Pharmacy Calculations: Pediatric Dosing

Pediatric Dosing

Pediatrics refers to the practice of medicine in children from childbirth until adolescence. This
range of ages is subdivided into various groups:
● Neonates: birth to one (1) month
● Infant: one (1) month to one (1) year
● Early childhood: one (1) year through 5 years
● Late childhood: 6 years through 12 years
● Adolescence: 13 years through 17 years

Calculating Pediatric Doses

Four methods can be used to calculate Pediatric Doses:
● Fred’s Rule for Infants
● Clark’s Rule
● Young’s Rule
● BSA Dosing

Fred’s Rule for Infants

𝐴𝑔𝑒 (𝑖𝑛 𝑚𝑜𝑛𝑡ℎ𝑠)
Infant dose = Adult dose x 150 𝑚𝑜𝑛𝑡ℎ𝑠

Please note: In Fred’s Rule, 150 months is a constant.

Example:
1. AJ is a 4-week-old infant weighs 8 lb and the physician wants to give him Captopril. The
manufacturer recommends an initial adult dose of 12.5 mg two or three times a day.
What is an appropriate initial dose for AJ? Round answer to the 3 rd decimal place.

𝐴𝑔𝑒 (𝑖𝑛 𝑚𝑜𝑛𝑡ℎ𝑠)

Infant dose = Adult dose x 150 𝑚𝑜𝑛𝑡ℎ𝑠

1 𝑚𝑜𝑛𝑡ℎ
Infant dose = 12.5 mg x 150 𝑚𝑜𝑛𝑡ℎ𝑠
= 0.083 mg

AJ’s appropriate initial dose would be 0.083 mg 2-3 times a day.

Clark’s Rule
𝑊𝑒𝑖𝑔ℎ𝑡 (𝑖𝑛 𝑙𝑏)
Child dose = Adult dose x 150 𝑙𝑏

Please note: In Clark’s Rule, 150 lb is a constant. 150 pounds represents the average adult weight.

Example:
2. TJ is a 5-year-old male patient who weighs 46 lb. the physician wants to give Captopril
to him. The manufacturer recommends an initial adult dose of 12.5 mg two or three
times a day. What is an appropriate initial dose for TJ? Round answer to the 3 rd decimal
place.

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𝑊𝑒𝑖𝑔ℎ𝑡 (𝑖𝑛 𝑙𝑏)

Child dose = Adult dose x 150 𝑙𝑏

46 𝑙𝑏
Child dose = 12.5 mg x 150 𝑙𝑏
= 3.83 mg

TJ’s appropriate initial dose would be 3.83 mg 2-3 times a day.

Young’s Rule
𝐴𝑔𝑒
Child dose = Adult dose x (𝐴𝑔𝑒 + 12 ) 𝑦𝑒𝑎𝑟𝑠

Please note: In Young’s Rule, the unit of age is years and 12 is a constant.

Example:
3. MJ is a 5-year-old female patient who weighs 46 lb. The physician wants to give
Captopril to her. The manufacturer recommends an initial adult dose of 12.5 mg two or
three times a day. What is an appropriate initial dose for MJ? Round answer to the 3rd
decimal place.

𝐴𝑔𝑒
Child dose = Adult dose x (𝐴𝑔𝑒+12)

5 𝑦𝑒𝑎𝑟𝑠
Child dose = 12.5 mg x (5+12) 𝑦𝑒𝑎𝑟𝑠
= 3.68 mg

MJ’s appropriate initial dose would be 3.68 mg 2-3 times a day.

BSA Dosing
𝐵𝑆𝐴 (𝑖𝑛 𝑠𝑞𝑢𝑎𝑟𝑒 𝑚𝑒𝑡𝑒𝑟)
Child dose = Adult dose x 1.73 𝑠𝑞𝑢𝑎𝑟𝑒 𝑚𝑒𝑡𝑒𝑟

Please note: 1.73 m2 is a constant and is the average BSA of an adult.

AND

Child dose = Recommended dose per m2 x Child’s BSA

ℎ𝑒𝑖𝑔ℎ𝑡 (𝑖𝑛 𝑐𝑚) 𝑥 𝑤𝑒𝑖𝑔ℎ𝑡 (𝑖𝑛 𝑘𝑔)

Remember the equation…BSA = 3600

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Example:
4. Z is a 5-year-old intersex patient who weighs 42 lb and is 109.22 cm. The physician
wants to give Diazepam to Z. The manufacturer recommends 1.17 – 6 mg per square
meter three to four times a day. What is an appropriate initial dose for Z? Round answer
to the 2nd decimal place.

