Pediatrics

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Paediatrics Module

💊 Drug Dosing
🔢 Calculators
💉 Vaccine Schedule
🚨 Emergency
📏 Growth
🩺 Conditions
🍼 Neonatal
📋 PG Case Log

Paracetamol (Acetaminophen)

Dose
10–15 mg/kg/dose
Frequency
Q4–6h (Max 4 doses/day)
Max Dose
75 mg/kg/day · Max 4g/day
Route
PO / PR / IV
Indication
Fever, Pain
Note
Hepatotoxic in overdose

Ibuprofen

Dose
5–10 mg/kg/dose
Frequency
Q6–8h
Max Dose
40 mg/kg/day · Max 2.4g/day
Route
PO
Age Limit
≥ 6 months only
Caution
Avoid in dengue, dehydration, renal disease

Amoxicillin

Standard Dose
25–50 mg/kg/day
High Dose
80–90 mg/kg/day
Frequency
Divided Q8–12h
Route
PO / IV
High Dose for
AOM, Pneumonia (resistant)
Duration
5–10 days depending on indication

Azithromycin

Day 1
10 mg/kg (max 500 mg)
Day 2–5
5 mg/kg/day (max 250 mg)
Route
PO / IV
Indication
Atypical pneumonia, Pertussis, Typhoid
Note
Avoid in hepatic disease, QTc prolongation risk

Cetirizine

2–5 years
2.5 mg OD–BD
6–11 years
5 mg OD–BD
≥12 years
10 mg OD
Route
PO (Syrup / Tablet)
Indication
Allergic rhinitis, Urticaria

Salbutamol (Albuterol)

Nebulization
0.15 mg/kg (min 2.5 mg)
MDI
2–4 puffs Q20 min × 3
IV (severe)
15 mcg/kg over 10 min
Oral
0.1–0.15 mg/kg Q6–8h
Indication
Asthma, Bronchospasm, Wheeze

Prednisolone

Asthma Acute
1–2 mg/kg/day × 3–5 days
Croup
1 mg/kg single dose (max 40 mg)
Max Dose
40–60 mg/day
Route
PO
Note
Give with food; taper if >2 weeks

Zinc Sulfate (Diarrhoea)

< 6 months
10 mg/day × 14 days
≥ 6 months
20 mg/day × 14 days
Route
PO (Dispersible tablet)
Indication
Acute / Persistent diarrhoea (WHO-UNICEF)

Co-trimoxazole (TMP-SMX)

UTI Dose
4–6 mg/kg/day TMP (÷ BD)
PCP Prophylaxis
5 mg/kg/day TMP OD
Route
PO / IV
Note
Avoid in G6PD deficiency, neonates

Metronidazole

Amoebic Dys.
30–40 mg/kg/day ÷ TDS × 7–10d
Giardia
15 mg/kg/day ÷ TDS × 5–7d
Anaerobic Inf.
7.5 mg/kg Q6h
Max
2g/day
Route
PO / IV

Albendazole (Deworming)

1–2 years
200 mg single dose
≥ 2 years
400 mg single dose
Hydatid / Neurocysticercosis
15 mg/kg/day ÷ BD × 28 days
Route
PO (with food)
Note
Avoid in <1 year

Phenobarbitone

Loading Dose
20 mg/kg IV slow
Maintenance
3–5 mg/kg/day OD–BD
Neonatal seizure
20 mg/kg IV (may repeat 10 mg/kg × 2)
Route
PO / IV / IM
Caution
Respiratory depression with IV; monitor

Diazepam

Febrile Seizure
0.3–0.5 mg/kg PR or IV
Status Epilepticus
0.3 mg/kg IV slow · Max 10 mg
Rectal Gel
0.5 mg/kg PR
Route
IV / PR / Intranasal
Caution
Respiratory depression; have bag-valve-mask ready

Midazolam

Status Epilepticus
0.1–0.2 mg/kg IV / IM
Buccal/Intranasal
0.2–0.3 mg/kg (max 10 mg)
Sedation
0.05–0.1 mg/kg IV titrate
Route
IV / IM / Buccal / IN
Note
Preferred over diazepam in many guidelines

