml|
|CALC1||Propofol||2 mg/kg||10 mg/ml||>3 years of age|
|CALC1||Rocuronium||0,6 mg/kg||10 mg/ml|
|SECTION||Tidal volume in the ventilator||EMPTY|
Medications at cardiac arrest in children
|Age||0||3 months||1 year||5 years||9 years||12 years||14 years||15 years and older|
|Weight||3 kg||5 kg||10 kg||20 kg||30 kg||40 kg||50 kg||> 50 kg|
|Epinephrine (0,1 mg/ml)* 0,01 mg/kg, 0,1 ml/kg||0.3||0.5||1||2||3||4||5||10||ml|
|Amiodarone (15 mg/ml)* 5 mg/kg, |
|Glucose 100 mg/ml, 2 ml/kg||6||10||20||40||60||80||100||ml|
|Ringer's Acetate 20 ml/kg||60||100||200||400||600||800||1000||ml|
|Tribonate (0,5 mmol/ml) 2 ml/kg||6||10||20||40||60||80||100||100||ml|
|Defibrillation 4 J/kg||12||20||40||80||120||150-200||150-200||150-360||J|
|Endotracheal tube inner diameter||3||3.5||4||5||6||7||7||7||mm|
|*Amiodarone 50 mg/ml. 6 ml diluted with 14 ml glucose 50 mg/ml = 15 mg/ml|
Drugs delivered during CPR
- Epinephrine 0.01 mg/kg imediately
- Repeat every four minutes
At VF/pulseless VT:
- Epinephrine 0.01 mg /kg after third defibrillation. Repeat every four minutes.
- Amiodarone 5 mg/kg after third defibrillation.
- Repeat the same dose after the fifth defibrillation.
Correct reversible causes
- Cardiac tamponade
- Pressure pneumothorax
- Toxic conditions
- Thromboembolic events
Fasting for children before general anesthesia:
- 6 hours of fasting on anything but clear liquids (2 hours)
- Prior to the age of 6 months, 4 hours apply to breast milk (compensation?)
- If breastfeeding after 6 months of age: (4 or 6 hours of fasting?)
- Ice cream is not considered a clear liquid.
Some practical anesthesia routines:
- Only one (1) parent accompanies to the operating room if the child is over 4 months.
- Limit for outpatient care: 3 months of age (corrected age).
- Atropine given only on specific indication
- Always endotracheal tubes with a cuff
- Endotracheal tube positioning (cm from lips) = patient length (cm)/10 + 5. Nasal: + 20%
- Recommended concentration of Propofol is always 5 mg/ml, lidocaine is not required
- Volume pumps (20 kg limit), no children’s units
- Often TIVA mode for children but never TCI <16 years of age
- A lot of topical anesthesia (transdermal) EMLA, even newborn.
Some common anesthetic procedures for children:
- Induction: Propofol 5 mg/ml (as 10 mg/ml infusion); Thiopentone 25 mg/ml (for cardiac procedures only); Esketamine (different concentrations depending on the size of the child, often 1 or 5 mg/ml)
- Anesthetic gas: Sevoflurane (induction by inhalation, laryngeal mask). Isoflurane (for cardiac procedures or neurosurgery). Desflurane (other anesthetic procedures).
- Opioid: Fentanyl 50 mcg/ml; Remifentanil 10 or 25 mcg/ml. Alfentanil is not routinely used. Morphine is always available.
- Muscle relaxants: Rocuronium 10 mg/ml. (Succinylcholine 50 mg/ml is always available, as well as atropine during anesthetic procedures)
If the child shows no signs of life:
- Start cardiac and pulmonary resuscitation (CPR) with five insufflations
- Then make three series with 30 compressions and two insufflations
- Alarm others
- Continue CPR switching between 30 compressions and two insufflations until help is in place or the child breathes normally
Cardiopulmonary Resuscitation (CPR) to infants
CPR is going to last all the time. Do not stop breathing or pulse control. If possible, replace the one that compresses every two minutes. Just quit CPR if the child begins to breathe normally. Keep in mind that you should not take too long between compression and inflation.
Check in turn: Consciousness. Breathing. Are there any signs of life? Does the baby touch, swallow or breathe normally? Then give the necessary help.
- Is the child aware? Shout to the baby and nip or shake it gently in the shoulders. If the child does not respond, cry out loudly for help from the surrounding area. Put the child on the back.
- Does the child breathe?
- Create open airway
- See if the chest and stomach moves and what color the child has. Listen if air flows in and out through the mouth and nose. Feel the airflow against your chin. If the child breathes normally: put it in a stable side body position. Continue to check that the baby is breathing. Alarm. If the child does not breathe: Give five slow insufflations. If it is not possible to insufflate air or if the chest is not raised when blowing, there may be some objects in the child’s throat.
