Pediatric Dosing & Fluid Resuscitation

Pediatric resuscitation fundamentals

Children have higher metabolic rates, smaller functional reserve, and age-specific vital sign normals. The CDC child safety program stresses injury prevention and rapid EMS access when pediatric emergencies occur.¹ Bradycardia in infants is often pre-arrest from hypoxia, ventilate before epinephrine when heart rate is low with poor perfusion.

Weight-based epinephrine for anaphylaxis and arrest, defibrillation joules (2-4 J/kg), and dextrose doses (0.5-1 g/kg) depend on accurate weight. Length-based tapes estimate weight when parents cannot report it, know color zone and corresponding kilograms for your equipment.

Fluids and equipment sizing

Isotonic crystalloid boluses for shock are commonly 20 mL/kg, repeat per protocol with reassessment between aliquots to avoid fluid overload in cardiogenic failure.² Endotracheal tube size by age formula (age/4 + 4 uncuffed) guides airway planning; have smaller backup tubes ready.

Family presence during resuscitation may be supported per policy, communicate clearly while maintaining procedural focus. Hypoglycemia in infants may present with jitteriness or seizures; check glucose early. Transport with warming measures, hypothermia worsens coagulopathy and resuscitation outcomes in small patients.