Dexamethasone

Croup
0.6 mg/kg single dose (max 10 mg)
Meningitis
0.15 mg/kg Q6h × 4 days
Cerebral Edema
0.5–1 mg/kg load, then 0.25 mg/kg Q6h
Route
PO / IV / IM

ORS (Oral Rehydration Salt)

Mild Dehydration
50 mL/kg over 4 hours
Moderate Dehydration
100 mL/kg over 4 hours
Maintenance
10 mL/kg per loose stool
Route
PO / NG tube
Note
WHO Low-Osmolarity ORS preferred (245 mOsm/L)

💊 Paediatric Dose Calculator (mg/kg)

Total Daily Dose-
Per Dose-

💧 Maintenance IV Fluids (Holliday-Segar)

Per 24 Hours-
Per Hour (mL/hr)-
Formula Used-

⚖️ Estimated Weight by Age

Estimated Weight (APLS)-
Formula Used-
NoteAlways use actual weight if available

🧴 Rehydration Fluid Calculator

Total Rehydration Volume-
Rate (mL/hr)-

🩸 Paediatric Blood Volume & Transfusion

Estimated Blood Volume-
PRBC Transfusion (10 mL/kg)-
Platelets (10 mL/kg)-
FFP (10 mL/kg)-

🫀 Glucose Bolus (Hypoglycaemia)

Volume to Give-
NoteGive IV over 2–3 min, then glucose infusion
ℹ️ Based on IAP 2023 Immunization Schedule + India National Immunization Programme (NIP). Last updated per UIP guidelines.
💉 NIP — National Immunization Programme (Government / Free)
AgeVaccineDoseRouteSite
BirthBCG0.05 mL (<1 mo) / 0.1 mL (≥1 mo)IDLt upper arm
BirthOPV-0 (bOPV)2 dropsOralOral
BirthHep B – Birth dose0.5 mLIMAnterolateral thigh
6 weeksDTwP-10.5 mLIMAnterolateral thigh
6 weeksOPV-1 (bOPV)2 dropsOral-
6 weeksHep B-10.5 mLIMAnterolateral thigh
10 weeksDTwP-2, OPV-2, Hep B-2Same as aboveIM/Oral-
14 weeksDTwP-3, OPV-3, Hep B-3, IPVIPV: 0.1 mLIM / ID-
9 monthsMR-1 (Measles-Rubella)0.5 mLSCLt upper arm
9–12 monthsJE-1 (endemic districts)0.5 mLSC-
16–24 monthsDTP Booster-1, OPV Booster0.5 mLIM-
16–24 monthsMR-2 (Measles-Rubella)0.5 mLSCLt upper arm
5–6 yearsDPT Booster-20.5 mLIM-
10 yearsTT0.5 mLIMDeltoid
16 yearsTT0.5 mLIMDeltoid
🏥 IAP Advisory — Additional Recommended Vaccines
VaccineAgeDosesRouteNote
Hib (Haemophilus influenzae b)6 wks – 5 yrs3+1 (6, 10, 14 wks + 15–18 mo)IMUsually in pentavalent
PCV (Pneumococcal)6 wks – 5 yrs3+1 or 2+1 scheduleIMPCV13 recommended
Rotavirus6 wks – 8 months2 (Rotarix) or 3 (RotaTeq)OralDo not start after 15 weeks
MMR9 months + 15 months2 dosesSCAvoid in immunocompromised
Varicella15 months + 4–6 yrs2 dosesSCIf unvaccinated, give 2 doses ≥3 months apart
Hepatitis A≥12 months2 doses (0, 6 months)IMSingle dose after 2 years also acceptable
Typhoid Vi PS≥2 years1 dose; Booster Q3 yrIM/SCVi conjugate preferred
HPV9–14 yrs (girls & boys)2 doses (0, 6 months)IM3 doses if ≥15 yrs or immunocompromised
Influenza≥6 months annually2 doses in first year; 1 dose yearlyIMSeasonal (Oct–Nov)
Meningococcal≥2 years (high risk)1–2 dosesIMHigh-risk groups, travellers
⚠️ Vaccine Contraindications & AEFI
VaccineContraindicationAEFI to Watch
MMR / VaricellaImmunocompromised, pregnancy, anaphylaxis to gelatin/neomycinFebrile seizure (rare), thrombocytopenia
BCGHIV (symptomatic), severe immunodeficiencyBCG-itis, lymphadenitis, disseminated BCG (rare)
RotavirusSCID, intussusception historyIntussusception (rare), mild diarrhoea
DTwP / DPTEncephalopathy within 7 days of prior doseFebrile convulsions, local reactions, HHE (rare)
HPVHypersensitivity to yeast (Gardasil); latex allergySyncope post-injection; observe 15 min
Any Live VaccinePrimary immunodeficiency, on high-dose steroids, active TB-
🚨 EMERGENCY REFERENCE ONLY. Always calculate doses using actual patient weight. Doses based on PALS/IAP guidelines.
⚡ PALS Emergency Drug Doses — Quick Reference

