💉 Pediatric Medication Administration
Everything is weight-based and double-checked. Sites, volumes, and how to get a toddler to take it.
⚖️ The safety rules
Pediatric doses are calculated, not looked up. A tenfold error is easy to make and can be fatal, which is why every step is checked twice.
Weigh in KILOGRAMS only. Recording pounds and treating it as kilograms is a 2.2-times overdose, and it has killed children.
🧠 Checking a dose
- Dose is mg per kg — know the safe range before you draw it up
- Independent double-check by a second nurse for high-alert drugs: insulin, opioids, chemotherapy, digoxin, anticoagulants
- If the calculated dose seems large or small, recalculate before questioning the child, not after
- Use oral syringes for liquids, never a kitchen spoon
- Two identifiers — and in pediatrics, ask the parent to confirm the name too
| Route | Site | Max volume per site |
|---|---|---|
| IM — infant | Vastus lateralis | 0.5–1 mL |
| IM — toddler/child | Vastus lateralis; deltoid once walking well | 1–2 mL |
| IM — adolescent | Deltoid or ventrogluteal | 2–3 mL |
| Subcutaneous | Abdomen, thigh, upper arm | 0.5 mL |
The dorsogluteal site is not used in children who are not yet walking - the muscle is undeveloped and the sciatic nerve is close.
🩺 Getting it into the child
✅ By age
- Infant — small amounts into the side of the cheek with an oral syringe; let them swallow between. Never squirt into the back of the throat
- Toddler — offer two acceptable choices: which cup, sitting on whose lap. Never ask “will you take it?”
- Preschooler — brief honest explanation; let them hold the syringe; a sticker afterwards
- School age — explain what it does; let them choose the order
- Adolescent — privacy, and involve them in the decision
🚨 Things not to do
- Never call medicine "candy" or "candy" - children then seek it out unsupervised.
- Never mix medicine into a full bottle of formula or a whole meal. If it is not finished, the dose is unknown.
- Never tell a child an injection will not hurt. Say it will hurt for a moment and that they can hold your hand.
A small amount of a strongly flavored food is acceptable if the drug allows it — check first, because some are inactivated.
💊 Comfort during procedures
- Topical anesthetic cream where time allows
- Sucrose and non-nutritive sucking for infants; breastfeeding during the procedure works well
- Swaddle; hold the child upright on a parent’s lap rather than lying flat — it is far less frightening
- Distraction: bubbles, a phone, counting, a favorite song
- Do painful procedures in a treatment room, never in the child’s bed — the bed must stay a safe place
🎯 NCLEX traps
- Kilograms only
- Vastus lateralis for infants; max 1 mL
- Two choices, not an open question, for a toddler
- Never in a full bottle; never called candy
- Painful procedures happen in the treatment room