Introduction:

Each and every pediatric scholar must learn the technique and develop skill in actually carrying out the frequently employed
practical procedures, some therapeutic and other diagnostic, in pediatric practice. Most of these procedures can be performed
bedside in addition to the procedure room.

Giving medications to children is a serious responsibility. The need for accuracy in preparing and giving medications to
children is even greater than with adult patient. Since the pediatric dose is often relatively small in comparison with the adult dose, a
slight mistake in the amount of a drug administered represents a greater proportional error.

Drug:
Drug is the single active chemical entity present is medicine that is used for diagnosis, prevention, treatment and cure of a
disease.

Drug is any substance that is used or it is intended to be used to modify or explore physiological systems or pathological states
for the benefit of the recipient.

Rights of Medication Administration

The rights of medication administration are following: the right patient, the right time, the right drug, the right dose, the right
route, the right of parents and child to know.

The Right Patient (Identification): Every hospital has a method for identifying patients. A identification band on the wrist or ankle
is commonly used to identify each child. A double check has to made, before administering medication.
The Right Drug, The Right Dose, The Right Route, and The Right Time: Although the physician prescribes drugs for patient, it is
the nurse who is legally liable for those administered. It is essential that the nurse who has questions concerning the accuracy of a
dose of medication or of the rout or timing of administration ask for clarification from the physician before giving the medication.

The Right of the Parents and Child to Know: This right is established by statements on patient’s rights published recently by
hospital and medical groups. It is the responsibility of health team member, the doctor and the nurse to share the information with
the parents and child regarding drug action and side effects.

Calculation of Drug Dosage

I. Calculation of Drug Dosage based on Body Size

a) Based on Body Weight

𝐵𝑜𝑑𝑦 𝑊𝑒𝑖𝑔ℎ𝑡 (𝐾𝑔)

1. Individual dose = 𝑋 𝐴𝑣𝑒𝑟𝑎𝑔𝑒 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
70

2. Clarke’s Formula
𝐵𝑜𝑑𝑦 𝑊𝑒𝑖𝑔ℎ𝑡 (𝑃𝑜𝑢𝑛𝑑𝑠)
Child dose = 𝑋 𝐴𝑣𝑒𝑟𝑎𝑔𝑒 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
150

b) Based on Body Surface Area

𝐵𝑆𝐴 (m2)
1. Individual dose = 𝑋 𝐴𝑣𝑒𝑟𝑎𝑔𝑒 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
1.7

BSA (m2) = BW (kg)0.425 x Height (cm)0.725 x 0.007184

 𝐵𝑆𝐴 𝑜𝑓 𝐶ℎ𝑖𝑙𝑑
2. Estimated Child Dose = 𝑋 𝐴𝑣𝑒𝑟𝑎𝑔𝑒 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝐵𝑆𝐴 𝑜𝑓 𝐴𝑑𝑢𝑙𝑡

II. Calculation of Drug Dosage based on Age

a) Young’s Formula

𝐴𝑔𝑒
Child Dose = 𝑋 𝐴𝑣𝑒𝑟𝑎𝑔𝑒 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
𝐴𝑔𝑒+12

b) Dilling’s Formula

𝐴𝑔𝑒
Child Dose = 𝑋 𝐴𝑣𝑒𝑟𝑎𝑔𝑒 𝐴𝑑𝑢𝑙𝑡 𝐷𝑜𝑠𝑒
20
 Generic Nurses
Trade Name Dose Route Mode of Action Indication Contra Indication Side Effects
Name Responsibility
CNS: Irritation,
restlessness,
Theophylline dizziness, muscle Assess the
competitively twitching and irritability and
Oral- blocks convulsions. restless.
Acute
1.5mg/Kg Oral phosphodiesteras GI: Loss of
Bronchospasm, Hypersensitivity Monitor for
Theophylline Theophylline and e which appetite and
Chronic and Porphyria cardiac rhythm.
IV- IV increases cAMP epigastric pain.
Bronchospasm
0.8mg/Kg tissue CVS: Palpitation,
and Apnea. Anticonvulsant
concentrations Ventricular
causing arrhythmias drugs should be
bronchodialation. kept ready to
Respiratory:
Taccypnea, treat
respiratory arrest. convulsions