🫀 Cardiac Arrest

Adrenaline (Epinephrine)0.01 mg/kg IV/IO Q3–5 min
Amiodarone (VF/pVT)5 mg/kg IV/IO bolus
Lidocaine (alt.)1 mg/kg IV
Sodium Bicarbonate1 mEq/kg IV (prolonged arrest)
Defibrillation2 J/kg → 4 J/kg → 4 J/kg
Atropine (Bradycardia)0.02 mg/kg IV · Min 0.1 mg

🧠 Status Epilepticus

Midazolam (1st line)0.1–0.2 mg/kg IV/IM or Buccal
Diazepam PR0.5 mg/kg PR (max 10 mg)
Lorazepam IV0.1 mg/kg IV (max 4 mg)
Phenytoin / Fosphenytoin20 mg/kg IV slow (over 20 min)
Phenobarbitone20 mg/kg IV slow (2nd line)
Levetiracetam40–60 mg/kg IV (max 3g)

😮‍💨 Severe Anaphylaxis

Adrenaline 1:1000 IM0.01 mg/kg IM (max 0.5 mg)
IV Fluid Bolus20 mL/kg NS fast
Chlorpheniramine0.1–0.2 mg/kg IM/IV (slow)
Hydrocortisone4 mg/kg IV (max 200 mg)
Salbutamol neb (wheeze)0.15 mg/kg neb Q20 min

🩸 Shock / Sepsis

IV Fluid Bolus (1st)20 mL/kg NS over 5–10 min
Dopamine5–10 mcg/kg/min infusion
Noradrenaline0.1–2 mcg/kg/min infusion
Adrenaline (refractory)0.1–1 mcg/kg/min
Hydrocortisone (adrenal)2 mg/kg IV Q6h

🫁 Severe Asthma

Salbutamol neb0.15 mg/kg Q20 min × 3
Ipratropium neb250 mcg (<20 kg) / 500 mcg (>20 kg)
Prednisolone PO1–2 mg/kg (max 40 mg) OD
IV MgSO425–75 mg/kg IV over 20 min (max 2g)
Salbutamol IV15 mcg/kg over 10 min
Heliox / NIVIf deteriorating

🍬 Hypoglycaemia (BSL <2.6)

D10% — Neonates2 mL/kg IV bolus
D10% — Infants/Children5 mL/kg IV bolus
D25% (if no other)2 mL/kg IV slow
Glucagon IM0.5 mg (<25 kg) / 1 mg (>25 kg)
Maintenance D10%GIR 6–8 mg/kg/min after bolus
🚨 Paediatric Advanced Life Support (PALS) Algorithm
1
Assess — Paediatric Assessment Triangle (PAT)

Appearance (tone, interactability) · Breathing (work, sounds) · Circulation (skin colour, cap refill)

2
Unresponsive / No breathing → Start CPR

Ratio 15:2 (2 rescuers) or 30:2 (1 rescuer). Rate: 100–120/min. Depth: ≥1/3 AP diameter