The open airway can be created in two different ways: Jaw lift. Carefully bend the child’s head backwards by placing one hand on the child’s forehead. Lift the child’s jaw with the other hand’s pointer and middle finger. In younger infants it is important not to bend the head too far backwards. Bending the head back too strongly may cause airway blocking. Lift the jaw manually. Put one hand on the child’s forehead. Now use the other hand’s thumb to grab the point of the chin of the little child and the mandibel of children over a year. Hold your index finger over the chin and lift the chin upwards. Ventilations.
Infants zero to one years old
Make a jaw lift. Put your mouth over the baby’s mouth and nose. Blow slowly in air for 1-1.5 second, five times. Blow in so much air that the chest is raised and lowered. Check signs of life, any spontaneous movements, swallowing or normal breathing in conjunction with the insufflations.
Infants zero to one years old
The baby can lay on hard surfaces. Start with five insufflations. Use the pointer and middle finger and press the lower third of the sternum. Press 30 times, almost two compressions per second. Each time you push down the baby’s chest a third. Release the chest between the compressions. After 30 compressions, you make two blowouts. Then start over again, with 30 compressions followed by two insufflations. If you’re alone, call 911 (local alarm number) after three series with 30 compressions and two insufflations. Then continue with cardiovascular and pulmonary resuscitation, 30 compressions and two insufflations until the helper is in place or the child breathes normally.
Children 1 years old to puberty
Clamp the nostrils with thumb and index finger. Put your mouth over the baby’s mouth and slowly blow it in for 1-1.5 second, five times. Blow in so much air that the chest is raised and lowered. Check signs of life, movements, swallowing or normal breathing in conjunction with the insufflations .
Does the child show life signs?
If the child shows signs of life but does not breathe normally: Make 20 insufflations for one minute and then call 112. If possible, carry the child to the phone if you are alone. Then continue with insufflations. About 20 insufflations per minute are right. If the child does not show any signs of life: Give cardiac and pulmonary resuscitation (CPR).
In case of krupp, pseudokrupp or severe bronchospasm.
Dosage for Inhalation Therapy
|Body Weight||Racepinephrine 22,5 mg/ml|
|< 5 kg||0,25 ml|
|5-10 kg||0,3 ml|
|10-15 kg||0,5 ml|
|15-20 kg||0,7 ml|
Recomended Syringe Sizes for Children up to 15 kg
|Propofol (Propofol®)||5 ml syringe|
|Ketamin (Ketalar®)||5 ml syringe|
|All muscle relaxants||1 ml syringe|
|Fentanyl (Fentanyl®)||1 ml syringe|
|Morphine (Morphine®)||1 ml syringe|
|Alfentanil (Rapifen®)||1 ml syringe|
|Anticolinergics (Atropine, Glycopyrrolone)||1 ml syringe|
|(Robinul-Neostigmine®)||1 ml syringe|
|Sodium Thiopentone (Pentothal®)||5 ml syringe (sodium thiopentone)|
Recomended Syringe Sizes for Children over 15 kg
|Propofol (Propofol®)||10 ml syringe|
|Ketamin (Ketalar®)||10 ml syringe|
|All muscle relaxants||3 ml syringe|
|Fentanyl (Fentanyl®)||3 ml syringe|
|Morphine (Morphine®)||3 ml syringe|
|Alfentanil (Rapifen®)||3 ml syringe|
|Anticolinergics (Atropine, Glycopyrrolone)||1 ml syringe|
|(Robinul-Neostigmine®)||1 ml syringe|
|Sodium Chloride||10 ml alternativt 5 ml syringe|
|Succamethonium||Branded with white syringe label with red text.|
|Sodium Thiopentone (Pentothal®)||10 ml syringe (thiopentalnatrium)|
Recomended sizes of Endotracheal Tubes for Children.
|Age||0||3 months||1 year||5 years||9 years||12 years||14 years||> 15 years|
|Weight||3 kg||5 kg||10 kg||20 kg||30 kg||40 kg||50 kg||> 50 kg|
|Endotracheal tube inner diameter (mm)||3||3.5||4||5||6||7||7||7|
There are a variety of medicines used in premedication to children to get analgesia and anxiolysis. The main principle is that these medicines should be pain relieving and relaxing. The general preoperative care of children with parents is essential to gaining trust from the patient and parents with good and safe anesthesia. Scared and anxious parents can easily spread their concern to the child, preoperative information is essential. During anesthesia induction, it is advisable if only a parent who is calm is present.
Dosage: 2-5 μg/kg orally, provides good sedation in the premedication. The disadvantage is that the drug has a slow onset and must be given in good time, at least 60-90 minutes in advance. Premedication with Mixtur Clonidine Hydrochloride 20 μg/ml or Tablet Clonidine 75 μg.
