Appendix
mgllOOml mmol/l mmHg kPa
1260 70.0 ISO 20.0
10ro 60.0
900 SO.O 135 18.0
720 40.0 120 16.0
540 30.0
360 20.0 105 14.0
270 15.0 252 14.0 90 12.0 234 13.0 216 12.0 75 10.0 198 11.0 180 10.0 162 9.0 60 8.0 144 8.0 126 7.0 45 6.0 108 6.0
90 5.0 72 4.0 30 4.0
54 3.0 36 2.0 15 2.0 18 1.0
0 0 0
Blood glucose Blood gases: Carbon dioxide (Peal) and oxygen (Pal)
SI unit conversions
297
Centile table for boys
Age Weight Height Head circumference (kg) (cm) (cm)
Centile 3 50 97 3 50 97 3 50 97
Birth 2.5 3.5 4.4 50 33 35 38 3 months 4.4 5.7 7.2 55 60 65 38 41 43 6 months 6.2 7.8 9.8 62 66.5 71 41 44 46
9 months 7.6 9.3 11.6 66.5 71 76 43 46 47 12 months 8.4 10.3 12.8 70 75 80 44 47 49
18 months 9.4 11.7 14.2 75 81 87 46 49 51 2 years 10.2 12.7 15.5 80 87 93 47 50 52
3 years 11.6 14.7 18.0 86 94 101 48 50 53 4 years 13.0 16.7 20.4 94 102 110
5 years 14.4 18.5 23.2 99 108 117 49 51 54 6 years 16 20.5 26.5 105 115 124
7 years 17 23 30 110 121 131 8 years 19 25 34 115 126 137 50 52 55
9 years 21 27.5 39 120 132 143 10 years 23 30 44 125 137 148
11 years 25 34 48 130 142 154 12 years 27 36.5 53 135 147 159 51 54 56
13 years 30 40.5 64 138 153 168 14 years 36 48 66 148 161 173 53 56 58
15 years 43 56 74 156 169 181 16 years 47 60 78 160 172 187
17 years 49 62 80 162 174 187 18 years 50 64 81 162 175 187
Centile table for girls
Age Weight Height Head circumference (kg) (cm) (cm)
Centile 3 50 97 3 50 97 3 50 97
Birth 2.5 3.5 4.4 50 32 35 37 3 months 4.2 5.2 7.0 55 58 62 37 40 43 6 months 5.9 7.3 9.4 61 65 69 40 43 45
9 months 7.0 8.7 10.9 65 70 74 42 44 47 12 months 7.6 9.6 12.0 69 74 78 43 46 48
18 months 8.8 10.9 13.6 75 80 85 45 47 50 2 years 9.6 12.0 14.9 79 85 91 46 48 51
3 years 11.2 14.4 17.6 86 93 100 47 49 52 4 years 13 16 20 92 100 109
5 years 15 18 23 98 107 116 48 50 53 6 years 16 20 27 104 114 123
7 years 18 23 30 109 119 130 8 years 19 25 35 114 125 136 50 52 54
9 years 21 28 40 120 130 142 10 years 23 31 45 125 136 147
11 years 25 34 50 130 142 153 12 years 29 40 58 138 149 161 51 53 56
13 years 37 47 66 145 157 168 14 years 42 53 71 149 160 172 52 54 57
15 years 44 55 74 150 162 173 16 years 45 56 75 151 162 174
17 years 46 56 75 18 years 46 57 75
Weight and height centi1es adapted from Tanner, J. M., Whitehouse, R. H. and Takaishi, M. (1966). Arch. Dis. Child., 41, 454. Head circumference centi1es adapted from Westrop, C. K. and Barber, C. R. (1956). J. Neurol. Neurosurg. Psychiatr., 19, 52.
APPENDIX
Drug doses for children
A list follows of the commonly prescribed drugs in acute paediatrics. The dose stated is for each individual dose prescribed and the recommended number of times it is given per 24 hours has been stated. It is not the total daily dosage.
Drug doses in children can be estimated according to age, body weight or surface area. Calculations based on surface area are generally agreed to be the most reliable way to estimate dosage for a child. A nomogram is needed to calculate the surface area. It is easier in practice to express doses as a percentage of the adult dose. Table 1 shows a comparison of the dose expressed as a percentage of the adult level based on the surface area when applied to a child of average size.
Doses may also be expressed in terms of weight but a uniform scheme suitable for children of all ages cannot be formulated on this basis. In addition the dose for an obese child may be overestimated as fat plays little part in drug metabolism. These factors are automatically recognized when using the percentage method which compensates for the relatively larger surface area of children in relation to their weight and so this method of dose estimation has been adopted. For children under one year the dose has been shown on a mg/kg basis because of the rapid growth in this period. It actually results in a slight underdosage in the first few months of life. In view of the very different metabolism and excretion of drugs in neonates a separate list has been made for the neonatal period.
Full details of the indications for use of the various drugs and their side effects can be found in the British National Formulary and the Paediatric Prescriber by P. Catzel and R. Olver (Blackwell Scientific Publications, Oxford, 1981).
Table 1
Adult 7 years 3 years I year
Doses for different ages as percent of adult dose
299
100% 50% 33%
approx25%
Dru
g do
ses
Dru
g
Adr
enal
ine
(epi
neph
rine
) 1:
1000
1:10
000
All
opur
inol
(Z
ylor
ic)
Am
ikac
in
(Am
ikin
)
Am
inop
hyll
ine
Rou
te
s.c.
I.V
.