3
Attach Monitor / Defibrillator — Shockable?

VF / Pulseless VT → Shock 2 J/kg → CPR 2 min → Adrenaline → Shock 4 J/kg → Amiodarone

4
Non-Shockable (PEA / Asystole)

CPR immediately. Adrenaline 0.01 mg/kg IV/IO every 3–5 min. Treat reversible causes (4H + 4T)

5
Reversible Causes — 4H + 4T

Hypovolaemia · Hypoxia · Hypo/Hyperkalaemia · Hypothermia · Tension PTX · Tamponade · Toxins · Thrombosis

6
ROSC → Post-Resuscitation Care

Airway secured · Avoid hypoxia (SpO₂ 94–99%) · Avoid hypotension (MAP > 5th percentile for age) · Targeted temperature management

🫁 Croup — Assessment & Management
Westley Croup ScoreMild (0–2)Moderate (3–7)Severe (≥8)
StridorNone or mildAt restSevere at rest
RetractionsNoneModerateSevere
Air EntryNormalDecreasedMarkedly decreased
CyanosisNoneNoneWith agitation/at rest
ConsciousnessNormalNormalAltered
Treatment: Dexamethasone 0.6 mg/kg PO/IV (all grades) · Nebulised Adrenaline 0.5 mL/kg of 1:1000 (max 5 mL) for moderate-severe · Heliox / Intubation if deteriorating
📏 Weight-for-Age Reference (WHO / IAP)
AgeBoys (median kg)Girls (median kg)Milestones
Birth3.33.2Birth weight; regains by 10–14 days
3 months6.05.4Doubles birth weight by ~4–5 months
6 months7.97.2Starts solids; sits with support
9 months9.28.5Crawls, pulls to stand
12 months10.29.5Triples birth weight; walks with support
18 months11.510.8Runs, speaks a few words
2 years12.512.0Quadruples birth weight
3 years14.514.0Gains ~2 kg/year after age 2
5 years18.518.2School-age start
10 years32.033.0Pre-pubertal; Girls gain earlier
📐 Height / Length for Age Reference
AgeBoys (cm)Girls (cm)Rule of Thumb
Birth5049Avg. 50 cm
3 months6261+12 cm in first 3 months
6 months686650% increase by 1 year
1 year767475 cm at 1 year
2 years8887Half adult height at ~2 years
4 years103102Doubles birth length by 4 years
10 years138140Girls taller pre-puberty
🧠 Head Circumference & Developmental Milestones
AgeHC (cm)Gross MotorFine MotorLanguageSocial
Birth35Head lagGrasp reflexCryRegards face
3 mo40Head controlHands openCooingSocial smile
6 mo43Sits with supportTransfersBabblingStranger anxiety
9 mo45Stands holdingPincer (crude)Mama/Dada (non-specific)Wave bye-bye
12 mo47Walks with supportFine pincer1–2 words meaningfulSeparation anxiety
18 mo48RunsScribbles10–20 wordsDomestic mimicry
2 yr49Up stairs 2 feetTower 6 cubes2-word phraseParallel play
3 yr50TricycleCopies circleFull sentencesGroup play
⚠️ Malnutrition Classification (SAM / MAM)
TypeCriteriaAction
SAM (Severe Acute)WHZ < -3 SD · MUAC <11.5 cm · Bilateral pitting oedemaInpatient CMAM / NRC
MAM (Moderate Acute)WHZ -3 to -2 SD · MUAC 11.5–12.5 cmOutpatient supplementary feeding
StuntingHAZ < -2 SD (chronic undernutrition)Long-term dietary intervention
UnderweightWAZ < -2 SDDietary counselling + monitoring
⚠️ MUAC <11.5 cm = SAM → refer immediately. Measure MUAC at left mid-arm, arm at 90°.

