Route guidelines

• PO medications may be given as liquid suspensions.

  • Mix drug before measuring out dose.

  • Never crush timed-release capsules or tablets or enteric-coated drugs.

• SubQ route is commonly used for childhood immunizations and insulin injections.

  • Make sure injection contains no more than 1 mL of solution.

  • Administer in any area with sufficient subcutaneous tissue.

• IM route is commonly used for vaccines.

  • Inject the appropriate amount per location.

  • Administer in the vastus lateralis, deltoid, or ventrogluteal muscles.

• IV drugs should be diluted carefully and administered cautiously.

  • Use an infusion pump with infants and small children.

• For topical route, absorption is greater in infants and small children.

  • Wipe off any remaining drug after application.

  • Apply according to doctor's order and drug manufacturer's recommendations.

Dosage per kilogram

• Dosages are expressed as mg/kg/day or mg/kg/dose.

• Multiply the child's weight in kilograms by the required milligrams of drug per kilogram.

BSA

• Measured in m²

• Determined through intersection of height and weight on a nomogram

• Multiplied by the prescribed dose in mg/m²/day to calculate safe pediatric dosages

Weight-based formulas for fluid needs

• A child weighing less than 10 kg: weight in kg × 100 mL = fluid needs in mL/day

• A child weighing 10 to 20 kg: (total kg – 10 kg) × 50 mL = additional fluid need in mL/day; 1,000 mL/day + additional fluid need = fluid needs in mL/day

• A child weighing more than 20 kg: (total kg – 20 kg) × 20 mL = additional fluid need in mL/day; 1,500 mL/day + additional fluid need = fluid needs in mL/day

Calorie-based formula for fluid needs

• Fluid-to-calorie ratio: 120 mL per 100 kcal

• Fluid requirements in mL/day = (calorie requirements ÷ 100 kcal) × 120 mL

BSA-based formula for fluid needs

• For a well-dehydrated child: fluid maintenance needs in mL/day = BSA in m² × 1,500 mL/day/m²