PEDIATRIC DOSAGES

Learning Outcomes
1. Convert weight in pounds to kilograms ,
kilograms to pounds, grams to kilograms.

2. Calculate the lower and upper safe dosage

ranges and total daily safe dosage.

3. Estimate body surface area using a

nomogram or a formula.
 Learning Outcomes
4. Calculate oral and parenteral dosages based
on body weight (mg/kg)

5. Calculate oral and parenteral dosages using

body surface area (BSA)
Current evidence shows that children are 3x
more at risk for experiencing a medication
error than adults (TJC 2008).
•Medication errors involving
children frequently happen for
the following reasons:
1. Confusion between formulation for adults and
children
2. Availability of multiple pediatric
concentrations of oral liquid medications
3. Inaccurate preparation of medication that
need to be diluted.
4. Similar packaging of medications and names
of medications that look alike sounds alike.

5. Parents who do not understand how to

correctly prepare and administer medications.

6. Errors in calculation and use of inaccurate

measuring devices (e.g., household teaspoons
and tablespoons ) as opposed to devices make
to measure small volume doses
 Calculating children’s medication doses
requires caution.

Even small errors or discrepancies in

medication amounts can negatively affect a
child’s health.
Use the following guidelines when
calculating pediatric doses.
1. Most pediatric medications are ordered in
milligrams per kg (mg/kg). Therefore, to
ensure that the patient’s weight is expressed
in kilograms. Avoid converting the patients
weight whenever possible. If you have to
convert pounds to kilograms remember that
1kg = 2.2 lb and convert the patient’s weight
before calculating the medication dosage.
.
2. Pediatric doses are usually a lot smaller than
adult doses for the same medication. You
frequently use micrograms and small syringes
(tuberculin or 1mL).

2. IM doses are very small and usually do not

exceed 1mL in small children or 0.5mL in
infants.

3. Subcutaneous dosages are als very small and

do not usually exceed 0.5mL.
4. Most medications are not rounded off to the
nearest tenths. Instead, they are rounded to the
nearest thousandth.

5. Measure dosages that are less than 1mL in

syringes that are marked in tenths of a millilter
if the dosage calculation comes out even and
does not need to be rounded. Use a tuberculin
syringe for medication preparation when the
medication needs to be rounded to the nearest
thousandths.
6. Estimate the patients dose before beginning
the calculation; label and compare the answer
with the estimate before preparing the
medication.

7. To determine if a dose is safe before giving

the medication, compare and evaluate the
amount of medication ordered over 24 hours
with the recommended dosage.
Nursing Concerns for Pediatric Drug
Administration
When administering medications to children,
you need to be aware of the following:

1. Explain honestly what will be done; explain at

the level of the child’s understanding.

2. Use supplemental materials to promote

understanding (stuffed animals, dolls)
3. Suggest that the child help as much as
possible; encourage the child to pretend, and
switch roles with the child.

4. Reinforce positive behaviour with praise and

rewards as necessary.

5. Make sure you have obtained an accurate

height and weight measurement.
6. Be sure you have compared the safe dosage
range with the dosage you plan to give; know
toxic and lethal doses.

7. Do not force medication to a frightened child

especially one who is crying.

8. Disguise or dilute medications as necessary.

The 2 most common methods of calculating
pediatric dosages are based on
a. child’s weight

b. BSA (Body surface area)

Mosteller’s formula
standard nomogram
Extreme care must be taken when preparing
and administering medications to :

 Infants ( birth to 12 months)

 Children ( 1 to 12 years)
• Adolescents ( 13 to 18 years)
You need to be comfortable converting
• pounds to kilograms
2.2.lb = 1 kg
• grams to kilograms
1000g=1kg
• micrograms to milligrams
1000mcg=1mg

You need to be familiar with the nomogram.

• You must determine that the ordered dosage is
safe before administering the medication.

• Always compare the prescribed dosage to the

recommended safe dosage range using a
reference drug resource when calculating
dosages.
• Oral pediatric medications are prescribed in
liquid form whenever possible.

• It is best to use a syringe or a dropper to give

medications to infants or toddlers.

• cup can be used for school age children.

• Parenteral medications are most commonly
given:

subcutaneously (upper arm, abdomen and

thigh for immunizations and insulin
Intramuscularly c(vastus lateralis) for infants
and gluteus after toddlers starts
walking) for vaccines.
Dosage amounts are limited to:

▪ usually 0.5ml for infants

▪ 1mL per site for those younger than 5 years of age

▪ 2mL per site can be given for children ages 6 to 12
years old
▪ 3 mL per site - The volume limit for adolescents

The quantity is measured using a tuberculin syringe.

