Pediatric

Medication

Facilitator:
Rubina kousar
RN,RM,BScN Post RN
 Introduction
Caring for children who are ill challenges every nurse to
function at the highest level of professional competence.
Giving medication is one of the most important nursing
responsibilities. the nurse must calculate the correct
dosage to provide safe and effective care.
Great care must be taken when administering medication
to children
“the smallest error is potentially life-threatening”
What you need to know
 Two methods of computing doses are used to determine accurate
pediatric medication dosages:
the body weight method
the body surface area method
 There are wide variations in the actual weight of a child of a
given age compared to the average weight for a child of that age.
 Consequently dosages are usually calculated according to body
weight.
 In more complex situations dosages are based on body surface
area, for example in chemotherapy.
Conti..
 Body surface area can be determined using the body weight
and height of a child.
 When dealing with an infant (a child aged less than 1 year)
body weight and length are used.
 The prescription should specify whether to use weight or
body surface area.
Body Weight Method
 The first method of computing dosages uses the child’s
weight.
 The child’s weight in kilograms is used to calculate a safe
dose range for the child.
 To use the body weight method of dosage calculation, a
child’s weight recorded in pounds has to be converted into
kilograms.
Pounds To Kilograms .

Nursing Alert: In pediatrics you need to carry out to the

hundredths (do not round)
Pounds to kilograms
 Example:
20 pounds 5 ounces
First need to convert 5 ounces to a fraction of a
pound.
5 divided by 16 = 0.31
20.31 pounds
20.31 pounds convert in Kg
20.31 divided by 2.2 = 9.23 kilograms
Note medication would be calculated based on
9.23 kilograms.

DO NOT ROUND
 Calculating dose by Body Weight Method
Calculating the size of a single dose is based on the recommended dosage
(in milligrams per kilogram per day) and a child’s weight.

Note: There is no particular formula required for these calculations.

Example 1
A child is prescribed erythromycin.
The recommended dosage is 40 mg/kg/day, 4 doses daily.
If the child’s weight is 15 kg, calculate the size of a single dose.
15 kg × 40 mg/kg/day = 600 mg/day
Then
600 mg ÷ 4 doses = 150 mg/dose
Example 2
A child is to be given ampicillin.
The recommended dosage is 80 mg/kg/day, 4 doses per day.
Calculate the size of a single dose if the child’s weight is 27 kg.
27 kg × 80 mg/kg/day = 2160 mg/day
Then
2160 mg ÷ 4 doses = 540 mg/dose
Example 3
A child is 2 years and weighs 36 lbs
Physician order: Amoxicillin 215 mg po tid for a bilateral otitis media
(ear infection)
First you would need to change 36 lbs to kg
36 divided by 2.2 • Patient weight in kg = 16.36 kg
Home Assignment:
Calculate the size of 24 h dose and single dose for the following medicine,
child weights are 12 kg, 20 kg and 36 kg:

1. Erythromycin, 40 mg/kg/day, 4 doses per day

2. Penicillin , 50 mg/kg/day, 4 doses per day
3. Cefalexin, 30 mg/kg/day, 4 doses per day
4. Cloxacillin, 50 mg/kg/day, 4 doses per day
5. Chloramphenicol, 40 mg/kg/day, 4 doses per day
6. Amoxicillin, 45 mg/kg/day, 4 doses per day,
7. Flucloxacillin, 100 mg/kg/day, 4 doses per day
8. Capreomycin sulphate, 20 mg/kg/day, 3 doses per day
9. Cephalothin, 60 mg/kg/day, 4 doses per day
Body Surface Area Method
The second formula used to calculate dosages is the body
surface area (BSA) method.
West nomogram. 
The West nomogram, commonly used to calculate BSA, is a
graph with several scales arranged so that when two values are
known, the third can be plotted by drawing a line with a
straight edge.
The child’s weight is marked on the right scale, the height on
the left scale.
Use a straight edge to draw a line between the two marks.
The point where the lines cross the column labeled SA (surface
area) is the BSA expressed in square meters (m2).
Formula:
Child's dose = (BSA of child / 1.73 m2) x Adult dose
Example.1
A child is 47 cm tall and weighs 2.5 kg

 The usual adult doe of the medication is 500mg.