Do
wn
ET
tu
be
Intr
acar
dia
c
Co
nti
nu
ou
s in
fusi
on
ora
l
l.m
. i.v
.
l.V.
Tim
es
dail
y
Sin
gle
dose
Sin
gle
dose
3 2
Dos
age
per
dose
giv
en
0-2
2
wee
ks-
1 ye
ar
7 ye
ars
wee
ks
1 ye
ar
--0
.01
mlj
kg
--
0.12
S 0.
2Sm
l m
l
--0
.01
ml/
kg
--
Iml
2.S
ml
------O
.S-I.S
/lg
kg
-l
min
-1
See
Tab
le 2
Sm
g/kg
SO
mg
100m
g
7.S
mg/
kg
Adu
lt
O.S
ml
Sm
l
20
0m
g
Loa
ding
dos
e: S
-6 m
g/kg
, ov
er 2
0 m
in t
hen
by c
onti
nuou
s in
fusi
on:
Loa
ding
do
se
6.2
mg
/ kg
the
n 4
.4m
g
kg
-1
(24
h)-
l by
con
ti
nuou
s in
fusi
on
I m
g kg
-1
h -
1 if
< 9
y,
or:
0.7
mg
kg
-1 h
-1
if >
9y
Rem
arks
Fo
r as
thm
a, a
naph
ylax
is.
Rep
eat
afte
r IS
min
x 2
if n
eces
sary
.
Fo
r ca
rdia
c ar
rest
, lif
e th
reat
enin
g an
aphy
laxi
s. M
ay p
rodu
ce a
rryt
hmia
s.
Fo
r pr
ofou
nd h
ypot
ensi
on.
Incr
ease
do
se a
ccor
ding
to
resp
onse
.
Fo
r pr
even
tion
of
uric
aci
d ne
phro
path
y in
mal
igna
nt d
isea
se.
Sid
e-ef
fect
s-as
Gen
tam
icin
.
Fo
r st
atus
ast
hmat
icus
. M
on
ito
r le
vels
if
nec
essa
ry.
Arr
ythm
ias,
con
vuls
ions
m
ay o
ccur
.
Ap
no
ea in
pre
term
inf
ants
.
Am
inop
hyll
ine,
or
al
2 1
0-1
4m
g/k
g--
225-
Fo
r as
thm
a. M
onit
or le
vels
. T
able
ts
slow
rel
ease
4
50
mg
22
5,10
0mg.
(P
hyll
ocon
tin)
Am
oxyc
illi
n or
al
3 --6
2.5
mg
--
125m
g 25
0mg
500m
g S
yrup
125
mg/
5 m
l. (A
mox
il)
l.v.
4 Se
e 12
.5-2
5 12
5mg
25
0m
g
500m
g M
enin
giti
s: 4
00 m
g k
g-
I (2
4 h)
-I.
l.m.
Tab
le 2
ru
g/kg
Am
pici
llin
or
al
4 --6
2.5
mg
--
125m
g 2
50
mg
50
0mg
Syr
up 1
25 m
g/5
ml.
(Pen
brit
in)
i.v.
4 Se
e 12
.5-2
5 12
5mg
25
0m
g
500m
g M
enin
giti
s: 4
00 m
g kg
-1
(24
h) -
I.
i.m.
Tab
le 2
ru
g/kg
Asp
irin
, or
al
3 o
r 4
No
t su
itab
le-u
se
100
mg
300m
g 60
0mg
As
anti
pyre
tic,
ana
lges
ia.
Sol
uble
so
lubl
e pa
race
tam
ol
tabl
ets
300
mg,
Pae
diat
ric
75 m
g.
Ant
irhe
umat
ic:
100
mg
kg -
1 (2
4 h)
-1
divi
ded
4-6
hou
rly
and
mea
sure
sa
licy
late
lev
el.
Atr
opin
e i.v
. Si
ngle
-0
.01
-0.0
3m
g/k
g-
0.1
5m
g
0.3
mg
0
.6m
g
Fo
r ca
rdia
c ar
rest
, br
adyc
ardi
a.
dose
Azl
ocil
lin
l.v.
4 Se
e 50
-100
50
0mg
I g
2g
D
oubl
e do
se in
sev
ere
infe
ctio
ns.
May
(S
ecur
open
) T
able
2
mg/
kg
caus
e hy
poka
laem
ia.
Ben
dro-
oral
O
nce
-0.1
25
mg
/kg
-1.
25m
g 2
.5m
g
5m
g
Pot
assi
um s
uppl
emen
t re
quir
ed.
flua
zide
Cal
cium
l.v
. Si
ngle
--0
.1 m
ljk
g--
1.2m
l 2
.5m
l 5
ml
Fo
r ca
rdia
c ar
rest
, as
ysto
le.
Inje
ct
chlo
ride
(10
%)
slow
ly u
nder
EC
G c
ontr
ol.
Ver
y ir
rita
nt i
f inf
usio
n tis
sues
.
Cal
cium
l.v
. Si
ngle
--3
mljk
g--
3.5m
l 7.
5ml
15m
l F
or
card
iac
arre
st,
asys
tole
. gl
ucon
ate
(10%
)
l.v.
Sing
le
0.2
Neo
nata
l te
tany
. In
ject
slo
wly
. M
ay
ml/
kg
caus
e br
adyc
ardi
a.
Dru
g R
oute
D
osag
e pe
r do
se g
iven
T
imes
R
emar
ks
dail
y 0
-2
2 w
eeks
-1
year
7
year
s A
dult
w
eeks
1
year
Car
bam
azep
ine
oral
2
or3
IO
mg/
kg
100m
g 20
0mg
400m
g (T
egre
tol)
Car
beni
cill
in
l.v.