💩 Acute Diarrhoea / AGE

  • ORS: 50–100 mL/kg over 3–4 hrs (mild-mod dehydration)
  • Zinc: 10 mg/day (<6 mo) / 20 mg/day (≥6 mo) × 14 days
  • Ondansetron 0.15 mg/kg PO (for vomiting)
  • Antibiotics: Bloody diarrhoea → Azithromycin 10 mg/kg/day × 3 days
  • Probiotics: Lactobacillus GG / Saccharomyces boulardii (adjuvant)
  • Avoid: Antidiarrhoeals (Loperamide) in children

🌡️ Fever / ARI

  • Paracetamol 10–15 mg/kg Q4–6h (first line)
  • Ibuprofen 5–10 mg/kg Q6–8h (≥6 months, alternate)
  • Avoid Aspirin in children (Reye syndrome risk)
  • Tepid sponging: No benefit over antipyretics alone
  • ARI with bacterial features → Amoxicillin 40–45 mg/kg/day
  • Danger signs → refer: fast breathing, chest indrawing, cyanosis

🧠 Febrile Seizure

  • Simple FS: Duration <15 min, generalized, resolves spontaneously
  • Acute: Diazepam 0.3 mg/kg IV or 0.5 mg/kg PR
  • Midazolam 0.2 mg/kg buccal/IN if IV not available
  • Treat underlying fever with Paracetamol
  • No long-term AED for simple FS (AAP/IAP recommendation)
  • Complex FS (>15 min / focal): full evaluation, EEG, imaging

🫁 Acute Asthma

  • Salbutamol neb 0.15 mg/kg Q20 min × 3 (initial)
  • Ipratropium 250/500 mcg neb (add in moderate-severe)
  • Prednisolone 1–2 mg/kg/day × 3–5 days PO
  • IV MgSO4 25–75 mg/kg over 20 min (severe, ≥6 years)
  • SpO2 target: ≥95% · Supplemental O2 if <94%
  • ICU/Intubation if no response, exhaustion, altered consciousness

🫀 Dengue

  • Group A (No warning signs): ORS, Paracetamol, monitor
  • Group B (Warning signs): IV fluids NS 5–10 mL/kg/hr
  • Group C (Severe dengue): 20 mL/kg NS bolus, admit ICU
  • Avoid Ibuprofen / Aspirin (bleeding risk)
  • Platelets: Transfuse if <10,000 or active bleeding
  • Monitor CBC, PCV Q6–12h in warning signs group

🦠 Typhoid (Enteric Fever)

  • Azithromycin 10–20 mg/kg/day PO × 7 days (uncomplicated, 1st line)
  • Ceftriaxone 75 mg/kg/day IV × 10–14 days (severe/MDR)
  • Cefixime 20 mg/kg/day PO BD × 10–14 days (oral alt.)
  • Chloramphenicol/Amoxicillin if sensitive (resource-limited)
  • Dexamethasone: Only for severe typhoid with altered sensorium
  • Widal: Titres ≥1:160 suggestive; confirm with culture

🦟 Malaria

  • P. vivax: Chloroquine 25 mg/kg over 3 days + Primaquine (check G6PD)
  • P. falciparum: Artemether-Lumefantrine (AL) weight-based
  • Severe malaria: Artesunate IV 2.4 mg/kg at 0, 12, 24h then daily
  • Quinine IV (alt if artesunate not available): 10 mg/kg Q8h
  • Paracetamol for fever; avoid Ibuprofen in severe malaria
  • Primaquine contraindicated in G6PD def, <1 yr, pregnancy

🩺 Neonatal Jaundice (Pathological)

  • Phototherapy: Bilirubin ≥ phototherapy threshold (by age in hours)
  • Exchange transfusion: Bilirubin ≥ exchange threshold or kernicterus signs
  • Intensive phototherapy: Multiple lights, fibreoptic blanket
  • IVIG 0.5–1 g/kg over 2h (Rh/ABO isoimmunization)
  • Monitor: Repeat TSB Q4–12h on phototherapy
  • Breastfeeding: Continue; supplement if poor intake

🩸 Iron Deficiency Anaemia

  • Elemental Iron: 3–6 mg/kg/day ÷ BD–TDS × 3 months
  • Ferrous sulphate: 200 mg tab = 65 mg elemental iron
  • Give 1 hour before meal for max absorption
  • Vitamin C co-administration enhances absorption
  • Response: Retics rise in 5–10 days; Hb rises 1–2 g/dL/month
  • Continue 3 months after Hb normalises to replete stores

