Paediatrics Module
Paracetamol (Acetaminophen)
Ibuprofen
Amoxicillin
Azithromycin
Cetirizine
Salbutamol (Albuterol)
Prednisolone
Zinc Sulfate (Diarrhoea)
Co-trimoxazole (TMP-SMX)
Metronidazole
Albendazole (Deworming)
Phenobarbitone
Diazepam
Midazolam
Dexamethasone
ORS (Oral Rehydration Salt)
💊 Paediatric Dose Calculator (mg/kg)
💧 Maintenance IV Fluids (Holliday-Segar)
⚖️ Estimated Weight by Age
🧴 Rehydration Fluid Calculator
🩸 Paediatric Blood Volume & Transfusion
🫀 Glucose Bolus (Hypoglycaemia)
| Age | Vaccine | Dose | Route | Site |
|---|---|---|---|---|
| Birth | BCG | 0.05 mL (<1 mo) / 0.1 mL (≥1 mo) | ID | Lt upper arm |
| Birth | OPV-0 (bOPV) | 2 drops | Oral | Oral |
| Birth | Hep B – Birth dose | 0.5 mL | IM | Anterolateral thigh |
| 6 weeks | DTwP-1 | 0.5 mL | IM | Anterolateral thigh |
| 6 weeks | OPV-1 (bOPV) | 2 drops | Oral | - |
| 6 weeks | Hep B-1 | 0.5 mL | IM | Anterolateral thigh |
| 10 weeks | DTwP-2, OPV-2, Hep B-2 | Same as above | IM/Oral | - |
| 14 weeks | DTwP-3, OPV-3, Hep B-3, IPV | IPV: 0.1 mL | IM / ID | - |
| 9 months | MR-1 (Measles-Rubella) | 0.5 mL | SC | Lt upper arm |
| 9–12 months | JE-1 (endemic districts) | 0.5 mL | SC | - |
| 16–24 months | DTP Booster-1, OPV Booster | 0.5 mL | IM | - |
| 16–24 months | MR-2 (Measles-Rubella) | 0.5 mL | SC | Lt upper arm |
| 5–6 years | DPT Booster-2 | 0.5 mL | IM | - |
| 10 years | TT | 0.5 mL | IM | Deltoid |
| 16 years | TT | 0.5 mL | IM | Deltoid |
| Vaccine | Age | Doses | Route | Note |
|---|---|---|---|---|
| Hib (Haemophilus influenzae b) | 6 wks – 5 yrs | 3+1 (6, 10, 14 wks + 15–18 mo) | IM | Usually in pentavalent |
| PCV (Pneumococcal) | 6 wks – 5 yrs | 3+1 or 2+1 schedule | IM | PCV13 recommended |
| Rotavirus | 6 wks – 8 months | 2 (Rotarix) or 3 (RotaTeq) | Oral | Do not start after 15 weeks |
| MMR | 9 months + 15 months | 2 doses | SC | Avoid in immunocompromised |
| Varicella | 15 months + 4–6 yrs | 2 doses | SC | If unvaccinated, give 2 doses ≥3 months apart |
| Hepatitis A | ≥12 months | 2 doses (0, 6 months) | IM | Single dose after 2 years also acceptable |
| Typhoid Vi PS | ≥2 years | 1 dose; Booster Q3 yr | IM/SC | Vi conjugate preferred |
| HPV | 9–14 yrs (girls & boys) | 2 doses (0, 6 months) | IM | 3 doses if ≥15 yrs or immunocompromised |
| Influenza | ≥6 months annually | 2 doses in first year; 1 dose yearly | IM | Seasonal (Oct–Nov) |
| Meningococcal | ≥2 years (high risk) | 1–2 doses | IM | High-risk groups, travellers |
| Vaccine | Contraindication | AEFI to Watch |
|---|---|---|
| MMR / Varicella | Immunocompromised, pregnancy, anaphylaxis to gelatin/neomycin | Febrile seizure (rare), thrombocytopenia |
| BCG | HIV (symptomatic), severe immunodeficiency | BCG-itis, lymphadenitis, disseminated BCG (rare) |
| Rotavirus | SCID, intussusception history | Intussusception (rare), mild diarrhoea |
| DTwP / DPT | Encephalopathy within 7 days of prior dose | Febrile convulsions, local reactions, HHE (rare) |
| HPV | Hypersensitivity to yeast (Gardasil); latex allergy | Syncope post-injection; observe 15 min |
| Any Live Vaccine | Primary immunodeficiency, on high-dose steroids, active TB | - |
🫀 Cardiac Arrest
🧠 Status Epilepticus
😮💨 Severe Anaphylaxis
🩸 Shock / Sepsis
🫁 Severe Asthma
🍬 Hypoglycaemia (BSL <2.6)
Appearance (tone, interactability) · Breathing (work, sounds) · Circulation (skin colour, cap refill)
Ratio 15:2 (2 rescuers) or 30:2 (1 rescuer). Rate: 100–120/min. Depth: ≥1/3 AP diameter
VF / Pulseless VT → Shock 2 J/kg → CPR 2 min → Adrenaline → Shock 4 J/kg → Amiodarone
CPR immediately. Adrenaline 0.01 mg/kg IV/IO every 3–5 min. Treat reversible causes (4H + 4T)
Hypovolaemia · Hypoxia · Hypo/Hyperkalaemia · Hypothermia · Tension PTX · Tamponade · Toxins · Thrombosis
Airway secured · Avoid hypoxia (SpO₂ 94–99%) · Avoid hypotension (MAP > 5th percentile for age) · Targeted temperature management
| Westley Croup Score | Mild (0–2) | Moderate (3–7) | Severe (≥8) |
|---|---|---|---|
| Stridor | None or mild | At rest | Severe at rest |