Child dose = Recommended dose per m2 x Child’s BSA

BSA = 0.761 m 2

Child dose = 1.17 mg per m2 x 0.761 m2 = 0.89 mg

AND
Child dose = 6 mg per m2 x 0.761 m2 = 4.57 mg

Please note: The reason we have two calculations for this dose is because the
manufacturer recommended a dose range (lower and upper limits).

Z’s appropriate initial dose would be 0.89 - 4.57 mg 2-3 times a day.

Example:
❖ Z is a 5-year-old intersex patient who weighs 42 lb and is 109.22 cm. The physician
wants to give Diazepam to Z. The manufacturer recommends adult dose 1.17 – 6 mg
three to four times a day. What is an appropriate initial dose for Z? Round answer to the
2nd decimal place.

𝐵𝑆𝐴 (𝑖𝑛 𝑠𝑞𝑢𝑎𝑟𝑒 𝑚𝑒𝑡𝑒𝑟)

Child dose = Adult dose x 1.73 𝑠𝑞𝑢𝑎𝑟𝑒 𝑚𝑒𝑡𝑒𝑟

Child’s BSA = 0.761 m 2

0.761
Child dose = 1.17 mg x ( 1.73
) = 0.515 mg
AND
0.761
Child dose = 6 mg x ( 1.73
) = 2.64 mg

Please note: The reason we have two calculations for this dose is because the
manufacturer recommended a dose range (lower and upper limits).

Z’s appropriate initial dose would be 0.515 - 2.64 mg 2-3 times a day.

Practice Problem:
1. Based on an adult dose of 600 mg, what is the appropriate dose for a 6-year-old boy that
is 3 feet 4 inches tall and weighs 44 pounds? Use the following to find the appropriate
dose for this boy.
a. BSA formula,

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b. Young’s Rule, and

c. Clark’s Rule.
2. Doctor orders Amoxil for a child that weighs 63 lbs. The safe dosage range for this
medication is 50 mg/kg/day and is to be given every 8 hours.
What is the safe dose for this child per dose?
3. Doctor orders Zofran 2 mg for a child that weighs 13.6 kg, is this a safe dose?
The manufacturer recommends the safe dosage of this drug is 0.15 mg/kg.
4. Doctor orders Zithromax for a child that weighs 82 lbs. The manufacturer recommends a
safe dose range for this medication is 10-12 mg/kg/day.
What is the maximum safe daily dose for this child?
5. Doctor orders 300 mg of Zmax once a day for a child that weighs 72 lb. Is this a safe
dose for this patient?
The manufacturer recommends a safe dose range for this medication is 10-12 mg/kg/day.
6. Doctor orders an IV drip of Dopamine for a child that weighs 78 lbs. The manufacturer
recommends a safe dosage range for this medication is 5-20 mcg/kg/min.
What is the safe dosage range for this child?
7. Doctor orders Cefazolin 350 mg IV every 4 hours. The child weighs 31 lb, is this a safe
dose for this patient?
The safe dosage range for this medication is 25-75 mg/kg/day.
8. A child weighing 52 lb has a fever and the doctor orders Tylenol. The safe dose range of
this medication is 10-15 mg/kg every 6 hours.
What is the maximum safe dose this child can have per day?
9. Doctor orders 200 mg of Ibuprofen every 8 hours for a child that weighs 49 lb. The safe
dosage range for this medication is 5-10 mg/kg/dose.
What is the safe dosage range for this particular child?
10. Doctor orders Benadryl for a child that weighs 98 lbs. The safe dose range for Benadryl
is 5 mg/kg/day.
What is the safe dosage for this child?
11. Doctor orders Digoxin 0.92 mg daily for a child that weighs 16 lbs. Is this a safe dosage
for this child?
The safe dosage for this medication is 8-12 mcg/kg/day.

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Answer Key:

2. Amoxil 477.3 mg per dose

3. Yes. This is a safe dose of Zofran.
4. Zithromax 447.3 mg per day
5. No. This is not a safe dose. A safe dose is 327.3 to 392.7 mg per day.
6. Dopamine 177.3 to 709.1 mcg per min
7. No. This is not a safe dose. A safe dose would be Cefazolin 58.7 to 176.1 mg per dose.
8. Tylenol 1,418 mg per day
9. Ibuprofen 111.4 to 222.7 mg per dose
10. Benadryl 222.7 mg per day
11. No. This is not a safe dose. A safe dose is Digoxin 0.06 to 0.09 mg per day.

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