Pediatric Medication Administration
Overview
Children are not small adults — body composition, organ maturity, and drug metabolism differ dramatically by age, so pediatric dosing is weight-based, calculated in mg/kg/dose or mg/kg/day. Every administration starts with an accurate current weight in kilograms (measured, never estimated, never converted from a parent's memory in pounds). After calculating, compare the result against the published safe range AND any absolute adult maximum: if the ordered dose exceeds either, do not give it — clarify with the provider. The nurse independently verifies the mg/kg calculation even after pharmacy or provider review. Liquid formulations dominate: always measure with a calibrated oral syringe, never a household spoon. The vastus lateralis is the preferred IM site for infants and young children; the deltoid is too small and the dorsogluteal is avoided (sciatic-nerve proximity). IV drugs run through a volume-controlled device to prevent fluid overload.
Indications
Before the Procedure
During — Monitoring
Technique
Infant IM vaccination (in order)
- Verify rights: order, vaccine, dose, route, expirationvaccine errors are high-frequency in peds
- Select vastus lateralis (anterolateral thigh)largest muscle under 12 months
- Secure infant on parent's lap, thigh exposedfirm hold to prevent movement
- Insert at 90° and inject1-inch needle reaches the muscle (5/8 inch for newborns)
- Dry gauze, document sitedocumenting guides next placement
After — Complications
Patient Teaching
Clinical Pearl
No weight, no med. Weigh in kilograms, calculate in mg/kg, and verify against the safe range AND the adult maximum — every single time, even after pharmacy. Oral syringe for liquids (never a spoon), vastus lateralis for infant IMs, and the volume-controlled pump is your IV safety net.