4 Se
e 50
-100
50
0mg
I g
2g
D
ose
may
be
doub
led
in s
ever
e (P
yope
n)
Tab
le 2
m
g/kg
in
fect
ions
. M
ay c
ause
hyp
okal
aem
ia.
Cef
urox
ime
i.m
.or
3 Se
e 20
mg/
kg
200m
g 37
5mg
750m
g (Z
inac
ef)
i.v.
Tab
le 2
Cep
hazo
lin
i.m.
or
4 12
.5-2
5 l2
5m
g
250m
g 50
0mg
(Kef
zol)
l.v
. m
g/kg
Cep
hale
xin
oral
4
--1
2 m
g/k
g--
125m
g 25
0mg
500m
g (C
epor
ex,
Kef
lex)
Cep
hrad
ine
oral
4
--
12 m
g/kg
--
l25
mg
25
0mg
500m
g (V
elos
ef)
l.m.
or
4 Se
e 12
.5-
125m
g 25
0mg
500m
g l.v
. T
able
2
25m
g/kg
Cha
rcoa
l or
al
Sin
gle
---
0.5-
1 g/
kg w
ith
wate
r--
10-5
0 g
Acu
te p
oiso
ning
. ac
tiva
ted
in 5
0ml
(Med
icoa
l)
wat
er
Chl
oral
or
al
Sin
gle
--
30 m
g/kg
--
300
mg
500m
g l.
Og
Sing
le h
ypno
tic
dose
. E
lixi
r 20
0 m
g/
hydr
ate
5 m
l, 50
0 m
g/5
ml.
Chl
oram
-or
al
4 Se
e 12
.5
--1
2.5
-25
mg
/kg
-l.
Og
M
ay c
ause
apl
asti
c an
aem
ia.
phen
icol
l.v
. T
able
2
mg/
kg
(Chl
orom
ycet
in)
Chl
orot
hiaz
ide
oral
2
-IO
mg
/kg
--
12S
mg
2S0m
g SO
Om
g P
otas
sium
sup
plem
ent
need
ed.
(Sal
uric
)
Chl
oroq
uine
or
al
Init
ial
IS
ISO
mg
300m
g 60
0mg
Fo
r be
nign
ter
tian
mal
aria
. F
ollo
w w
ith
(as
base
) do
se:
mg/
kg
Pri
maq
uine
for
14
days
. F
or
P.
(Niv
aqui
ne)
then
7.
S 7S
mg
ISO
mg
300m
g Ja
lcip
arum
fro
m c
hlor
oqui
ne r
esis
tant
ar
ea u
se q
uini
ne o
r F
ansi
dar
give
n 6
h
mg/
kg
(pyr
imet
ham
ine
and
sulf
adox
ine)
la
ter:
then
3.
7S
37.S
mg
7Sm
g IS
Om
g do
se
mg/
kg
give
n 12
-ho
urly
fo
r 2
days
:
Chl
orph
enir
-or
al
30
r4
Img
2
mg
4
mg
A
cute
ana
phyl
axis
am
ine
i.v.
Sing
le
0.2S
2.
Sm
g S
mg
IOm
g (P
irit
on)
mg/
kg
Cho
line
or
al
3 S
mg/
kg
SOm
g 10
0mg
200m
g M
on
ito
r le
vels
. T
able
ts 1
00 m
g an
d th
eoph
ylli
nate
20
0 m
g. S
yrup
62.
S m
g/S
ml.
(Cho
ledy
l)
Cim
etid
ine
oral
4
S-I
Om
g/kg
10
0mg
20
0m
g
Tab
lets
200
mg.
Syr
up 2
00 m
g/S
ml.
(Tag
amet
) td
s an
d td
san
d
200m
g 4
00
mg
at
nig
ht
at n
ight
i.v.
4 4
mg
/kg
10
0mg
20
0m
g
(ove
r 2
hour
s)
Clo
naze
pam
or
al m
ain-
4 0.
2Sm
g O
.Sm
g Im
g
2m
g
Ant
icon
vuls
ant.
May
cau
se d
row
sine
ss
(Riv
otri
l)
tena
nce
and
incr
ease
d sa
liva
tion
. S
tart
wit
h do
se
dose
st
ated
onc
e a
day,
and
gra
dual
ly
incr
ease
.
Dos
age
per
dose
git'
en
Rem
arks
D
rug
Rou
te
Tim
es
dail
y 0
-2
2 w
eeks
-I
year
7
year
s A
dult
w
eeks
J
year
Co-
trim
oxaz
ole
oral
2
See
24
240m
g 4
80
mg
96
0mg
Dos
e gi
ven
in t
erm
s o
f tot
al o
f (S
eptr
in,
Tab
le 2
m
g/kg
T
rim
etho
prin
I p
art
and
Bac
trim
) i.v
. P
roph
y-Se
e 12
12
0mg
240m
g 4
80
mg
S
ulph
amet
hoxa
zole
5 p
arts
. T
able
ts:
lact
ic
Tab
le 2
m
g/kg
96
0,48
0, 1
20m
g. S
uspe
nsio
n: 4
80
mg
/ at
nig
ht
5 m
!. P
aedi
atri
c sy
rup
240
mg/
5 m
!.
Des
ferr
ioxa
min
e i.
m.a
nd
S
ingl
e 20
mg/
kg g
iven
i.m
. im
med
iate
ly.