 Weight Conversions:
Convert weight in Pounds to Kilograms and
Kilograms to Pounds
• When medications are prescribed in milligrams
per kilogram (mg/kg) of body weight, you must
convert pounds to kilograms before calculating
the dosage.
• Rule:
• To convert pounds to kilograms: Divide the
patients body weight in pounds by 2.2.

• To convert kilograms to pounds: Multiply the

patients body weight in kilograms by 2.2

• For premature infants, you will probably work

with grams (1000grams = 1kg)
Use one of these 3 methods for calculation of
dosages:

• simple division or multiplication

• ratio and proportion
• dimensional analysis
•
Convert child’s weight of 44lb to kg
1. Basic division
• Move the decimal point in the divisor and the
dividend the same number of places. Put the
decimal point directly above the line for the
quotient.

• 44 divided by 2.2 = 20 kg.

Convert child’s weight of 44lb to kg
2. Ratio and Proportion
2.2 lb: 1kg = 44 lb: x kg
2.2lbs x X = 44lb x 1 kg
X= 44
2.2
X = 20
Convert child’s weight of 44lb to kg
3. Dimensional analysis
44 lb x 1kg
2.2 lb
44lb x 1kg = 44
2.2 2.2
= 20kg
Convert child’s weight of 25 kg to pounds
1. Basic multiplication
2.2 lb x 25 kg / lb = 55 lb

2. Ratio and Proportion

2.2 lb : 1 kg = x lb: 25 kg X = 25 x 2.2
X = 55 lb
3. Dimensional analysis
25 kg x 2.2lb = 25 x 2.2 = 55 lb
1kg 1
Convert weight in grams to kilograms

Rule :
To convert grams to kilograms for infants
Divide the infants body weight in grams by
1000 and round to the nearest tenth
Convert infants weight of 2270 g to kg

• Ratio and Proportion

1kg: 1000g = x kg: 2270g
1000 x = 2270
x = 2270
1000
x = 2.27 kg

Dimensional Analysis
2270 g x 1 kg = 2770 = 2.27 or 2.3 kg
1000g 1000
 • Estimate Safe Total Daily Dosage
• Pediatric medications have an upper and a lower
safe dosage range used to indicate a safe , total
daily dose.

• You can find this information on the drug package

insert, a drug reference or an institutional protocol.

• You need this information before you calculate any

dose to give to a child.
• Rule: To calculate safe, total, daily dosage:
Multiply the patients weight in kilograms by
the recommended dosage in milligrams.

• Example:
1. A child weighs 15 kg. The safe daily drug
dosage is 4mg/kg/day
• 4mg x 15 kg = 60mg/day

Total daily dosage = 60mg/day

Example:
A child weighs 20 kg. The physician orders 10 mg of a drug
every 6 hours. The safe daily dosage is 2.5mg/kg/day
Estimate total daily dosage

10 mg x 4 doses = 40 mg/day ( 24 hours ÷ 6 = 4 doses/day)

• Determine if the prescribed dose is safe

• Safe dosage is 2.5mg/kg/day

• Estimate: 2.5mg x 20 kg = 50 mg, divided into 4 doses
= 12.5 mg/dose

• Determine: Dose of 10 mg q6h is safe

Rule:
• To calculate the safe lower and upper dosage
range: Multiply the child’s weight in kilograms
by the lower and upper dosage ranges in
milligrams: milligrams per kilogram
(mg/kg/day) or milligrams per kilogram per
dose (mg/kg/dose)
•
Example:
• A physician orders 75 mg of an antibiotic q8h
for a child who weighs 30 kg. The safe dosage
range is 6 to 8mg/kg/day). Calculate the lower
and upper dosage ranges.

• Estimate total daily dosage: 75mg x 3 doses

(24 ÷ 8 hr) = 225 mg
.
• Calculate lower dosage range:
6mg/kg/day x 30 kg = 180 mg

• Calculate upper dosage range:

8mg/kg/day x 30 kg = 240 mg

• Determine if the dose is safe. Yes the total daily

dosage of 225mg is safe.
 Calculate oral dosage based on body weight
(mg per kg)
• Rule: Calculate the dosage based on body
weight: Convert pounds to kilograms (divide by
2.2), calculate safe dosage range, compare the
prescribed dosage with the safe dosage range
and calculate the dose needed using one of the
3 calculation methods.

