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Pediatric Dosage Calculation

Pediatric dose calculation differs from adult practice in one decisive way: there is no standard dose to fall back on and no familiar number to recognise as wrong. Everything is derived from the child's weight in kilograms, so an error in the weight, the conversion or the arithmetic passes straight through into the syringe. Because the resulting volumes are small, a tenfold error still looks like a plausible amount. The safeguards are procedural rather than intuitive: a measured weight, a calculated safe range, a second nurse on high-alert drugs, and a syringe rather than a cup.

Weight in kilograms drives every pediatric dose Hallmark
There is no standard dose to compare against Hallmark
which is why the safe-range check is mandatory
Small volumes go in an oral or tuberculin syringe Hallmark
A cup or household spoon is unreliable below about 5 mL
High-alert drugs need an independent second check Hallmark
Round only to what the syringe can measure

The pediatric sequence, every time

  1. Weigh in kilogramsmeasured, not reported
  2. Calculate the doseordered mg/kg x weight
  3. Calculate the rangereference low and high x weight
  4. Compareinside means give, outside means call
  5. Draw up in a syringethen have it checked if high-alert
Re-weigh on admission and when the dose is questioned Hallmark
Watch for a decimal point in an unexpected place Hallmark
a tenfold error looks ordinary in a child
Check the volume against the syringe's smallest marking
Document the weight used for the calculation
Use the syringe that came with the medicine Hallmark
Give small volumes slowly into the cheek
squirting it back can make the child gag or spit
Do not mix a dose into a full bottle or cup Hallmark
an unfinished bottle means an unknown dose
Bring the medicine and the syringe to appointments
Report Nowescalate immediately
A dose calculated without a current weight Hallmark
A volume too small for the syringe to measure Hallmark
A high-alert drug drawn up without a second check
An answer ten times the expected size Hallmark
a misplaced decimal point
An adult dose ordered for a child

Clinical Pearl

Weigh, calculate, check the range, then draw it up in a syringe. In a child there is no dose small enough to be safe by accident.

NurseSavvy™·nursesavvy.com

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