If
Fo
r se
vere
iro
n po
ison
ing.
May
cau
se
(Des
fera
l)
i.v.
nece
ssar
y, t
hen
i.v.
80m
g/kg
ove
r 24
hou
rs.
hypo
tens
ion.
R
ate
not
to e
xcee
d 15
mg/
kg.
Dex
amet
haso
ne
i.v.
4 --0
.1 m
g/kg
--
I mg
2m
g
4m
g
Fo
r ce
rebr
al o
edem
a. M
ay i
niti
ally
giv
e (D
ecad
ron.
do
uble
thi
s do
se.
In G
ram
-neg
ativ
e O
rade
xon)
sh
ock,
up
to 1
0 ti
mes
sta
ted
dose
.
Dex
tros
e. 5
0%
l.v.
Sin
gle
up to
4 m
l/kg
(2 g
/kg)
F
or
hypo
glyc
aem
ia.
Dil
ute
befo
re
inje
ctio
n.
Dia
zepa
m
l.v.
Sin
gle
-0.
25 m
g/k
g-
2.5m
g 5
mg
IO
mg
As
anti
conv
ulsa
nt o
r fo
r se
dati
on.
May
(V
aliu
m.
slow
ly
repe
at i
n 15
min
if
nece
ssar
y. M
ay c
ause
D
iaze
mul
s)
resp
irat
ory
depr
essi
on.
Inje
ctio
n: 5
mg/
m
!. D
iazo
xide
i.v
. U
pt0
4
3-5
mg
/kg
30
0mg
Fo
r se
vere
hyp
erte
nsio
n. M
ay c
ause
(E
udem
ine)
hy
pote
nsio
n. I
njec
t ra
pidl
y.
Dic
hlor
al-
oral
O
nce
-2
2.5
mg
/kg
-22
5mg
65
0m
g
l.3
g
Fo
r se
dati
on.
Tab
lets
650
mg.
Eli
xir
phen
azon
e 22
5 m
g/5
m!.
(Wel
ldor
m)
Dic
yclo
min
e or
al
4 ---5
mg
--
Fo
r th
ree
mo
nth
col
ic.
Giv
e 15
min
(M
erbe
ntyl
) be
fore
fee
d. S
yrup
10
mg/
5 m
!.
Dig
oxin
se
e pa
ge 2
15
(Lan
oxin
)
Dis
opyr
amid
e i.v
. Si
ngle
--
2 m
g/kg
to
max
of
ISO
mg,
slo
wly
, the
n --
F o
r ve
ntri
cula
r ar
rhyt
hmia
s,
(Nor
pace
, O
Am
g k
g-
I h
-I by
con
tinu
ous
infu
sion
pa
roxy
smal
sup
rave
ntri
cula
r R
hyth
mod
an)
tach
ycar
dia.
Dio
ctyl
sod
ium
or
al
3 12
.Sm
g 12
.S-
20
mg
4
0m
g
sulp
hosu
ccin
ate
2Sm
g (D
ioct
yl- M
edo)
Dop
amin
e l.v
. Si
ngle
S
20
Ilg
kg
-I m
in -
I. A
djus
t do
se a
ccor
ding
to
res
pons
e In
otro
pic
agen
t fo
r hy
pote
nsio
n an
d (l
ntro
pin)
p
oo
r ca
rdia
c ou
tput
. C
orre
ct
hypo
vola
emia
fir
st.
May
cau
se
arrh
ythm
ias.
Dob
utam
ine
l.v.
Sing
le
2.S
10 Il
g kg
-1
min
-I.
Adj
ust
dose
acc
ordi
ng t
o In
otro
pic
agen
t.
hydr
ochl
orid
e re
spon
se
(Dob
utra
x)
Dro
peri
dol
i.v.
i.m
. Si
ngle
--
0.1
mg
/kg
--1.
2Sm
g 2.
Sm
g S
mg
F
or
seda
tion
or
prem
edic
atio
n. T
able
ts
(Dro
lept
an)
oral
2
.Sm
g,I
Om
g.
Ery
thro
myc
in
oral
4
--1
2 m
g/k
g--
12S
mg
2S0m
g SO
Om
g (E
ryth
roci
n,
Ery
thro
ped,
Il
oson
e)
Eth
ambu
tol
oral
O
nce
-1
2-2
Sm
g/k
g-
May
cau
se o
cula
r to
xici
ty.
(Mya
mbu
tol)
Eth
osux
imid
e or
al
Onc
e 12
2S
0mg
SOO
mg
Init
ial
dose
. In
crea
se b
y 2S
0 m
g ev
ery
4 (Z
aron
tin,
m
g/kg
(m
ax.
(max
.2g
) 7
days
acc
ordi
ng t
o re
spon
se,
to
Em
esid
e)
(up
to S
O 1 g
) m
axim
um d
ose.
m
g/kg
Fer
rous
or
al
3 6
mg
/kg
6
0m
g
120m
g 20
0mg
Tre
atm
ent
of i
ron
defi
cien
cy a
naem
ia.
sulp
hate
T
able
ts 2
00 m
g an
d 30
0 m
g. P
aedi
atri
c m
ixtu
re 6
0 m
g/S
m!.
Dos
age
per
dose
giv
en
Dru
g R
oute
T
imes
R
ema
rks
dail
y 0
-2
2 w
eeks
-I
year
7
year
s A
dult
w
eeks
I
year
Flu
clox
acil
lin
oral
4
See
62.5
mg
l25
mg
2
50
mg
50
0mg
Bet
ter
oral
abs
orpt
ion
wit
h (F
loxa
pen)
an
d
i.m
. T
able
2
fluc
loxa
cill
in.