🦴 Rickets (Vitamin D Deficiency)

  • Therapeutic: Vit D 2000–6000 IU/day PO × 3 months
  • Stoss therapy: 3–6 lakh IU single dose IM (severe, poor compliance)
  • Calcium: 500–1000 mg/day elemental calcium (concurrent)
  • Maintenance after treatment: 400–1000 IU/day Vit D
  • Monitor: ALP, Ca, Phosphate, 25-OH Vitamin D
  • Sun exposure: 15–20 min daily (arms/face)
⚠️ Neonates require special dosing. Hepatic and renal immaturity alter drug metabolism significantly. Always verify doses for gestational age (GA) and postnatal age (PNA).
💊 Neonatal Drug Dosing Quick Reference
DrugDoseFrequencyRouteIndication
PhenobarbitoneLoading: 20 mg/kg
Maint: 3–5 mg/kg/day
ODIV/PONeonatal seizures (1st line)
PhenytoinLoading: 20 mg/kg
Maint: 4–8 mg/kg/day
BDIV slowSeizures (2nd line)
Ampicillin50–100 mg/kg/doseQ12h (<7d) / Q8h (≥7d)IVSepsis, Meningitis
Gentamicin4–5 mg/kg/doseQ24–36h (depending on GA)IV/IMNeonatal sepsis
Cefotaxime50 mg/kg/doseQ8–12hIVNeonatal sepsis, Meningitis
Meropenem20 mg/kg/doseQ8–12hIVLate-onset sepsis, resistant organisms
Caffeine CitrateLoading: 20 mg/kg
Maint: 5–10 mg/kg/day
ODPO/IVApnoea of prematurity
Surfactant (Poractant)100–200 mg/kgMay repeat Q6–12h × 2ITRDS in prematurity
Indomethacin0.1–0.2 mg/kgQ12–24h × 3 dosesIV/POPDA closure (preterm)
Ibuprofen (PDA)10 mg/kg → 5 → 5 mg/kgQ24h × 3 dosesPO/IVPDA closure (alt to indomethacin)
Dopamine2–20 mcg/kg/minContinuous infusionIVHypotension, shock
Vitamin K1 mg (>1.5 kg) / 0.5 mg (<1.5 kg)Single dose at birthIMVKDB prophylaxis
Erythromycin Eye Oint.1 cm ribbon each eyeSingle dose at birthTopicalOphthalmia neonatorum prophylaxis
🚫 Drugs Contraindicated / Avoid in Neonates

Chloramphenicol

Grey Baby Syndrome — cardiovascular collapse. Immature glucuronyl transferase cannot conjugate chloramphenicol → toxic accumulation.

Aspirin

Kernicterus risk (displaces bilirubin from albumin) + Reye syndrome risk. Absolutely contraindicated.

Sulphonamides (incl. Co-trimoxazole)

Displaces bilirubin from albumin → kernicterus. Avoid in first 2 months of life.

Tetracyclines

Deposits in growing bone and teeth → enamel hypoplasia, bone growth inhibition. Avoid <8 years.

Fluoroquinolones (Ciprofloxacin etc.)

Arthropathy risk — cartilage damage in animal studies. Avoid in children unless no alternative.

Benzyl Alcohol (Preservative)

"Gasping Syndrome" — metabolic acidosis, CNS depression, cardiovascular collapse in neonates. Use preservative-free formulations only.

Metoclopramide

High risk of extrapyramidal reactions (acute dystonia) in neonates and infants. Avoid.

Ibuprofen / NSAIDs (general)

Risk of renal failure, PDA reopening (except specific PDA closure indication). Avoid for fever/pain.

🍼 Neonatal Fluid Requirements
Day of LifeTerm Neonate (mL/kg/day)Preterm (mL/kg/day)
Day 160–8080–100
Day 280–100100–120
Day 3100–120120–140
Day 4120–150140–160
Day 5+150–180150–180
ℹ️ Use D10% for neonatal IV fluids (not D5%). Add electrolytes (NaCl, KCl) after Day 2 based on serum levels.

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