Dexmedetomidine and Clonidine for Children. Sedation ("Sedanalgesia").
|Dexmedetomidine 100 µg/ml||Clonidine 150 µg/ml||(Catapres)|
|1 µg/kg (max 200 µg) in an infusion or by a slow injection||1,5-2 µg/kg (MR 4 µg/kg) Max 200 µg||1-4 µg/kg x 3||1-4 µg/kg x 3||0,1-0,3 µg/kg/tim|
Dosage interval: 2-4- (6) μg/kg. Dose: We recommend 3 μg/kg. Children <3 years and all children with ENT surgery 2-3 μg/kg. For an eample; the weight of a child is 15 kg x 3 μg/kg = 45 μg gives 2.2 ml (20 μg/ml) clonidine hydrochloride.
Provides a good premedication for small children who come for ENT surgery and anesthesia. Injection dexmedetomidine (Dexdor®) 100 μg/ml can be given both nasally and buccally. Nasal administration is preferred as it provides better absorption and faster effect. The solution has no taste and does not scratch the nose. Dexmedetomidine is a specific alpha2 receptor agonist and its effect is similar to Clonidine, but more pronounced. The main effects are sedation and some analgesia. Dexmedetomidine has a shorter half-life, approximately 2 hours versus Clonidine 5-10 hours. Onset time is significantly longer compared to orally administered Midazolam, approximately 20-40 minutes.
Children 1-3 years are given 1 μg /kg. Children 3-10 years are given 1-2 μg/kg. Children over 10 years of age are given 1-3 μg/kg. The dose may be increased with increasing age to a maximum of 3 μg /kg. Easily, nasal administration is performed with MAD (Mucosal Atomization Device) or MADdy (Pediatric Version) connected to a syringe. Ordinary dose of drug is diluted to the desired volume (usually 0.3-0.5 ml) with physiological saline.
The children must have the presence of parents or staff during the waiting period after application. Peroperative monitoring of blood pressure and ECG. The child may need a prolonged awakening time compared to patients without premedication.
Administered alone or in combination. Common combinations of premedication in children usually contain paracetamol (30 mg/kg x 1) with benzodiazepines or benzodiazepine-like drugs, sometimes with the addition of an NSAID preparation or atropine. Paracetamol is given either as a tablet, oral suspension or as a suppository (Table 6). Children under 6 months are usually not premedicated. Several different drug combinations are common. Different variants of sedative sympathetic stimulants have become more common lately as premedication, such as clonidine and dexmedetomidine. These are usually given as oral solutions but may also be administered intravenously. Routinely, dosage of paracetamol (max oral 30 ml/kg) is given in premedication. Common practice is to give oral paracetamol 24 mg/ml, 1 ml/kg in the care department for most operations. Prior to more painful surgery, children >6 months often receive NSAIDs.
|Premedication||Maintenance first 2 days
dosage 20 mg/kg body weight
|Child weight (kg)||Oral solution Paracetamol 24 mg/ml||Supp Paracetamol (mg)||Tablet Paracetamol (mg)||Oral solution Paracetamol 24 mg/ml||Tablet Paracetamol (mg)||Supp Paracetamol (mg)
|6 - 8 kg||8,5 ml||250 mg||-||2,5 ml x 4||-||60 mg x 4|
|8 - 10 kg||12 ml||310 mg||-||3,5 ml x 4||-||125 mg x 3|
|10 - 12 kg||14 ml||375 mg||-||5 ml x 3||-||125 mg x 4|
|12 - 15 kg||17,5 ml||500 mg||-||5 ml x 4||-||185 mg x 4|
|15 - 20 kg||22 ml||625 mg||-||7,5 ml x 4||-||250 mg x 3|
|20 - 25 kg||28 ml||750 mg||500 mg||10 ml x 4||500 mg x 3||250 mg x 4|
|Paracetamol intravenously||10 mg/ml|
|<1 mån||7,5 mg/kg|
|>1 mån||15 mg/kg|
|4 - 10 kg||6 - 15 ml x 4|
|10 - 20 kg||15 - 30 ml x 4|
|20 - 33 kg||30 - 50 ml x 4|
|33 - 50 kg||50 - 75 ml x 4|
|50 - 66 kg||75 - 100 ml x 4|
|>66 kg||100 ml x 4|
|Loading dose||Maintenance dose|