Syr
up 1
25 m
g/5
m!.
clox
acil
lin
or
(Orb
enin
) i.v
.
Fol
ic a
cid
oral
O
nce
0.25
2.
5mg
5m
g
10
mg
T
able
ts 0
.1 m
g an
d 5
mg.
m
g/kg
Fru
sem
ide
oral
O
nce
--2
mg
/kg
--
20
mg
4
0m
g
80
mg
N
eeds
K s
uppl
emen
ts u
nles
s gi
ven
wit
h (L
asix
) sp
iron
olac
tone
. P
aedi
atri
c m
ixtu
re
lmg
/m!.
i.
m.
Sin
gle
--lm
g/k
g-
10m
g 2
0m
g
40
mg
D
ou
ble
the
dos
e if
nec
essa
ry.
I.V.
Fus
idic
aci
d or
al
4 12
.5 m
g/kg
as
25
0m
gas
50
0mg
as
Fus
idic
aci
d su
spen
sion
250
mg/
5 m
!. (F
ucid
in)
fusi
dic
acid
so
dium
so
dium
C
apsu
les,
sod
ium
fus
idat
e 25
0 m
g.
fusi
date
fu
sida
te
i.v.
3 12
.5
l25
mg
2
50
mg
50
0mg
Giv
en a
s a
cont
inuo
us in
fusi
on.
mg/
kg
Gen
tam
icin
l.m
. 3
See
2
mg
/kg
M
ay b
e ot
otox
ic a
nd
nep
hrot
oxic
. (G
enti
cin,
i.v
. T
able
2
Mo
nit
or
seru
m l
evel
s. I
ncre
ase
tim
e C
idom
ycin
) be
twee
n do
ses
in r
enal
fai
lure
. D
o n
ot
com
bine
wit
h ca
rben
icil
lin
in s
ame
infu
sion
.
Glu
cago
n i.m
. S
ingl
e -
25-1
00 Ilg
/kg
-0.
25 m
g 0
.5m
g
Img
F
or
hypo
glyc
aem
ia.
l.V.
Gly
cero
l or
al
4 I g
/kg
Use
d in
No
rth
Am
eric
a fo
r ce
rebr
al
oede
ma.
Hyd
rala
zine
l.V
. 4
0.2-
0.4
mg/
kg
Fo
r se
vere
hyp
erte
nsio
n.
(Apr
esol
ine)
i.m
.
Hyd
roco
rtis
one
I.v.
4-6
Sm
g/kg
SO
mg
100m
g 20
0mg
Fo
r st
atus
ast
hmat
icus
. F
or
Gra
m-
nega
tive
sho
ck, i
niti
al d
ose
up t
o S
times
do
se s
tate
d. I
njec
tion
: IO
Om
g as
sod
ium
su
ccin
ate.
Indo
met
haci
n or
al
Sing
le
0.2
In n
eona
tes,
to
clos
e a
pate
nt d
uctu
s (I
ndoc
id)
mg/
kg
arte
rios
us.
Rep
eat
x 2,
8 h
ourl
y if
ne
cess
ary.
Ipec
acua
nha
oral
Si
ngle
IO
ml
ISm
l IS
ml
30m
l P
aedi
atri
c ip
ecac
uanh
a-em
etic
m
ixtu
re.
Rep
eat
afte
r 20
min
if
nece
ssar
y.
Ipra
trop
ium
ne
buli
zed
3 O
.I-O
.S m
g in
2 m
l ste
rile
wat
er
Fo
r st
atus
ast
hmat
icus
in c
hild
ren
over
(A
trov
ent)
3
y.
Ison
iazi
d or
al
Onc
e 7.
S 7.
S 7S
mg
ISO
mg
300m
g m
g/kg
m
g/kg
Isop
rena
line
i.v
. O
nce
O.I-
O.S
/lg
kg-
1 m
in -I by
con
tinu
ous
infu
sion
. A
djus
t In
otro
pic
agen
t fo
r br
adyc
ardi
a,
(Iso
prot
eren
ol;
dose
acc
ordi
ng t
o th
e re
spon
se
hypo
tens
ion
and
poor
car
diac
out
put.
Is
upre
l)
Lac
tulo
se
oral
O
nce
Sml
IOm
l 20
ml
30m
l D
ose
of e
lixir
, con
tain
ing
lact
ulos
e (D
upha
lac,
3.
3Sg/
Sm
l.
Gaf
inar
)
Lig
noca
ine
i.v.
Onc
e B
olus
of
I mg/
kg,
repe
at a
fter
S m
in i
f nec
essa
ry,
then
F
or
vent
ricu
lar
tach
ycar
dia.
(X
yloc
ard)
10
-SO
/lg
kg
-I m
in -I by
con
tinu
ous
infu
sion
Mag
nesi
um
I.m.
Sing
le
0.1
Fo
r ne
onat
al h
ypom
agne
saem
ia.
Giv
e su
lpha
te
i.v.
mg/
kg
i.v.
inje
ctio
n sl
owly
. (S
O%
)
Man
nito
l I.v
. Si
ngle
O
.S-I
g/k
g F
or
cere
bral
oed
ema.
Rep
eat
as
(20%
) .o
ver
indi
cate
d. M
ay c
ause
cir
cula
tory
20
min
ov
erlo
ad.
Mon
itor
osm
olal
ity.