Assess the for

Atropine is an
pupilary
anticholnergic
reaction.
agent which
CNS: Blurred
competitively
vision, mydriasis, Ensure
blocks the Brady cardia, Chronic respiratory
photophobia adequate
Atropine muscarinic Mydriatric, disease, Glaucoma,
IV- GI: dry mouth, hydration.
Atropine Sulphate IV rectpors in poisoning, and thryotoxicosis,
0.04mg/kg altered taste and
peripheral tissues Neuromuscular cardiac failure,
vomiting. Monitor for
such as the heart, blocker pyloric stenosis.
CVS: Palpitation, cardiac
intestines and
Bradycardia function.
bronchial
muscles.
Avoid bright
and glare light.
 Dopamine
Assess for the
stimulates the
Blood Pressure.
dopaminergic
receptors at
Record the
lower doses
Nausea, vomiting, Electro Cardio
producing renal
tachycardia, Graph.
and mesenteric
Pheochromocytom ectopic beats,,
vasodilatation
1- Acute heart a, uncorrected palpitation, angina Administer in
while at higher
Dopacef Dopamine 5mcg/kg/ IV failure and tachyarrhythmia pain, hypotension, the larger veins.
doses stimulate
Min Hypotension and ventricular vasoconstriction,
both
fibrillation. Bradycardia and Monitor intake
dopaminergic
hypertension. and output
and beta-
chart.
adrenergic
receptors and
vasoconstriction
is skeletal
muscles and a
rise in BP

Do not
Extra beats,
Digoxin is a administer
anorexia, nausea
cardiac glycoside when pulse rate
and vomiting,
which ahs Digitalis toxicity, is less than 50
Oral- 125 Supraventricula confusion,
positive inotropic ventricular beats.
to 250mcg Oral r Arrhythmias, dizziness,
activity tachycardia,
and Atrial drowsiness,
Digoxin Digoxin characterized by obstructive Do not
IV- 0.5- IV fibrillation and restlessness,
an increase in the myopathy. administer with
1mg Heart failure. nervousness,
force of Amino
agitation and
contraction. It glycosides.
amnesia.
also reduces the
conductivity Monitor for
through AV ECG for extra
node. beats.
 Maintain intake
output chart.
Paracetamol
exhibits Nausea, Allergic Taper the doses
Oral Oral,
antipyretic effect Mild to reactions, skin in hepatic
30mg/day Parent
by inhibiting the Moderate fever. Hepatic Nechrosis rashes, acute renal necrosis cases.
Fibrex Plus Paracetamol. eral,
hypothalamic and Know failure, hepatic and
Rectal 05- Rectal
heat-regulating Mild to Hypersensitivity renal necrosis. Administer test
1gm
centre. Moderate Pain dose.

Administer
Deep Intra
Muscular.

GI disturbances, Administer Test

It inhibits the
eosinophillia, dose.
bacterial cell Streptococcal
12 Lakh hyponatremia,
Benzathine IM wall synthesis infections.
Penidure Units Hypersensitivity injection site pain Assess for the
Penicillin. there by causes
reactions
the bacterial Prophylaxis and erythema.
lysis. It persists against RHD
Administer
for 26 days in the
Deep IM
plasma.

Treatment of Administer Test

It inhibits the
severe Agitation, dose.
bacterial cell
infections insomnia,
wall synthesis
caused by dizziness, Assess for the
Benzyl there by causes
10 Lakh IV Gram –ve Hypersensivity thrombocytopenia, reactions
CP Penicillin the bacterial
bacteria likes urticaria and
lysis. It persists
streptococci, hypersensitivity. Administer
for 26 days in the
staphylococci Deep IM
plasma.
and E-coli.
 Monitor
It blocks the patient’s blood
slow calcium pressure,
channel thus Peripheral edema, cardiac rhythm
preventing the hypotension, and cardiac
flow of calcium palpitations, output.
ions into the cell. tachycardia,
Acute MI,
It produces Hypertension, flushing, dizziness, Drug should not
Cardiogenic shock,
peripheral and Angina, as headache, nausea, be exposed to
Nicardia Nifedepine 10-20mg Oral acute unstable
coronary coronary increased sunlight.
angina and chronic
vasodilatation vasodilator micturition,
unstable angina
and reduces the lethargy, mental Assess for side
after load and deprivation, effects.
peripheral gingival
resistance and hyperplasia.
fall in BP.