 Place and hold one end of a straight edge on the first column at
47 cm tall and move it so that it lines up with 2.5 kg in the far
right column.
 On the SA column, the straight edge falls across 0.17m2
 You are ready to calculate the child’s dose by multiplying
0.17m2 times 500mg: 0.17×500= 85
 The child’s dose is 85mg.
Pediatric Drug Calculation
Calculating paediatric dosages for oral medications in
liquid form
 Children are frequently prescribed oral medication in liquid
form.
 Liquid medication allows a greater range of specific dosages
compared to solid form (tablets and capsules).
 This is especially relevant for children as there is a great range
of weights for a child of a given age.
 Generally a child finds a liquid medication easier to take than a
tablet or capsule.
 The liquid medication may be a syrup, an elixir, a solution or a
suspension.
 Suspensions must be shaken thoroughly before measuring the
volume.
Systems of Measurement
There are three systems of measurement used in nursing:
• The metric system
• The apothecaries system
• Household system
Metric System
The most widely used international system of measurement.
The basic units of metric measures are
The gram (weight)
Meter (length or distance)
Liter (volume).
Converting values between metric system
For drug dosages, the metric units used are the
Gram (g)
Milligram (mg)
Microgram (mcg)
For volume units milliliters (mL) and liters (L). 
 Unit Equivalents

1 gram (g) 1000 mg

1 mg 1000 microgram (mcg)

1 kilogram (kg) 1000 g

1 kilogram (kg) 2.2 lbs

1000 milliliter (mL)

1 liter
Apothecaries’ System
The apothecaries’ system is one of the oldest systems of measurement, older than
the metric system and is considered to be out of date.
The basic units used in this system are the
Grain (gr) for weight
Minim for volume , Unit Equivalents
Ounce, and pound. 1 grain (gr) 60 or 65 mg
5 grain (gr) 300 or 325 mg
15 grain (gr) 1000 mg or 1g
1 grain (gr) 60 or 65 mg
¾ grain 45mg
½ grain 30mg
¼ grain 15mg
Household System
 Household system measures may be used when more accurate systems of
measure are not required.
 Included units are drops, teaspoons, tablespoons, cups, pint and glasses

Unit Equivalents
1 teaspoon (tsp) 5 ml or 16 drops
1 tablespoon (T) 3 teaspoons or 15 mL
1 fluid ounce (fl oz) 2 tablespoons or 30 mL
1 cup (C) 8 fluid oz or 240 mL
1 pint (pt)  16 fluid oz or 480 mL
Household system weight
1 pound (lb) 16 ounce
2.2 pounds (lbs) 1 kilogram
Other Systems of Measurement
Millequivalent (mEq)
The millequivalents is an expression of the number of grams of a medication
contained in 1 milligram of a solution
Examples: the measure of serum sodium. Serum potassium, and sodium
bicarbonate is given in millequivalents.
Unit (U)
Unit measures a medication in terms of its action, not its physical weight. 
When documenting, do not write “U” for unit, rather spell it as
“unit”
as it is often mistaken as “0”. 
Examples: Insulin, penicillin and heparin sodium are measured in units.
10 Rights of Medication Administration
Understanding the 10 Rights of Drug Administration can help prevent many
medication errors.
1. Right Drug. The first right of drug administration is to check and verify
if it’s the right name and form. Beware of look-alike and sound-alike
medication names.
2. Right Patient. Ask the name of the client and check his/her ID band
before giving the medication. Even if you know that patient’s name, you
still need to ask just to verify.
3. Right Dose. Check the medication sheet and the doctor’s order before
medicating. Be aware of the difference between an adult and a pediatric
dose.
4. Right Route. Check and verify the order (i.e., per orem, IV, SQ, IM).
5. Right Time and Frequency. Check the order for when it would be given
and when was the last time it was given.
6. Right Documentation. Make sure to write the time and any remarks
on the chart correctly.
7. Right History and Assessment. Secure a copy of the client’s history
to drug interactions and allergies.
8. Right Drug Approach and Right to Refuse. Give the client enough
autonomy to refuse the medication after thoroughly explaining the effects
9. Right Drug-Drug Interaction and Evaluation. Review any medications
previously given or the diet of the patient that can yield a bad interaction
to the drug to be given. Check also the expiry date of the medication
being given.
10. Right Education and Information. Provide enough knowledge to the
patient of what drug he/she would be taking and what are the expected
therapeutic and side effects.
Responsibilities After Dosage Calculation
After computing the dosage, the nurse should:

Double-check the computation.

