ACCIDENT AND EMERGENCY DEPARTMENT UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE N.H.S. TRUST http://www.nelh-ec.warwick.ac.uk/NELH-EC_home.htm PAEDIATRIC DRUG DOSES For more information on dosages use Medicines for Children   (http://www.rcpch.ac.uk/library/Formulary/formulary.htm) >British National Formulary - current edition - Alder Hey ABCD of Childrens Doses 1994 with amendments 1996 -Braselow Tape - British Association of Emergency Medicine Guidelines for Children in the Accident and Emergency Department. -Advanced Paediatric Life Support- A practical approach BMJ Publishing Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Sarah Crowther - Valerie Madden (B. Pharm M.R .Pharm S. Paediatric Pharmacist.) DISCLAIMER - It is the individual's responsibility to double-check all doses in this guideline and ensure they are correct. 2012 WHO Library Cataloguing-in-Publication Data Persisting pain in children package: WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Contents: WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses - Three brochures with important information for physicians and nurses; pharmacists; policy-makers and medicines regulatory authorities, hospital managers and health insurance managers - Dosing card - Pain Scale for children (4 years of age and up) - Pain Scale for children (6 - 10 years) - Wall chart for waiting rooms 1.Pain - drug therapy. 2.Pain - classification. 3.Pain measurement. 4.Analgesics, Opioid. 5.Drugs, Essential. 6.Drug and narcotic control. 7.Palliative care. 8.Child. 9.Guidelines.[Lire] INDEX OF DRUGS: All Drugs and Fluids should be calculated according to childs weight. Quick weight calculation = 2 x (age + 4) or use dose according to approximate weight on charts Paracetamol Ibuprofen Morphine sulphate oral solution- Oramorph (10mg/5ml) Trimeprazine (Vallergan) Pethidine I.V. Morphine I.V. Lignocaine 1% (10mg in 1ml) Entonox (50% Oxygen, 50% Nitrous oxide) Salbutamol (for nebulisation) Antibiotic doses Codeine phosphate (pain relief dose) Naloxone (Narcan) Mannitol 20% (2g in 10ml) Hydrocortisone Paraldehyde Aminophylline Diazepam Diazemuls Phenobarbitone Phenytoin Paracetamol Liquid 120mg in 5ml Tablets 500mg (Quick weight calculation =2 (age + 4)) Stat. Dose 15mg/kg. Doses at least 4 hours apart and no more than 4 in 24 hours Check time of previous doses at home. Make sure an effective dose is given.   AGE APPROX WEIGHT DOSE 6 MONTHS 5 kg 60mg (2.5 ml) 1 YEAR 10kg 120mg (5ml) 3 YEARS 15kg 180mg (7.5 ml) 5 YEARS 20kg 240mg (10ml) 10 YEARS 30kg 360mg (15ml) 12 YEARS 40kg 480mg (20ml) or 500mg (tab) 15 YEARS 50kg 1000mg (tabs) Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Back to index Ibuprofen Liquid 100mg in 5ml Tablets 200mg (Quick weight calculation = Twice age +8) Stat dose 5mg/kg Repeat 4 to 6 hourly. No more than 4 doses in 24 hours   AGE APPROX WEIGHT DOSE May only be prescribed by senior medical staff if patient less than 1 year old 1 YEAR 10kg 50mg (2.5ml) 3 YEARS 15kg 75mg (3.75ml) 5 YEARS 20 kg 100mg (5ml) 10 YEARS 30kg 150mg (7.5ml) 12 YEARS 40 kg 200mg (10ml) 15 YEARS 50 kg 200mg to 400mg (tablets) Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Back to index Morphine Sulphate Oral Solution Oramorph (10mg/5ml) (Quick weight calculation =2 (age + 4) Stat dose 200 microgrammes to 400 microgrammes per kg Measure doses with oral syringe.   AGE APPROX WEIGHT DOSE NOT RECOMMENDED UNDER 2 YRS OLD WITHOUT SENIOR MEDICAL STAFF CONSENT 1 YEARS 10 kg 2mg (1ml) 3 YEARS 15 kg 3 mg (1.5ml) 5 YEARS 20 kg 4 mg (2ml) 10 YEARS 30 kg 6 mg (3ml) 12 YEARS 40 kg 8mg (4ml) Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Back to index Trimeprazine (Vallergan) Liquid 7.5mg in 5ml Tablets 10mg (Quick weight calculation =2 (age + 4)) Sedative: Stat dose 1 to 2 mg/kg.(may need up to 3mg/kg)   AGE APPROX WEIGHT SEDATIVE DOSE NOT RECOMMENDED UNDER 6 MONTHS. 