|Weight (kg)||Oral solution 24 mg/ml||Supp.||Weight (kg)||Oral solution 24 mg/ml||Supp.|
|3||2,5 ml||S. 60 mg||3||2,5 ml x 3||S. 60 mg x 3|
|4||3,5 ml||S. 60 mg||4||3,5 ml x 3||S. 60 mg x 4|
|5||5 ml||S. 125 mg||5||4 ml x 4||S. 125 mg x 3|
|6 - 8||7 ml||S. 250 mg||6 - 8||5 ml x 4||S. 125 mg x 4|
|9 - 12||12 ml||S. 310 mg||9 - 12||7,5 ml x 4||S. 185 mg x 4|
|13 - 15||16 ml||13 - 15||11 ml x 4|
|Weight (kg)||Oral solution||Tablet||Weight (kg)||Oral solution||Tablet|
|16 - 19||20 ml||T. 500 mg||16 - 19||13 ml x 4||T. 250 mg x 4|
|20 - 24||25 ml||T. 500 mg||20 - 24||17 ml x 4||T. 500 mg x 3|
|25 - 30||30 ml||T. 750 mg||25 - 30||21 ml x 4||T. 500 mg x 4|
|31 - 34||40 ml||T. 1000 mg||31 - 34||25 ml x 4||T. 750 mg x 3|
|35 - 42||40 ml||T. 1000 mg||35 - 42||30 ml x 4||T. 750 mg x 4|
|43 - 50||50 ml||T. 1250 mg||43 - 50||35 ml x 4||T. 1000 mg x 3|
|50 - 70||60 ml||T. 1500 mg||50 - 70||40 ml x 4||T. 1000 mg x 4|
|>70 kg||80 ml||T. 2000 mg||>70 kg||40 ml x 4||T. 1000 mg x 4|
Benzodiazepines – alone or in combination.
A common combination for small children (< 20 kg) is midazolam + atropine in a solution as premedication. This combination is dosed according to a schedule based on weight. Midazolam often leads to a trouble-free peripheral venous catheterization (PVC) if a topical analgetic such as EMLA has been used initially. Midazolam can be given either rectally, 0.3 mg/kg (max 10 mg), or as nasal spray 0.2 mg/kg (max 5 mg) and orally 0.5 mg/kg (max 15 mg).
|0,1 mg/kg (max 5 mg)||0,2-0,3 mg/kg (max 7,5-10 mg)||0,2 mg/kg (max 5 mg)||0,3-0,5 mg/kg (max 10-15 mg)|
|An additional dose can be given according to the schedule below|
|0,05 mg/kg (after 5 minuter)||0,05 mg/kg (after 20 minuter)||0,05 mg/kg (after 10 min)||0,05 mg/kg (after 20 min)|
|At least one hour of monitoring after the last dose||At least one and a half hour of monitoring after the last dose||At least one hour of monitoring after the last dose|
Some children, such as very anxious or who have previously experienced some anesthesia related pain may require heavier premedication. Flunitrazepam in tablet form 0.05 mg/kg, gives about 20 minutes heavy sedation with moderate effect lasting at least 1 hour. This premedication can be given at the care giving department and the time must be coordinated with the operation department. In some cases, midazolam may be given by the anesthetic staff themselves to facilitate a difficult induction. The child must not be left alone after receiving flunitrazepam or midazolam. Older children may experience moments before the operation to be long and worrisome. Diazepam (Stesolid), tablet or suppository, 0.5 mg/kg, max 25 mg rectally, may cause some relief. Atropine is given by the physician’s ordinance before surgery, either intravenously, p o, s c, rectally or sublingually.
Premedication with midazolam
A common standard mix for children is midazolam + atropine in mixtures given orally (children 10-25 kg). In addition, paracetamol is usually given 30 mg/kg x 1. Pharmacy prepared oral solution Midazolam 1 mg/ml + Atropine 0.05 mg/ml. Dosage: 0.4 mg (= 0.4 ml)/kg according to list below. Maximum dose for the mixture is 10 ml (orange flavor).
|Weight (kg)||Dose in ml Midazolam/Atropine|
Premedication with midazolam (children 10-25 kg).
Midazolam + Atropine in mixtures that are mixed in the operating department by the anesthesia staff. Midazolam 1 mg/ml is mixed with Atropin 0.5 mg/ml and fruity juice to a solution of 5-12 ml. Dosage: Midazolam 0.4 mg/kg + Atropine 0.02 m /kg orally according to the list below. In addition, paracetamol is usually given at 30 ml/kg x 1.
|Weight (kg)||Volume in ml of the solution||Dose of respective drugs in the solution
Premedication for rectal administration of midazolam (children 5-20 kg).