The nurse should always have the computation checked by another staff person
qualified to give medication or someone in the department who is delegated for
this purpose.

Compute separately.
Errors are easy to make and easy to overlook; a second person should do the
computation separately; then both results should be compared.
Drug Calculation
There are 3 primary methods for the calculation of medication
dosages. These include
• Desired Over Have Method or Formula
• Dimensional Analysis
• and Ratio and Proportion

Desired Over Have or Formula Method

A basic formula, solving for x, guides us in the setting up of an
equation:
D/H x Q = x, or
Desired dose (amount) x Quantity = ordered Dose
amount/amount on Hand
D x V = ordered Dose
H
Example 1
The doctor has prescribed 50 mg of Amitriptyline to a client. There
are 10 mg tablets available in
stock. How many tablets will you administer?
Answer
Stock required: 50 mg
Stock strength: 10 mg
This is an oral dose.

Stock required volume

Formula = stock strength

50 mg
So, tablet dosage = --------- 1 = 5 tablets
10 mg
Example 2
A client is ordered 0.4 mg Thyroxine. Each tablet contains 200 mcg. How
many tablets will you administer?

Answer
Required dose/ doctor orders: 0.4 mg
Stock strength: 200 mcg

Formula = Stock required volume

stock strength

Need to convert the SR amount to mcg.

So, SR= 0.4mg= 0.4 X 1000 = 400mcg

Dosage = 400mg. 1 = 2 tablets

200mg
Example 3
The client was ordered Oral Phenergan 0.1g, TDS (three times a day). The
pharmacy has dispensed Phenergan 25mg tablets.
How many tablets will you administer?
What dose of Phenergan will this client receive in 24 hours?
Answer
Stock required : 0.1g
Stock in hand : 25mg/tablet
You need to convert the SR amount to mg.
So, SR= 0.1g
= 0.1 1000 = 100 mg

Dosage = 100 mg 1 = 4 tablets

25 mg
One dosage is 4 tablets.
So the dose that the client will receive in 24 hours;
4 tablets x TDS (three times a day)
= 12 tablets of 25 mg Phenergan
Example 4
A child is to be given 175 micrograms of digoxin, orally.
Paediatric mixture contains 50 micrograms per mL.
Calculate the required volume.
Example 5
A child is prescribed 80mg of paracetamol elixir. Stock on hand is 100mg in 5mL.
Calculate the volume to be given.

FORMULA =
 Example 6
A child is prescribed digoxin 40 micrograms, IV.
Paediatric ampoules contain 50 micrograms/2 mL.
Calculate the amount to be drawn up in a syringe.
Calculating volumes for injection in paediatric patients
Example 1
A boy is prescribed pethidine 35 mg, IM.
Stock ampoules contain 50 mg in 1 mL.
What volume must be withdrawn for injection?

The formula can be abbreviated

to:
Fluid calculation
Fluid calculation
Fluid needs should be calculated on every patient to assure that the
infant / child is receiving the correct amount of fluids.
Standard formula for pediatrics needs to be memorized.

IV fluid calculation
The maintenance dose for administration of IV fluids is based on
the following formula
100 mL of fluid for the 1st 10 kg of weight
50 mL of fluid for the 2nd 10 kg of weight
20 mL of fluid for and additional kg
You need to memorize this
Example:
1. Jose weighs 16 pounds
Weight in kg = 7.27 kg
Using the formula provided how many ml of fluid would he need in 24
hours?
Fluid Calculation 
7.27 kilograms
100 mL x 7.27 kg = 727 mL
727 mL / 24 hours or 30 mL per hour
2.
64 pound child
Convert pounds to kilograms = 29.09 kg
100 mL x 10 kg = 1000 mL
50 ml x 10 kg = 500 mL
20 ml x 9.09 kg = 181 mL
1681 mL / 24 hours or 70 mL / hour