NG-410 · NUR 235

💉 Pediatric medication safety & dosing

Everything in peds is per kilogram, and the margin for error is a fraction of an adult’s. The exam tests three things: is this dose safe, is this route right for this age, and is this volume too much for this muscle.

🧮 Is this dose safe?

The single most common calculation in this course.

⭐ The three steps, every time

1. Convert the weight to kilograms — divide pounds by 2.2
2. Multiply by the safe range from the reference: mg/kg/day
3. Compare the ordered dose to that range — and if it is outside it, the answer is hold and call the provider, never give it and monitor.

Watch the units. A range given per day and an order written per dose is the classic trap — divide the daily range by the number of doses first.

🔢 A worked one

A child weighs 33 lb. The safe range is 20–40 mg/kg/day divided into 3 doses. The order reads 150 mg every 8 hours.

33 ÷ 2.2 = 15 kg
15 × 20 = 300 mg/day · 15 × 40 = 600 mg/day
Per dose: 100–200 mg
150 mg sits inside that — safe to give

⚠️ Where it goes wrong

Using pounds as kilograms — a 2.2× overdose
Comparing a per-dose order to a per-day range
Rounding a pediatric dose the way you would an adult's
Giving a dose outside the safe range because it is “only slightly” over

💉 Injections — site and volume

The muscle has to be big enough for what you are putting in it.

Age	IM site	Rough volume ceiling
Infant	Vastus lateralis	0.5–1 mL
Toddler / child	Vastus lateralis or deltoid once walking	up to 2 mL
Adolescent	Deltoid or ventrogluteal	adult volumes

✅ The rules that carry marks

Vastus lateralis is the infant site — the gluteal muscle is not developed until they have been walking about a year
Two nurses check high-alert drugs and any weight-based dose
Give the injection in a treatment room, and let a parent comfort afterwards
Never say it will not hurt — say how long it will last

💊 Routes, and what only peds does

💊 Immunization routes

Rotavirus — PO
MMR and varicella — SQ
Everything else — IM

💧 IV fluids in children

Only normal saline and lactated Ringer's are appropriate
Infuse slowly, on a pump, with strict intake and output
Watch for overload: crackles, rising heart rate and blood pressure

🤕 Getting it into them

Never call medicine candy or a treat
Never mix a dose into a full bottle or a whole meal — if they do not finish it, you do not know what they got
Offer a choice about how, never about whether
Iron tablets look like candy and are a classic pediatric poisoning

☠️ Two antidotes worth knowing cold

Acetaminophen overdose → N-acetylcysteine
Lead above 5 mcg/dL → chelation
Never induce vomiting after a corrosive ingestion

👂 The ear-drop rule

⭐ It flips at age 3

Under 3 — pull the pinna down and back
Over 3 — pull the pinna up and back

Then massage the tragus, and warm refrigerated drops in your hand first — cold drops in the ear cause vertigo.

The same up-and-back rule reappears in the preschool ear assessment. It is the same fact asked twice.