Administer 30
minutes earlier
Ranitidine blocks Benign Gastric
Headache, the meals.
histamine H2- and Duodenal
dizziness, rarely
receptors in the ulcers,
hepatitis, Monitor for the
Oral- stomach and Eradication of
Oral thrombocytopenia, leukocytes
150mg prevents H-pylori
Rantac Ranitidine and Porphyria leucopenia, count.
histamine infection,
IV hypersensitivity,
IV- 50mg mediated gastric GERD,
confusion, Monitor for the
acid secretions. It Zollinger-
impotence, vertigo platelet count.
does not affect Ellison
and hallucinations
pepsin secretion. syndrome.
Liver function
test.
 Monitor the
Blood Pressure.
It inhibits the
Fluid and
reaborption of Monitor for
Hypertension, electrolyte
Na and chloride Severe sodium and serum
edema imbalance, rashes,
mainly in the water depletion, electrolytes.
Oral- 40- associated with photosensitivity,
Oral medullary hypersensitivity to
80mg heart failure, nausea, diarrhea,
Lasix Frusemide and portion of the sulphonamidea and Monitor for the
pulmonary blurred vision,
IV ascending Loop furosamide, blood cells
IV-40mg edema , dizziness, head
of Henle. It hypokalemia, level.
oliguria and ache, hypotension
reduces BP and hyponatremia and
chronic renal and bone marrow
also it reduces precomatose states. Place the
failure. suppression.
pulmonary patient in calm
Edema environment.

Lower Use small doses

It is a beta respiratory administered in
Nausea, vomiting,
lactam antibiotic infection, fractions.
anorexia, diarrhea,
IV- which inhibits Upper Hypersensitive to
head ache,
Cefotaxime 50mg/kg the bacterial cell respiratory tract Cephalosporin, Check for the
Cefotaxime IV dizziness, lethargy,
sodium body wall synthesis. infection, Skin Renal failure and hypersensitivity
parasthesia and
weight. And thereby infection, lactation. reactions.
bone marrow
causes bacterial Septicemia,
suppression.
lysis. Bone and soft Monitor for
tissue infection. blood cells.
 Dietary Avoid
deficiency of extravasations
Calcium calcium, of the infusion.
Renal calculi, Slowed heart rate,
supplementation Tetany, Acute
Hypovolemic local burning and
50mg/kg IV to the normal and chronic Use large veins
Calcium Calcium shock, peripheral
body and function of the thyroiditis, to administer.
Gluconate Supplement Hypercalcemia, vasodilatation,
weight Oral body and normal Rickets,
Ventricular Nausea, Anorexia
growth and Prophylaxis of Avoid oral
fibrillation. and polyuria.
development. GI bleeding administration
due to stress after antacids.
ulcers.

It is a plasma Prevention and Administer to

volume expander treatment of the larger veins.
and also acts as oliguria in renal Dizziness, blurred
osmotic diuretic failure, Anuria, Pulmonary vision, convulsion, Do not spill the
10%, 15%
by creating a Reduction of congestion, active nausea, vomiting, solution over
Mannitol Mannitol and 20% in IV
osmotic gradient ICP and intracranial anorexia, dry skin.
100ml.
between cerebral edema, bleeding, mouth and
intravascular forced dieresis dehydration and hypertension. Avoid
compartment and in case of CCF extravasations
third spaces poisoning. of the fluid.

Avoid use of
Amikacin binds
Urinary tract concurrent
to 30s ribosomal Pregnancy,
infection and ototoxic drugs.
subunits of Perforated Tinnitus, Vertigo,
IV- severe Gram –
Amikacin Amikacin IV susceptible eardrum, Ataxia and overt
15mg/kg ve infection Renal function
bacteria thus Myasthenia gravis, Deafness
resistant to test routinely.
inhibiting its hypersensitivity.
Gentamycin
protein synthesis.
Assess for
hearing acuity.
 Hydrocortisone
Monitor for the
is a
serum
corticosteroid
electrolytes.
used for its anti-
Sodium and fluid
inflammatory
retention, Administer
and Anaphylaxis,
potassium morning time
immunosuppress Severe Asthma,
Oral-400- depletion, for hormone
ive effects. Its Shock,
800mcg/kg Osteoporosis, GI replacement.
Oral anti- Hormonal Viral and fungal
Hydrocortiso Corticosteroi /day disturbances,
and inflammatory replacement in infections and
ne d Increased appetite, Monitor for the
IV action is due to case of Syphilis.
IV- 25- Increased ICP, Increased IOP
the suppression adrenalhectomy
100mg Psychosis,
of migration of and Addison’s
Hyperglycemia, Monitor for the
polymorph disease.
Obesity and raised blood glucose
nuclear
IOP in Diabetic
leukocytes and
patients.
reversal of
capillary
permeability.

