PAEDIATRICS DOSE CALCULATION

1. YOUNG’S RULE: Dose calculation related to age (1 to 12 yrs)

 In situations where the pediatric patient's weight is unknown, for instance, at the
point of injury, then Young's Rule can be safely implemented if their age and the
recommended adult dosing are known.
 Additionally, certain classes of medications require weight-based dosing, such as
antibiotics and antiepileptics.
 Ultimately, age-based dosing has been demonstrated to be a safe and effective
approach. However, caution should be used depending on the class of the drug.

DEFINITION:
Young's Rule is an equation used to calculate pediatric medication dosage based on the
patient's age and the known recommended adult dose. The definition of Young's Rule is
the age of the patient, divided by the age added to twelve, all multiplied by the
recommended adult dose. This formula appears below:

Age / (Age + 12)] x Recommended Adult Dose = Pediatric Dose

EXAMPLES:
Q1. The pediatric dose for a 9-year old child who weighs 63lbs needs to be
determined. You learn that the adult dose for the same drug is 200mg. Using
Young’s rule, what dose should the child be given?

We can now plug these values into the equation:

 Child’s dose = 200mg x [9 / (9 + 12)]
 Child’s dose = 200mg x [9 / 21]
 Child’s dose = 200mg x 0.43
 Child’s dose = 86mg
Q2. A two year old needs amoxicillin, The normal adult dose is 250mg, using young’s
Rule what is the appropriate dose for 2 year old child?
Using the formula:
 Child’s dose = 250mg x [ 2 / (2+12)
 = 35.7
 = 36mg

2. FRIED’S RULE ( INFANT< 1 YRS)

Fried's rule is a method of estimating the dose of medication for a child by dividing the
child's age in months by 150 and multiplying the result by the adult dose.

Dose for infant = Age (months) x Adult dose

150

FOR EXAMPLE:

Q. The doctor orders an adult dose of Ibuprofen 600mg PO. Calculate the dose for a child
who is 24 months old.

Pediatric dose = 24months x 600mg

150 months

= 0.16 x 600mg

= 96mg
 3. CLARK’S RULE

The formula for Clark’s rule is as follows:

Adult dose x [weight of child (lbs) / 150 ] = Child’s dose

In words – we must multiply the standard adult dose by the child’s weight in pounds (lbs)
divided by 150.

It is important to remember that the child’s weight must be in pounds. The question may offer
the weight in kilograms, in which case you must convert kilograms to pounds (to convert kg to
lbs, we multiply by 2.2)

{CONVERSION:
 To convert Kg into pounds

Weight x2.2 = weight in pounds

 To convert pound into Kg

Weight in pounds = weight in Kg }

2.2
Here is a sample question:
Q. Using Clark’s rule, what is the dose for a 12-year old girl who weighs 31.7kg if the
average adult dose is 500mg?

In this case, we simply plug the values into the equation – but first, we must convert 31.7
kilograms to pounds.

31.7kg x 2.2 = 70 pounds (lbs)

Now, we can complete the equation:
 Child’s dose = 500mg x (70lbs / 150)
 Child’s dose = 500mg x (0.47)
 Child’s dose = 235mg
Q. The average adult dose for a drug is 250mg. Using Clark’s rule, what dose should be
given to an 8-year old child who weighs 57lbs?

This time, we are given pounds and so do not need to perform any conversions.

Now, we can complete the equation:

 Child’s dose = 250mg x (57lbs / 150)
 Child’s dose = 250mg x (0.38)
 Child’s dose = 95mg
And that is how we use Clark’s rule. The method is simple – you merely need to remember the
equation and the need, if necessary, to perform any conversions.

FLUID DOSAGE FOR PEDIATRICS

 Dosages for medication administration to pediatrics are almost always determined

by the patient’s size (height and weight)
 However, most reference manuals for medications focus primarily on the adult
dosages
 Therefore, the healthcare provider must be able to determine the appropriate
dosage for the pediatric patient when given the adult dosage.

CALCULATION FOR FLUID REQUIREMENT

DROP FACTORS

1. Normal IV set 1 ml = 15gtt

2. Micro volume 1 ml = 60 micro drops
CALCULATING FLOW RATE

VOLUME (ml) x DROP FACTOR (gtt/ml) = FLOW RATE (gtt/ min)

MINUTES

DAILY FLUID REQUIREMENT FOR FIRST WEEKS OF LIFE

(NEONATES)

BIRTH DAY 1 DAY 2 DAY 3 DAY 4 DAY 5 DAY 6 DAY 7

WEIGHT

< 1000g 80 100 120 130 140 150 160

1000 to 80 90 110 120 130 140 150

1500g

> 1500g 60 75 90 105 120 135 150

FORMULA FOR CALCULATING DAILY FLUID MAINTENANCE

DOAGES FOR PEDIATRIC
 Assimilating the known physiology at the time, they observed that “there was a
DIRECT LINEAR relationship between Physiologic Water Needs (insensible losses
+ urinary losses) and Energy Metabolism".
 In other words “the average needs for water, expressed in milliliters, equals energy
expenditure in calories (under normal resting conditions, 1 ml of water is required to
metabolize 1 kcal)". 
 THE HOLLIDAY – SEGAR 4-2-1
TO ESTIMATE MAITENANCE FLUID REQUIREMENT

Weight Hourly Daily

(Kg)

10-20 kg 40ml/Kg/hr. 100ml/kg/day

10 – 20 40ml + 2ml/kg for every kg >10 Kg 1000ml + 50ml/kg/day for every kg >10
Kg

> 20kg 60ml+ 1ml/kg for every kg > 20 kg 1500ml + 20 ml/kg/day for every kg > 20