Midazolam + atropine in mixtures that are prepared by the anesthesia staff. Midazolam 5 mg/ml is mixed with 2 ml NaCl to the concentration of 3 mg/ml. Dosage 0.3 mg/kg = 0.1 ml/kg + Atropine 0.5 mg/ml is mixed.
|Weight (kg)||Midazolam 3 mg/ml|
|Midazolam 3 mg/ml|
|Atropine 0,5 mg/ml |
|Atropine 0,5 mg/ml
|Flumazenil 0,1 mg/ml iv||Antidote for bensodiazepine overdose|
|5 µg/kg (0,05 ml/kg) intravenously once per minute up to 40 µg/kg (maximum dose 2 mg)||If lack of effect: continous infusion 2-10 µg/kg/hour|
Another option, especially for children with heart diseases aged 1-4 years, is ketamine in a dosage of 7 mg/kg mixed with midazolam 0.3 mg/kg. In cases where the child does not participate at all, ketamine may be administered intramuscularly. It is possible to give 3-5 mg/kg, occasionally up to 10 mg/kg, preferably as an injection in the deltoid muscle. If you do not want to inject and the child does not cooperate, ketamine may be given orally. Oral induction is time consuming, 20 minutes is needed, until peripheral venous catherization can occur. You can give 6 mg/kg blended in small amounts of liquid, eg. Coca-Cola for oral administration.
|Ketamine (Ketalar)||10 mg/ml||50 mg/ml|
|Iv bolus:||0,5 mg/kg||Iv infusion 0,02-0,12 mg/kg/hour|
|Esketamin (Ketanest)||5 mg/ml||25 mg/ml|
|Must be combined with Midazolam or Dexmedetomidine!|
Barbiturates – Sodium thiopental (thiopentone)
Rectal induction with thiopental (Trapanal, Pentocur – “Pentorect”/”Sleeping tail”) can be given to small children 1-4 years old (10-20 kg) if you do not want to insert a needle when the child is awake. This is an older form of anesthetic that is hardly used anymore. Thiopental (thiopentone) can be given rectally at the dose of 30 mg/kg from a concentrated solution (100 mg/ml). This premedication works well as an anesthetic induction and is given in the operating department. Weight limits are not sharp, this induction often works well for sensitive children weighing 5-30 kg. Maximum dose rectally is 600 mg Thiopental. Thiopental can be used as the sole drug for minor surgical procedures or when you only want the child to lie still, for example, during x-ray examinations and some radiological interventions.
Some medications that can be used for smaller children are ibuprofen (Brufen) and supp diclofenac (Voltaren).
|Weight (kg)||Dose (ml)|
|7 kg||2,5 ml x 3|
|8 kg||3,0 ml x 3|
|9 kg||3,5 ml x 3|
|10 kg||4,0 ml x 3|
|Ibuprofen||Oral suspension 20 mg/ml|
|≥ 6 months 7,5 mg/kg x 4 alt. 10 mg/kg x 3||Max 1200 mg/day|
|0,375 ml/kg x 4 alt. 0,5 ml/kg x 3.||Max 60 ml/day|
|Weight (kg)||Dosage of suppositories (number)|
|10 kg||½ supp x 2|
|12,5 kg||½ supp x 2|
|15 kg||½ supp x 3|
|20 kg||1 supp x 2|
|25 kg||1 supp x 3|
|30-40 kg||1½ supp x 3|
|8-14 kg||25 mg||25 mg|
|15-19||25+0+25 mg||25+0+25 mg|
|20-24||25+0+25 mg||25+0+25 mg|
|25-27||50+0+25 mg||25+0+25 mg|