• Remember the sequence of activities: convert,

calculate, compare and calculate.
Example:
The physician prescribed an antibiotic, 20
mg/kg/day p.o. The patient weighs 44lb. The
antibiotic is available as 250 mg per 10 ml. the
safe dosage range for the antibiotic is 20 to 40
mg/kg/day. The nurse should give x mL twice
daily.
Convert: 44 lb to kilograms
44 lbs ÷ 2.2 lb/kg = 20 kg

Calculate safe dosage:

The safe dosage range is 20 to 40 mg/kg/day
•20kg x20 mg (low range) = 400 mg
•20 kg x 40 mg (high range) = 800 mg

• The safe dosage range for this child is: 400 to

800mg per day.
Compare prescribed dose with safe dose:
• The prescribed dose is 20mg/kg/day or 400mg
daily
• This dose is within the lower range of safe
dosage. Therefore, it is safe to give.

Calculate the dose

• Calculate ml to give by using one of the 3
calculation methods.
Ratio and Proportion:
250mg: 10mL = 400mg: x mL
250 x = 4000
X = 4000
250
X = 16
1
X = 16 mL
The Formula Method:
Use D x Q
H
400mg x 10mL = x
250mg
4000 = 16 = 16
250 1
Example:
• The physician prescribed 125 mg of an
antibiotic , po q8h for a 33lb child. The
antibiotic is available as 250mg per 5mL. The
safe dosage range is 20 to 40mg/kg/day. The
nurse should give x mL, three times daily.
Convert: 33 lb to kilograms
33 lb ÷ 2.2 lb/kg = 15kg

Calculate safe dosage.

The safe dosage range is 20 to 40mg/kg/day
15 kg x20mg (low range) = 300mg
15 kg x 40mg (high range) = 600mg

The safe dosage range for this child is: 300 to

600mg per day
Convert prescribed dose with safe dose:
The prescribed dose is 125 mg q8h or
375mg daily
This dose is within the safe dosage range.
Therefore, it is a safe dose to give.

Calculate the dose:

Calculate mL to give by using one of the 3
calculation methods.
•
Ratio and Proportion:

125 mg: x mL = 250mg: 5 mL

250x = 625
X = 625
250
X = 2.5 mL per 8 hours
The Formula Method:

125mg x 5 = x
250mg
1251 x 5 = 5 = 2.5mL per 8 hours
2502 2
•
Dimensional Analysis:

125 mg x 5mL
250mg
625 = 2.5mL per 8 hours
250
 Estimate Body surface Area
• Estimating body surface area(BSA) in square
meters (m2), is the most accurate way of
calculating drug dosages.
• There are 2 ways to estimate BSA.
1. You can use a chart- the West Nomogram
2. Formula that uses a metric system but
requires a calculator that can perform the
square root function.
Example:
• A child weighs 24 lb and is 36 inches tall. To
estimate BSA, draw a line from the weight of
24 lb and the height of 36 inches. The line will
intersect at 0.5m2.
• Answer: BSA = 0.5 m2
Example:
A child weighs 50lb and has a height of 40
inches. What is the BSA?

Use this formula:

Weight (kg) x height(cm) = x
3600
Take the square root:
x = BSA
Convert 50lb to kg
1 kg= 2.2 lb
50 lb ÷ 2.2 lb/kg = 22.7 kg

• Convert 40 inches to cm
1 inch = 2.5cm
40 inches x 2.5cm/inch = 100cm
Apply the formula:
22.7(kg) x 100 (cm) = 2270 = 0.63
3600 3600

• 0.63 the square root of 0.63 is 0.79

Answer: BSA = 0.79
 Dosage Calculations Based on Body Surface
Area:
• There are 2 rules that can be used: Rule #2 is
the most accurate approach.

• Rule # 1. To calculate a safe child’s dosage

when you only have the average adult dose.
Estimate the child’s BSA, divide the child’s
BSA in square meters (m2) by 1.73 m2 (surface
area of an average adult), and multiply by the
adult dose.
Example # 1
• The physician prescribed Benadryl for an 8
year old child who weighs 75lb and is 50 inches
tall (4 feet, 2 inches). The normal adult dose is
25mg q.i.d. The nurse should give x mg, q.i.d. A
straight line drawn from height to weight,
using the west nomogram, intersects at
1.05m2.
•
Use Body Surface Area Rule:
Child’s BSA x adult dose
1.73m2