6 MONTHS 5 kg 5 to 10 mg 1 YEAR 10 kg 10 to 20 mg 3 YEARS 15 kg 15 to 30 mg 5 YEARS 20 kg 20 to 40mg 10 YEARS 30 kg 30 to 60 mg 12 YEARS 40 kg 40 to 80 mg 15 YEARS 50 kg 50 to 100 mg Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Back to index Pethidine I.V. 50 mg/ml or 100mg/2ml injection ampoules Dilute in sodium chloride 0.9% before administration to make a solution of pethidine 50mg in 5ml i.e. 10mg in 1ml (Quick weight calculation =2 (age + 4)) Stat Dose 0.5 to 1mg/kg. Give over 2 to 5minutes. Doses can be repeated after 4 hours. Monitor respiration , SaO2 and ECG   AGE APPROX WEIGHT SINGLE DOSE 6 MONTHS 5 kg 5 mg 1 YEAR 10 kg 10mg 3 YEARS 15 kg 15 mg 5 YEARS 20 kg 20 mg 10 YEARS 30 kg 30 mg 12 YEARS 40 kg 40 mg 15 YEARS 50 kg 50 mg Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Back to index Morphine I.V. Morphine 10mg in 1ml Dilute in Sodium chloride 0.9% to 10mg in 10ml ie 1mg in 1ml to titrate Give slowly IV over 10 minutes. (Quick Weight calculation =2 (age + 4)) Monitor respirations, SaO2 and ECG. Dose varies according to age Stat dose 100 to 200microgrammes/kg over 1 year old. Stat dose 50 microgrammes/kg 3 to 6 months. Stat dose 25microgrammes /kg 1 to 3 months. Give slowly over 5 to 10 minutes. Start with lower dose AGE APPROX WEIGHT DOSE 6 MONTHS 5 kg 0.25mg 1 YEAR 10 kg 1 to 2 mg 3 YEARS 15 kg 1.5 to 3mg 5 YEARS 20 kg 2mg to 4mg 10 YEARS 30 kg 3 to 6mg 12 YEARS 40 kg 4 to 8mg 15 YEARS 50 kg 5 to 10mg Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Back to index Lignocaine 1% (10mg in 1ml) (Local anaesthetic) Available as 2ml and 5ml ampoules (Quick weight calculation =2 (age + 4)) Maximum safe dose is 3mg/kg by local infiltration repeated after 4 hours. (1% Lignocaine contains 10mg/ml.) AGE APPROX WEIGHT DOSE OF LIGNOCAINE VOLUME OF LIGNOCAINE 1% 6 MONTHS 5 kg 15mg 1.5ml 3 YEARS 10 kg 30mg 3 ml 5 YEARS 15 kg 45mg 4.5ml 10 YEARS 20 kg 60mg 6 ml 12 YEARS 30 kg 90mg 9 ml Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Back to index Entonox (50% oxygen, 50% Nitrous Oxide) For use in children over 5 years old, must be patient administered. Mouthpiece must be used for young child. May be used whilst achieving intravenous access, performing as nerve block, moving a fractured limb in to a splint. Contraindicated in children with: A pneumothorax until drained. Head injury. Facial injury. Decompression sickness. CTITU Medias. Back to index Salbutamol for nebulisation (Quick weight calculation = 2 ( age + 4))   AGE APPROX WEIGHT DOSE 6 MONTHS 5 kg 1.25 mg 1 YEAR 10 kg 1.25mg 3 YEARS 15 kg 2.5 mg 5 YEARS 20 kg 2.5mg 10 YEARS 30 kg 2.5 to 5mg 12 YEARS 40 kg 2.5 to 5mg 15 YEARS 50 kg 2.5 to 5mg Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Back to index Antibiotic doses (Quick weight calculation =2 (age + 4)) All doses to be checked with Alder Hey ABCD or B.N.F. Try to prescribe eight hourly when possible to make it easier to fit in a school day. Back to index Codeine phosphate Pain relief dose (Quick weight calculation =2 (age + 4)) Codeine syrup 25mg in 5ml, Tablets 15mg and 30mg. (codeine linctus available for cough as 3mg in 5ml or 15mg in 5ml) Stat dose 0.5mg (500microgrammes )/kg with a maximum 30mg at 12 years Repeat dose after 4 hours upto 6 times a day. Total maximum 3mg/kg/day upto 180mg /day at 12 years. AGE APPROX WEIGHT DOSE of codeine phosphate syrup 25mg in 5ml NOT RECOMMENDED UNDER 1 YEAR OLD 1 YEAR 10kg 5mg (1ml) 3 YEARS 15 kg 7.5mg (1.5ml) 5 YEARS 20 kg 10mg (2ml) 10 YEARS 30 kg 15mg (3ml) 12 YEARS 40 kg 20mg (4ml) 15 YEARS 50 kg 30mg tablet Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. Back to index Other paediatric drug doses: Naloxone (Narcan) Stat dose 10microgrammesg/kg over 5 minutes. A larger dose upto 100mcg/kg (max 2mg) may be given if response not adequate Mannitol 20% (2g in 10ml) 0.5(2.5ml) to 1g (5ml)/kg IV Infusion Hydrocortisone 4mg/kg then 2 to 4mg/kg every 6 hours (Slow IV) Paraldehyde 0.3ml/kg (Rectal) (In glass syringe mixed in 50% Olive Oil A plastic syringe can be used if administered immediately) Aminophylline Loading Dose 5mg/kg over 10mins Then 1mg/kg/hr as IV Infusion Diazepam 400 mcg/kg slow IV Then 100 to 400 mcg/kg/hr Infusion. Under 1yr to 2.5mg Rectal 1 to 3 yrs to 5mg Rectal 4 to 12 yrs to 5 to 10mg Rectal Diazemuls Stat Dose by Slow IV 200 microgrammes/kg,larger doses my be needed to control convulsions Phenobarbitone 15mg/kg by Slow IV no more than 1mg/kg/minute. Must be diluted. See guides for further information. Phenytoin 15mg/kg loading dose by slow IV at no more than 1mg/kg/minute. Monitor ECG and BP. See guides for further information. Double check all doses before administration Doses contained in this guide are for quick reference only and should be used together with full prescribing information. DISCLAIMER - It is the individual's responsibility to double-check all doses in this guideline and ensure they are correct. Back to index Back to top Back to NeLH-EC home