|30-34||50+0+25 mg||50+0+25 mg|
|35-40||50+0+50 mg||50+0+50 mg|
|40-50||50+0+50 mg||50+0+50 mg|
|>50 kg||50+50+50 mg||50+50+50 mg|
|Age||Loading dose morphine (mg/kg)||Cont. infusion morphine (μg/kg/h)|
|0 - 3 months||0.05||5-15|
|3 - 12 months||0.1||10-20|
|1 - 5 years||0.15||10 - 40|
|6 -12 years||0.2||10 - 40|
|12 - 16 years||0.25||10 - 40|
|Morphine||1 mg/ml i v|
|<3 months||50 µg/kg (0,05 mg/kg = 0,05 ml/kg of morphine 1 mg/ml)|
|3-12 months||100 µg/kg (0,1 mg/kg = 0,1 ml/kg of morphine 1 mg/ml)|
|1-5 years||150 µg/kg (0,15 mg/kg = 0,15 ml/kg of morphine 1 mg/ml)|
|5-12 years||200 µg/kg (0,20 mg/kg = 0,20 ml of morphine 1 mg/ml)|
|12-15 years||250 µg/kg (0,25 mg/kg = 0,25 ml/kg of morphine 1 mg/ml)|
|Oral solution||0,1-0,2 mg/kg (max 10 mg) up til 4 times/day|
|Given against severe opioid-sensitive pain.||NOTE! At least one hour of monitoring after the last dose!|
|Fentanyl||50 µg/ml (0.05 mg/ml)|
|Nasally||>3 years 1,5 µg/kg|
|Naloxone i v||Dosage 2 µg/kg||The dose may be repeated if necessary|
|Weight (kg)||Solution 20 µg/ml||Solution 0,4 mg/ml (children > 20 kg)|
|3 - 5 kg||0,3 - 0,5 ml|
|5 - 10 kg||0,5 - 1,0 ml|
|10 - 20 kg||1,0 - 2,0 ml|
|20 - 40 kg||2,0 - 4,0 ml||0,1 - 0,2 ml|
|40 - 80 kg||4,0 - 8,0 ml||0,2 - 0,4 ml|
|Weight (kg)||Intravenous Dose|
Solution 2 mg/ml
|Weight (kg)||Oral dose|
Solution 0,8 mg/ml
|≥1 months: 0,1 mg/kg||Max 4 mg x 4||≥1 months: 0,2 mg/kg||Max 8 mg x 4|
|8 - 14 kg||1 mg = 0,5 ml||< 15 kg||2 mg = 2,5 ml||2 mg|
|15 - 24 kg||2 mg = 1 ml||15 - 30 kg||4 mg = 5 ml||4 mg|
|25 - 34 kg||3 mg = 1,5 ml||> 30 kg||8 mg = 10 ml||8 mg|
|> 35 kg||4 mg = 2 ml|
|Betametasone 4 mg/ml||Intravenous injection|
|Dosage||2 mg/kg||Max dose 4 mg x 1|
|Metoclopramide 5 mg/ml||Intravenous injection||Children ≥ 1 year|
|Dosage||0,15 mg/kg/dose||Max dose 10 mg x 3|
|Phenergan 25 mg/ml||Children ≥ 1 year|
|Orally||Tablet or Solution||Children ≥ 1 year. Max dose 25 mg x 4|
|Droperidol (Dridol) 2,5 mg/ml||Intravenously 0,010 - 0,075 mg/kg||Max dose 1,25 mg x 4-6|
Recommended Dosage of Parenteral Medications for Children
|Adenosine||1 mg/ml||100 μg/kg, increased by 50 μg/kg for each dose, step up to 300 μg/kg. Quick flush. Preferred in CVC.|
|Epinephrine (Adrenalin)||0,1 mg/ml||For anaphylaxis: 1-2 μg/kg. At heart stop: 10 μg/kg|
|Atropine||0,5 mg/ml||10 μg/kg. Max 0,5 mg/dose.|
|Betametasone (Betapred)||4 mg/ml||0,2 mg/kg. Max dose: PONV 4 mg Max dose: anafylaxi 8 mg|
|Calcium gluconate||0,5 ml/kg||Max 10 ml/dose.|
|Fentanyl||50 μg/ml||1-2 μg/kg|
|Furosemide||10 mg/ml||0,1-0,5 mg/kg|
|Clonidine||15 μg/ml||1-2 μg/kg x 3-6/day.|
|Midazolam||1 mg/ml||0,05-0,1 mg/kg|
|Morphine||1 mg/ml||0,05-1 mg/kg|
|Naloxone||0,02 mg/ml||10 μg/kg (adult 0.1-0.2 mg) Repeat as needed at 2 min intervals|
|Esomeprazole (Nexium)||8 mg/ml||0,5 mg/kg x 2|
|Ondansetrone||2 mg/ml||0,1 mg/kg. Max x 4/day.|
|Paracetamol||10 mg/ml||<1 year or 10 kg: 7.5 mg/kg.