| Retractions | None | Moderate | Severe |
| Air Entry | Normal | Decreased | Markedly decreased |
| Cyanosis | None | None | With agitation/at rest |
| Consciousness | Normal | Normal | Altered |
| Age | Boys (median kg) | Girls (median kg) | Milestones |
|---|---|---|---|
| Birth | 3.3 | 3.2 | Birth weight; regains by 10–14 days |
| 3 months | 6.0 | 5.4 | Doubles birth weight by ~4–5 months |
| 6 months | 7.9 | 7.2 | Starts solids; sits with support |
| 9 months | 9.2 | 8.5 | Crawls, pulls to stand |
| 12 months | 10.2 | 9.5 | Triples birth weight; walks with support |
| 18 months | 11.5 | 10.8 | Runs, speaks a few words |
| 2 years | 12.5 | 12.0 | Quadruples birth weight |
| 3 years | 14.5 | 14.0 | Gains ~2 kg/year after age 2 |
| 5 years | 18.5 | 18.2 | School-age start |
| 10 years | 32.0 | 33.0 | Pre-pubertal; Girls gain earlier |
| Age | Boys (cm) | Girls (cm) | Rule of Thumb |
|---|---|---|---|
| Birth | 50 | 49 | Avg. 50 cm |
| 3 months | 62 | 61 | +12 cm in first 3 months |
| 6 months | 68 | 66 | 50% increase by 1 year |
| 1 year | 76 | 74 | 75 cm at 1 year |
| 2 years | 88 | 87 | Half adult height at ~2 years |
| 4 years | 103 | 102 | Doubles birth length by 4 years |
| 10 years | 138 | 140 | Girls taller pre-puberty |
| Age | HC (cm) | Gross Motor | Fine Motor | Language | Social |
|---|---|---|---|---|---|
| Birth | 35 | Head lag | Grasp reflex | Cry | Regards face |
| 3 mo | 40 | Head control | Hands open | Cooing | Social smile |
| 6 mo | 43 | Sits with support | Transfers | Babbling | Stranger anxiety |
| 9 mo | 45 | Stands holding | Pincer (crude) | Mama/Dada (non-specific) | Wave bye-bye |
| 12 mo | 47 | Walks with support | Fine pincer | 1–2 words meaningful | Separation anxiety |
| 18 mo | 48 | Runs | Scribbles | 10–20 words | Domestic mimicry |
| 2 yr | 49 | Up stairs 2 feet | Tower 6 cubes | 2-word phrase | Parallel play |
| 3 yr | 50 | Tricycle | Copies circle | Full sentences | Group play |
| Type | Criteria | Action |
|---|---|---|
| SAM (Severe Acute) | WHZ < -3 SD · MUAC <11.5 cm · Bilateral pitting oedema | Inpatient CMAM / NRC |
| MAM (Moderate Acute) | WHZ -3 to -2 SD · MUAC 11.5–12.5 cm | Outpatient supplementary feeding |
| Stunting | HAZ < -2 SD (chronic undernutrition) | Long-term dietary intervention |
| Underweight | WAZ < -2 SD | Dietary counselling + monitoring |
💩 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)
| Drug | Dose | Frequency | Route | Indication |
|---|---|---|---|---|
| Phenobarbitone | Loading: 20 mg/kg Maint: 3–5 mg/kg/day | OD | IV/PO | Neonatal seizures (1st line) |
| Phenytoin | Loading: 20 mg/kg Maint: 4–8 mg/kg/day | BD | IV slow | Seizures (2nd line) |
| Ampicillin | 50–100 mg/kg/dose | Q12h (<7d) / Q8h (≥7d) | IV | Sepsis, Meningitis |
| Gentamicin | 4–5 mg/kg/dose | Q24–36h (depending on GA) | IV/IM | Neonatal sepsis |
| Cefotaxime | 50 mg/kg/dose | Q8–12h | IV | Neonatal sepsis, Meningitis |
| Meropenem | 20 mg/kg/dose | Q8–12h | IV | Late-onset sepsis, resistant organisms |
| Caffeine Citrate | Loading: 20 mg/kg Maint: 5–10 mg/kg/day | OD | PO/IV | Apnoea of prematurity |
| Surfactant (Poractant) | 100–200 mg/kg | May repeat Q6–12h × 2 | IT | RDS in prematurity |
| Indomethacin | 0.1–0.2 mg/kg | Q12–24h × 3 doses | IV/PO | PDA closure (preterm) |
| Ibuprofen (PDA) | 10 mg/kg → 5 → 5 mg/kg | Q24h × 3 doses | PO/IV | PDA closure (alt to indomethacin) |
| Dopamine | 2–20 mcg/kg/min | Continuous infusion | IV | Hypotension, shock |
| Vitamin K | 1 mg (>1.5 kg) / 0.5 mg (<1.5 kg) | Single dose at birth | IM | VKDB prophylaxis |
| Erythromycin Eye Oint. | 1 cm ribbon each eye | Single dose at birth | Topical | Ophthalmia neonatorum prophylaxis |
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.
| Day of Life | Term Neonate (mL/kg/day) | Preterm (mL/kg/day) |
|---|---|---|
| Day 1 | 60–80 | 80–100 |
| Day 2 | 80–100 | 100–120 |
| Day 3 | 100–120 | 120–140 |
| Day 4 | 120–150 | 140–160 |
| Day 5+ | 150–180 | 150–180 |
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