Dos
age
per
dose
giv
en
Dru
g R
oute
T
imes
R
emar
ks
dail
y 0
-2
2 w
eeks
-1
year
7
year
s A
dult
w
eeks
1
year
Met
hici
llin
i.
m.
4 S
ee
2S
2S0m
g SO
Om
g I g
(C
elbe
nin)
L
V.
Tab
le 2
m
g/kg
Met
hyld
opa
ora
l 3
6m
g/k
g
62.S
mg
12S
mg
2S0m
g In
crea
se a
ccor
ding
to
resp
onse
, up
to
3 (A
ldom
et,
tim
es s
tate
d do
se.
Co
pam
et,
Med
omet
)
Met
ocJo
pram
ide
oral
3
0.1
Img
S
mg
IO
mg
Syr
up S
mg/
S m
L
(Max
olon
, L
m.
Sin
gle
mg/
kg
Pae
diat
ric
liqu
id I
mg/
mL
P
rim
pera
n)
Lv.
S
ingl
e T
able
ts 1
0 m
g.
Met
roni
dazo
le
oral
3
7.S
mg/
kg
40
0m
g
Fo
r an
aero
bic
infe
ctio
ns.
(Fla
gyl)
re
ctal
3
7.S
mg/
kg
I g
LV
. 3
7.S
mg/
kg
SOO
mg
Mo
rph
ine
l.m
. S
ingl
e 0.
2 2.
Sm
g S
mg
1
0m
g
May
cau
se r
espi
rato
ry d
epre
ssio
n,
sulp
hate
L
v.
mg/
kg
espe
cial
ly in
you
ng c
hild
ren.
Nal
idix
ic a
cid
oral
4
2S0m
g SO
Om
g I g
S
uspe
nsio
n 30
0 m
g/S
mL
Fo
r (N
egra
m)
prop
hyla
xis,
giv
e on
ly t
wic
e da
ily.
Nal
oxon
e H
CI
Lm
. S
ingl
e -O
.Olm
g/k
g-
O.l
mg
0.2
mg
O
.·lm
g N
arco
tic
over
dosa
ge.
Rep
eat
in 2
min
if
(Nar
con)
Lv
. ne
cess
ary.
Inj
ecti
on 4
00 Il
g/m
L N
eona
tal
20 Il
g/m
L
Neo
myc
in
oral
4
--2
Sm
g/k
g--
2S0m
g SO
Om
g I g
su
lpha
te
(Niv
emyc
in)
Nit
rofu
ran
toin
or
al
4 A
void
2.
S 2S
mg
SOm
g 10
0mg
Tab
lets
SO
mg,
100
mg.
Sus
pens
ion
(Fu
rad
anti
n)
mg/
kg
2S m
g/S
mL
Fo
r pr
ophy
laxi
s, g
ive
twic
e da
ily.
Con
trai
ndic
ated
in i
nfan
ts <
I
mo
nth
old
.
Nys
tati
n or
al
4 F
or
oral
thr
ush,
100
000u
nits
S
uspe
nsio
n 10
0000
uni
ts/m
!.
(Nys
tan)
Pap
aver
etum
or
al
Sing
le
200
2.S
-Sm
g S
-IO
mg
10-2
0 F
or
seda
tion
, ana
lges
ia,
prem
edic
atio
n.
(Om
nopo
n)
i.m.
Jlg/
kg
mg
Dos
e o
f Om
nopo
n-S
copo
lam
ine
is
i.v.
0.03
mlj
kg i.
m.
(pap
aver
etum
20
mg
and
hyos
cine
400
j.tg
/ml)
I h
ou
r be
fore
op
erat
ion.
Par
acet
amol
or
al
4-6
24
24
0mg
SOO
mg
Ig
Tab
lets
SOO
mg,
sus
pens
ion
(Cal
pol)
(A
ceta
min
ophe
n m
g/kg
12
0 m
g/S
m!.
Pan
adol
, C
al p
ol,
Tyl
enol
(U
SA
)
Par
alde
hyde
i.m
. Si
ngle
--O
.IS
mlj
kg
--Im
l S
ml
IOm
l T
o a
void
ste
rile
abs
cess
es,
give
dee
p i.m
. do
se
Rep
eat
in I
S-3
0 m
in i
f nec
essa
ry.
rect
al
Sing
le
0.3
mlj
kg
Mix
wit
h eq
ual
volu
me
of m
iner
al o
i!.
dose
Pen
icil
lin
G
i.m.
4 Se
e IS
IS
Om
g 30
0mg
600m
g In
crea
se d
ose
and
fre
quen
cy i
n se
vere
(b
enzy
l i.v
. T
able
2
mg/
kg
infe
ctio
ns.
peni
cill
in,
Cry
stap
en)
Pen
icil
lin,
i.m
. E
very
tv
ial
!via
l 1
vial
O
ne v
ial
cont
ains
ben
etha
min
e pe
nici
llin
pr
olon
ged
2-3
47S
mg,
pro
cain
e pe
nici
llin
2S0
mg,
ac
tion
da
ys
benz
ylpe
nici
llin
300
mg.
(b
enet
ham
ine
peni
cill
in,
Tri
plop
en)
Pen
icil
lin
V
oral
4
--6
2.S
mg
--
12S
mg
2S0m
g SO
Om
g S
yrup
12S
mg,
2S
0mg/
Sm
!.
(phe
noxy
met
hyl
peni
cill
in)
(Cry
stap
en V
, V
-Cil
-K e
tc).