>1 year: 15 mg/kg. Max x 4 / day
|Hydrocortisone (Solu-Cortef)||50 mg/ml||5 mg/kg. Max 100 mg/dose.|
|Diazepam (Stesolid)||5 mg/ml||0,2-0,3 mg/kg|
|Klemastine (Tavegyl)||1 mg/ml||0,05 mg/kg. Max x 2/day. Slow infusion.|
|Sodium Bicarbonate (Tribonat)||0,5 mmol/ml||Weight x BE x 0.3 = mmol buffer. Start giving half the amount. At heart stop: 2 mmol/kg|
|Budesonide (Pulmicort)||0,25 mg/ml||0,25 mg x 2|
|Salbutamol (Ventoline)||1 mg/ml or 5 mg/ml||0,15 mg/kg x 4 – 6 (max x 24) Max 5 mg/dose.|
|Micronefrin-Racepinephrine||Racepinephrine conc: 22,5 mg/ml||0,05 ml/kg/dose (max 0,75 ml/dose) <5 kg 0,25 ml|
|Remember to pull up drugs in as small syringes as possible! If the dose is <0.5 ml then pull into 1 ml syringe|
|These are no general ordinances but rather an aid in the work with children. All medicines must be prescribed in writing on the daily record by name, strength and amount.|
Recommended Dosage of Drug Infusions for Children
|Epinephrine (Adrenalin)||20 μg/ml||20-300 nanog/kg/min||To be given in CVC|
|Amiodarone- Cordarone||15 mg/ml||Ev. loading dose 5 mg/kg|
given for 1-4 hours. Maintenance dose 0.3-1 mg/kg/h
|Max 1200 mg/24 h. Total treatment dose 100 mg/kg|
|Dopamine||2 mg/ml||2,5-20 μg/kg/min||To be administered in CVC|
|Furosemide||10 mg/ml||0,5-1 mg/kg/h|
|Potassium Chloride||1 mmol/ml||0,1-0,4 mmol/kg/h||Max 15 mmol/h.|
|Clonidine||15 μg/ml||0,5-2 μg/kg/h|
|Midazolam||<15 kg 1 mg/ml ≥15 kg 5 mg/ml||0,05-0,2 mg/kg/h||Bolus dose: 0,05-0,1 mg/kg.|
|Morphine||<15 kg 0,1 mg/ml ≥15 kg 1 mg/ml||5-30 μg/kg/h||Bolus dose: 0,05-0,1 mg/kg.|
|Norepinephrine (Noradrenalin)||20 μg/ml||20-300 nanog/kg/min||To be administered in CVC|
|Propofol (Propolipid)||20 mg/ml||1-4 mg/kg/h||Children> 3 years. Bolus: 1-3 mg/kg|
Recommended Doses of Parenteral Antibiotics to Children
|Erythromycin (Abboticin®)||10-15 mg/kg x 3||Caution in liver failure and in heart disease (arrhythmias). Dose reduction in renal impairment.|
|Phenoxymethylpenicilline (Bensyl PCV)||100 mg/ml||25-50 mg/kg x 3 (3g x 3) alt. 50-100 mg/kg x 4 (3 g x 4)|
|Cefotaxime (Cefotaxim®)||100 mg/ml||30 mg/kg x 3. (1g x 3) alt. 75-100 mg/kg x 3 (3 g x 3)|
|Ceftazidime (Ceftazidim®)||100 mg/ml||25 mg/kg x 3 (1 g x 3) alt. 50 mg/kg x 3 (2 g x 3) alt. 35 mg/kg x 3 (2 g x 3) Children< 2 months: 25 mg/kg x 2||Diluted with sterile water. Given for 3-5 min.|
|Cefuroxime (Cefuroxime®)||100 mg/ml||20-30 mg/kg x 3 (0,75-1,5 g x 3)||Diluted with sterile water. Given for 3-5 min.|
|Clindamycin (Dalacin®)||10 mg / kg x 3 (600 mg x 3)|
No child <4 weeks age
|Cloxacillin (Cloxacillin®)||50 mg/ml||Diluted with sterile water. Given in CVC 3-5 min. All infusion in pvc: Then dilute once more with NaCl 9mg/ml to 20 mg/ml. 20-30 min.|
|Meropenem (Meronem®)||50 mg/ml||40 mg/kg x 3 (2 g x 3) alt. 20 mg/kg x 3-4 (2 g x 3-4) alt. 10-20 mg/kg x 3 (0,5-1 g x 3)||Diluted with sterile water. Given for 3-5 min.|
|Tobramycin (Nebcin®)||10 mg/ml||7.5 mg/kg x 1. Higher dose 8-10-(12) mg/kg x1|
can be used in CF and neutropenic fever.
|Nebcina 40 mg/ml is diluted with NaCl 9 mg/ml alt. Glucose 50 mg/ml. Infusion for 20-60 min.|
|Vancomycin (Vancocin®)||5 mg/ml||20 mg/kg x 2 (-3) (1 g x 2) ev x 3||Diluted in two steps. First stock solution with sterile water to 50 mg/ml. Then dilute with sodium chloride 9 mg/ml or glucose 50 mg/ml to 5 mg/ml. Infusion for at least 60 minutes.|
|Piperacillin/Tazobactam||80 mg/kg x 3-4 alt. 100 mg/kg x 3-4 (4 g x 3-4)|
|Ceftriaxone (Rocephalin®)||100 mg/kg x 1. (2 g x 1)|
|Linezolid (Zyvoxid®)||10 mg/kg x 2 (600 mg x 2)||(max 28 days)|
FLACC – Face, Legs, Activity, Cry, Consolability
For pain estimation of children 0-7 years, a behavioral scale for pain estimation is used, it can also be used for children with multiple disabilities.
- Note the child for a few minutes and then look at face /legs/activity/cry/comfortability and decide whether the scoring graduation 0, 1 or 2 suits the child.
- Then add the score, to a maximum of 10 points.
- A value of <3 is sought. At values <4, nursing measures may be sufficient, at values > 4, pain relief should be considered.
