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.