Dos
age
per
dose
giv
en
Dru
g R
oute
T
imes
R
ema
rks
dail
y O~2
2 weeks~
1 ye
ar
7 ye
ars
Adu
lt
wee
ks
1 ye
ar
Pet
hidi
ne
i.m.
Sing
le
--1
-2
mg
/kg
-12.5~2S
2S~SO
SO~IOO
Fo
r an
alge
sia,
sed
atio
n, p
rem
edic
atio
n m
g m
g m
g I
hour
bef
ore
oper
atio
n.
Phe
noba
rbit
one
oral
O
nce
4~6mg/kg
60~120
60~360
As
an a
ntic
onvu
lsan
t. M
ay c
ause
m
g m
g be
havi
our
dist
urba
nce
in s
ome
chil
dren
. i.v
. Si
ngle
S~lOmg/kg
Sta
tus
epil
epti
cus.
May
cau
se
resp
irat
ory
depr
essi
on.
Rep
eat
afte
r 20
min
if n
eces
sary
. P
heny
toin
or
al
2 3m
g/kg
30
mg
SOm
g 10
0mg
Mai
nten
ance
ant
icon
vuls
ant
ther
apy.
(E
panu
tin)
Si
de e
ffec
ts i
nclu
de g
um h
yper
trop
hy,
atax
ia a
nd li
ver
dam
age.
Tab
lets
SO,
10
0 m
g. S
uspe
nsio
n 30
mg/
Sm
l.
i.v.
15~20mg/kg
Sta
tus
epil
epti
cus.
May
cau
se
(slo
w)
hypo
tens
ion
and
card
iac
dysr
hyth
mia
s.
Phy
tom
enad
ione
or
al
Sing
le
1 m
g 3m
g S
mg
IOm
g (V
it K
, i.m
. K
onak
ion)
i.v
.
Pot
assi
um
oral
1~2mmol K
+ kg~1 (
24h)
-1
Sta
rtin
g do
se in
diu
reti
c th
erap
y. B
ase
supp
lem
ents
do
se o
n cl
inic
al r
equi
rem
ents
and
pl
asm
a K
. G
ive
as p
otas
sium
chl
orid
e,
or
pota
ssiu
m g
luco
nate
, or
effe
rves
cent
po
tass
ium
(po
tass
ium
bic
arbo
nate
).
Pre
dnis
olon
e or
al
Onc
e ---2
mg
kg
-1 (
24h)~ I
or 60mgm~2(24h)~I-
For
indu
ctio
n o
f rem
issi
on in
nep
hrot
ic
synd
rom
e. M
inim
um d
ose
2S m
g/24
h,
max
80
mg/
24 h
.
Pri
maq
uine
or
al
Onc
e 37
S 3.
7Sm
g 7.
Sm
g IS
mg
Fo
r er
adic
atio
n o
f ben
ign
tert
ian
jlg/
kg
mal
aria
. Giv
e fo
r 14
day
s af
ter
trea
tmen
t wit
h ch
loro
quin
e. T
est f
or
G6P
D d
efic
ienc
y. T
able
ts o
nly,
7.S
mg.
Pro
met
hazi
ne
oral
3
0.5
5m
g
10m
g 25
mg
Fo
r us
e as
an
anti
hist
amin
e. F
or s
ingl
e H
CI
mg/
kg
seda
tive
dos
e th
e st
ated
dos
e ca
n be
(P
hene
rgan
) do
uble
d.
Pro
pran
olol
or
al
3 ---
0.2-
0.3
mg/
kg.
Max
dos
e 20
mg
Fo
r ar
rhyt
hmia
s.
(Ind
eral
) l.v
. Si
ngle
--
0.1
-0.1
5 m
g/kg
. M
ax s
ingl
e do
se 1
0 m
g---
Fo
r ar
rhyt
hmia
s, c
yano
tic
atta
cks
in
tetr
alog
y o
f F
allo
t. R
epea
t in
6 h
ours
if
nece
ssar
y.
Pro
stag
land
in
i.v.
Sing
le
0.05
-1 J
lg k
g -
1 1.
5 m
g pr
osta
glan
din
in 5
00 m
l de
xtro
se.
El
and
Ez
min
-1
as a
n
Giv
e vi
a a
syri
nge
pum
p.
infu
sion
Rif
ampi
cin
oral
O
nce
15
150m
g 30
0mg
600m
g M
ay c
ause
uri
ne,
sali
va t
o go
red
. In
(R
ifad
in,
mg/
kg
prop
hyla
xis
for
men
ingo
cocc
al o
r H
. R
imac
tane
) in
jlue
nzae
con
tact
s, 2
-4 d
ays
only
. C
apsu
les,
150
, 300
mg.
Sus
pens
ion
IOO
mg/
5m!.
Sal
buta
mol
or
al
3-4
0.1
Img
2
mg
4
mg
T
able
ts 2
mg,
4 m
g, 8
mg
(lon
g-ac
ting
).
(Ven
toli
n)
mg/
kg
Syr
up 2
mg/
5 m
!.
inha
la-
4 20
0 Jl
g 20
0-R
otac
aps
200,
400
Jlg
wit
h R
otah
aler
. ti
on
400
Jlg
(pow
der)
ne
buli
-4-
8 0.
05
0.5m
l Im
l 2
ml
In s
tatu
s as
thm
atic
us.
Res
pira
tor
zer
mlf
kg
solu
tion
0.5
% m
ade
up t
o 2
ml
wit
h no
rmal
sal
ine.