- When any pain is suspected and nursing measures do not help the child, a test of analgesic delivery is done.
- Evaluate the result with a new pain estimation.
FLACC Behavioral Scale Children
|Try to observe the child for at least|
|0 points||1 points||2 points|
|Face||Neutral facial expressions or smiles||Bister eyesight, wrinkles the forehead occasionally, withdrawn, uninterested||Frequent or constantly wrinkled brow, trembling chin, bumpy jaws|
|Legs||Normal position or relaxed||Worried, restless or tense legs||Kicking or legs drawn|
|Activity||Stands calm, normal position, moves unobstructed||Screws, often changes position, tense||Arc, raises or stems|
|Crying||No crying (awake or sleeping)||Gnaws or smells, complains off and on||Crying persistently, screaming or sneaking, complaining often|
|Ability to comfort||Satisfied, relaxed||Can be calm with touch, hugs or chatting. Distractable.||Hard to comfort or calm|
AS is a modified VAS scale for children 5-18 years. It consists of six faces, 1st face counting as 0 points and 6th face as 10 points. At 4 points and above, consideration should be given to pain relief. Keep in mind that some children may confuse state of mind with pain. Do not ask “Does it hurt” ask instead “Do you feel anything from the wound. If the answer becomes “Yes”, then ask “How does it feel “? If the child replies pain ask “How bad are you?” “Can you show on this scale?”
Age effect on MAC for children
|Age of Patient (Years)||Sevoflurane in oxygen (%)||Sevoflurane in 65% N2O/35% O2|
|0 - 1 months*||3.3%||Undetermined|
|1 - <6 months||3.0%||Undetermined|
|6 months - <3 years||2.8%||2,0 %**|
|3 to 12 years||2.5%||Undetermined|
|* Newborns after the end of pregnancy. MAC in prematures has not yet been established.|
|** In pediatric patients 1 - <3 years old, 60% N2O/40% O2 was used.|
The presence or absence of information in the product information specific for children are seen here. For nasal use, information is not available for all medicines. The information may differ between different preparations with the same active substance.
|Substance / substance group||Dosage for children in product information||Age of dosage or other relevant information in product information|
|Lidocaine/prilocaine||Yes||Cream / patches. Premature children or children with increased risk of methemoglobinemia.|
|Lidocaine/tetracain||Yes||Plaster: Children > 3 years.|
|Lidocaine||Yes||Injection solution: Children >1 year.|
|Glucose 300 mg/mL||No||Indications for the treatment of pain are missing|
|Ibuprofen||Yes||Children >3 months or >5 kg|
|Diclofenac||Yes||Children > 6 years. Gel: Contraindicated to children <14 years|
|Oxicodone||Yes||Tablets for children > 12 years. Oral solution: Not approved for children|
|Fentanyl||Yes||Dosage for children > 2 years is available for i.v. use|
|Dexmedetomidin||No||Approved for sedation of adults in the intensive care department|
|Clonidine||No||Pain / sedation is not accepted indications for any age group|
|Midazolam||Yes||Children < 5 years may require higher doses (mg/kg) than older children|
|Diazepam||Yes||Children > 1 year rectally. Children may require higher doses (mg/kg) than adults.|
|* Product information (Summary of Products Characteristics) for all authorized drug substances is available at www.lakemedelsverket.se|
Flow in Highflow Grid (Optiflow) for children.
|2-6 kg||Child's weight + 1 l up to 2 l/kg|
|7-9 kg||Child's weight + 1-2 l|
|10-14 kg||Start at 10 l / min increase as required to 15 l / min|
|15-19 kg||Start at 15 l / min increase as required to 20 l / min|
|20-49 kg||20-25 l/min|
|>50 kg||25 l/min up to 40 l/min|
Children’s steroid substitution schedule is recommended for children < 30 kg. For children weighing 30-60 kg, the half-adult schedule is recommended. Children over 60 kg are counted as adults and recommended adult schedule.
|Injection betametason 1 mg/ml||Dose (ml)||Dose (mg)|
|Day 1||2 ml x 2||2 mg x 2|
|Day 2||2 ml x 2||2 mg x 2|
|Day 3||1 ml x 2||1 mg x 2|
|Day 4||1 ml x 2||1 mg x 2|
|Day 5||0,5 ml x 1||0,5 mg x 1|
|Day 6||0,5 ml x 1||0,5 mg x 1|
|Orally||Tablet 0,5 mg||Dose (mg)|
|Day 1||4 st x 2||2 mg x 2|
|Day 2||4 st x 2||2 mg x 2|
|Day 3||2 st x 2||1 mg x 2|
|Day 4||2 st x 2||1 mg x 2|
|Day 5||1 st x 1||0,5 mg x 1|
|Day 6||1 st x 1||0,5 mg x 1|