1.05m2 = 0.06 x 25 mg = 15.17mg

1.73m2

Answer: 15mg q.i.d

Rule # 2:
To calculate a safe child’s dosage. Determine
the patient’s BSA (m2), calculate the safe
dosage in mg/m2/dose using a reference,
decide if the prescribed dose is within the safe
dosage range, and calculate the dose needed
using one of the 3 calculation method.
Example:

The physician prescribed 2.5mg of an antibiotic,

p.o twice daily for 5 days for a child who is 34
inches tall and weighs 25 lb. The medication is
available as a scored 5 mg tablet. The
medication label lists a safe dosage range of
10mg/m2/day. The nurse should give x tablets
per dose.
To Determine BSA: Draw a straight line from the
height of 34 inches to the weight of 25 lb. The
line intersects at 0.5m2

Calculate safe dosage:

The safe dosage range is 10mg/m2/day
10mg x 0.5m2 = 5mg/day.
Compare prescribed dose with safe dose:
The prescribed dose is 2.5mg q12h which
falls within the safe dosage range of 5mg per
day. Therefore, it is a safe dose to give.

Calculate the dose: Solve for x using one of the

3 calculation methods:
Ratio and Proportion:
5mg:1 tablet = 2.5mg: x
5 x = 2.51
52
X=1
2 tablet
Answer: 1 tablet every 12 hours
2
The Formula Method:
2.5mg x 1 tablet = x
5mg
2.51 = 1
52 2
Dimensional Analysis:
2.5mg x 1 tablet
5mg
2.51 = 1
52 2
Activity:
1. A physician prescribed Biaxin275mg, po, q8h
for a 44lb child with pneumonia. The safe
dosage is 15mg/kg/day. If the nurse gave 275mg
per dose, would this be a safe daily dose?
• Yes: ____ No_____
2. A physician prescribed codeine 30mg q4h as
needed for a child in pain. The child weighs
44lb. The safe dosage is 5 to 10mg/kg/dose. If
the nurse gave 30mg per dose, six times a day,
would this be a safe dose? Yes or No?
3. An emergency department physician ordered
4mg of a drug for a 44lb child with seizure. The
safe dosage range is 0.04 to 0.2mg/kg/dose.
The nurse gave _____. Is this a safe dose? Yes
or No?

4. The physician ordered Augmentin Suspension

550mg, PO, q8h for a child with otitis media.
Augmentin is labelled 250mg per 5mL. The
nurse should administer ____mL, q8h
3. An emergency department physician ordered
4mg of a drug for a 44lb child with seizure. The
safe dosage range is 0.04 to 0.2mg/kg/dose.
The nurse gave _____. Is this a safe dose? Yes
or No?

4. The physician ordered Augmentin Suspension

550mg, PO, q8h for a child with otitis media.
Augmentin is labelled 250mg per 5mL. The
nurse should administer ____mL, q8h
5. The physician prescribed 60 mg of a drug, PO
q6h for an 88lb child. The child weighs ____kg.
The safe dosage range is 5 to 7mg/kg/day.
Therefore, the safe dosage range for this child is
______mg per dose. If the nurse gave 60mg per
dose, would this be a safe dose? Yes or No
6. The physician prescribed nafcillin 1 g, q6h for
a 132lb teenager. The teenager weighs ____kg.
The safe dosage range is 50 to 100mg/kg/day.
Therefore, the safe dosage range for this
teenager is _____g/day. If the nurse gave 1 g
per dose, would this be safe?Yes or No?
7. A physician ordered penicillin V potassium
375mg po q6h for a 66lb child. The child weighs
___kg. The safe dosage range is 25 to
50mg/kg/24 hr. The dosage range for this child
is _____mg per day. Is this a safe dose? Yes or
No?
8. A physician prescribed dilantin 50mg, PO
q12h for a 33lb child with a seizure disorder. Tne
child weighs ____kg. The safe dosage range is 5
to 10mg/kg/day. The dosage range for this child
is _____mg per day. Is this a a safe dose? Yes or
No?
9. A physician ordered Orapred liquid 20mg, PO
q12h for a 44lb child . The child weighs ____kg.
The safe dosage range is 0.5 to 2mg/kg/day. The
safe dosage range for this child is ____mg per
day. Orapred liquid is labelled as 5mg per mL.
The nurse would give ___mL per dose. Is this a
safe dose? Yes or No?
•
10. The physician ordered rantidine HCl 15mg
PO, q12h for a 5kg infant with gastroesophageal
reflux disease (GERD). The safe dosage range is
5 to 10mg/kg/day. The safe dosage range for
this child is ___mg per day. If the nurse gave
30mg per day, would this be a safe dose?