Ibuprofen is a
potent anti-
inflammatory
Do not
with analgesic All painful Dyspepsia, Heart administer in
and antipyretic inflammatory burn, rash, GI Neonates
action, its conditions Active Peptic Ulcer bleeding, hepatic
Oral-
Ibugesic Plus Ibuprofen Oral analgesic and related to and GI bleeding, necrosis, vision
100mg Administer H2
antipyretics skeletal system, Neonates disturbances and receptor
effects are Dental
disorientation. antagonist with
further conditions.
medication
reinforced by
paracetamol.
 Aspirin is an
analgesic, anti- Do not
inflammatory administer in
and antipyretic. Dengue fever
GI disturbances,
It inhibits COX, Juvenile Hypersensitivity, and
Prolonged
which is Rheumatoid Angioedema, Hemophiliacs
Oral- 80- bleeding time,
responsible for arthritis, Pain, Urticaria,
Ecosprin Aspirin 100mg/Kg/ Oral Urticaria, Rhinitis,
the synthesis of Fever and Hemophilia, Check for
day Epigastric
prostaglandins Musculoskeleta Lactation and bleeding time.
discomfort and
and l disorders. Dengue Fever.
Bronchospasm.
thromboxane. It Observe for
also inhibits purpura,
platelet petechiae etc.
aggregation.

Use cautiously
in patients with
heart failure,
circulatory
insufficiency,
IV- 1.5 to Replaces the
renal
3 L (2% - Fluid and
dysfunction,
6% of Electrolytes- Electrolyte
Fluid And pulmonary
Ringer’s body Sodium, imbalances and
IVF.RL IV Electrolyte Renal Failure edema.
Lactate weight) Potassium,
Imbalance. fluid overload.
infused Calcium,
Use cautiously
over 18 to Chloride, and
in hepatic
24 hours. Lactate.
diseases
because of risk
of lactic acid
accumulation.
 Use cautiously
in patients with
heart failure,
circulatory
IV- 1.5 to
Replaces the insufficiency,
3 L (2% -
Fluid and renal
6% of
Electrolytes- Fluid And Electrolyte dysfunction,
Ringer’s Ringer’s body
IV Sodium, Electrolyte Renal Failure imbalances and pulmonary
Solution Injection weight)
Potassium, Imbalance. fluid overload. edema.
infused
Calcium and
over 18 to
Chloride. Only replace
24 hours.
the electrolytes
but insufficient
to treat severe
imbalances

CVS- Aggravation Use Cautiously

of heart failure, in elderly and
edema, post-operative
0.45%, 3 thrombophlebitis. patients.
Fluid and
to 5%, Metabolic-
It replaces the Electrolyte Usually no
0.9% and 2 Hypernatremia, Use Cautiously
Saline Sodium sodium and imbalance, contraindications
to ^5 of IV metabolic acidosis. in heart failure
Solution Chloride. chloride and Heat Cramp, except increased
body Respiratory- and renal
maintains levels. Excessive levels than normal
weight in pulmonary edema. dysfunction.
perspiration.
500ml Others- abscess,
tenderness and Monitor
tissue necrosis at electrolyte
injection site. levels.
Conclusion
Even though the physician is responsible for prescribing the drugs in the correct dosage to achieve the desired effect without
endangering the child’s health. However, nurses must have an understanding of the safe dosage of medication they administer to
children as well as the expected action,, possible side effects, and signs of toxicity. Unlike adult medications, there are few
standardized dosage ranges for children in the pediatric age-groups, and with a few exceptions, drugs are prepared and packaged in
average adult-dosage strengths.

Bibliography:

1. Tripati KD. Essentials of medical Pharmacology. 3rd ed. New Delhi: Jaypee Brothers Medical Publishers; 2005.

2. Lippincott. A Nursing Drug Manual. 24th ed. New York: Lippincott Publications; 2004.