I.V
. 5-
7 Jl
g kg
-1
h -
1 gi
ven
hour
ly o
r 25
0 Jl
g In
sta
tus
asth
mat
icus
. by
con
tinu
ous
infu
sion
ev
ery
4h
or
200
-12
00 J
lg/h
by
con
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nuou
s in
fusi
on
Dos
age
per
dose
gil'
en
Dru
g R
oute
T
imes
R
ema
rks
dail
y 0
-2
2 .....
eeks
-I
year
7
year
s A
dult
.....
eeks
1
year
Sod
ium
l.v
. 1-
2 m
mol
jkg
Fo
r ca
rdia
c ar
rest
. A
fter
init
ial d
ose,
bi
carb
onat
e ac
cord
ing
to b
lood
gas
es.
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ium
in
hale
d 4
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-2
pu
ffs--
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ler
20 m
g pe
r pu
ff.
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r yo
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crom
ogly
cate
ch
ildr
en 1
0-20
mg
by n
ebul
izer
(I
ntal
) (n
ebul
izer
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utio
n 10
mg/
ml)
.
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ium
l.v
. S
ingl
e -0
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gk
g-1
min
-I
init
iall
y, a
djus
t ac
cord
ing to
-F
or
seve
re h
yper
tens
ion.
Pot
ent
nitr
opru
ssid
e re
spon
se to
5 It
g kg
-I
min
-I
vaso
dila
tor.
Mon
itor
blo
od p
ress
ure.
(N
ipri
de)
Sod
ium
or
al
3 --7
-lO
mg
/kg
--
100-
200-
Sta
rt w
ith
low
er d
ose,
inc
reas
e if
va
lpro
ate
200m
g 40
0mg
nece
ssar
y ev
ery
3 da
ys t
o h
ighe
r do
se.
(Epi
lim
; M
axim
um a
dult
dos
e is
2.6
g d
aily
. F
or
Val
proi
c ac
id,
prop
hyla
xis
of f
ebri
le c
onvu
lsio
ns, c
an
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aken
e in
us
e 2
0-3
0m
gk
g-1
(24
h)-
I, g
iven
twic
e U
SA
) a
day.
Inc
reas
es p
heno
barb
iton
e le
vels
. T
able
ts 2
00 m
g. S
yrup
200
mg/
5 m
!.
Spi
rono
lact
one
oral
2
-4
-0.6
25
mg
/kg
-6.
25m
g 12
.5m
g 2
5m
g
Cou
nter
acts
K l
oss
of o
ther
diu
reti
cs.
(Ald
acto
ne,
Con
trai
ndic
ated
in a
cute
ren
al f
ailu
re.
Spi
roct
an)
Tab
lets
25
mg
(cru
shab
le).
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buta
line
or
al
3 0.
15
1.5m
g 3
mg
5
mg
R
educ
e do
se i
f the
re is
tre
mor
, (B
rica
nyl)
m
g/kg
ne
rvou
snes
s, n
ause
a.
s.c.
2
-4
5-10
50
-100
10
0-25
0-F
or
stat
us a
sthm
atic
us.
slow
i.v.
lt
g/kg
Itg
20
0 Itg
50
0 Itg
sp
acer
3
-4
250
Itg
250-
inha
ler
(I p
ull)
50
0 Itg
(1
-2
puff
s)
nebu
lize
r 4
0.2
2m
g
5m
g
IOm
g F
or
stat
us a
sthm
atic
us.
Neb
uliz
er
mg/
kg
solu
tion
10m
g/m
!. M
ake
up t
o 2m
l w
ith
norm
al s
alin
e.
The
ophy
llin
e,
oral
2
--1
2 m
g/k
g--
12S-
2S0-
Dos
e o
f R
ona-
Slo
phyl
lin
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s 60
, sl
ow r
elea
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g 12
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lets
can
be
rem
oved
(R
ona-
from
cap
sule
and
sw
allo
wed
(bu
t n
ot
Slo
phyl
lin)
ch
ewed
).
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roxi
ne
oral
O
nce
--1
2.S
Jlg
--
2S
Ilg
SO
jlg
10
0 jlg
In
itia
l do
se,
adju
st a
ccor
ding
to
(E
1tro
xin)
re
spon
se.
Tab
lets
2S,
SO,
100
jlg
.
Tri
mep
razi
ne
oral
Si
ngle
2
-4m
g/k
g
Fo
r se
dati
on,
prem
edic
atio
n 1-
2 ho
urs
tart
rate
be
fore
hand
. (V
alle
rgan
) 3
-4
0.2S
2.
Sm
g S
mg
10
mg
Fo
r pr
urit
us.
Syr
up 7
.S m
g/S
m!.
Syr
up
mg/
kg
fort
e 30
mg/
Sm
!.
Tob
ram
ycin
i.v
. 3
See
2m
g/k
g
1-2
Sid
e-ef
fect
s si
mil
ar t
o G
enta
mic
in.
(Neb
cin)
i.m
. T
able
2
mg
/kg
M
easu
re s
erum
leve
ls.
Tol
azol
ine
l.v.
Bol
us o
f In
neo
nate
s fo
r pu
lmon
ary
hype
rten
sion
H
Cl
(Pri
scol
) 2
mg
/kg
es
peci
ally
in p
ersi
sten
t fe
tal
circ
ulat
ion.
th
en
Mon
itor
blo
od p
ress
ure.
May
cau
se G
I 1
-2m
g
haem
orrh
age.
k
g-
1 h
-1
by
infu
sion
Ver
apam
il
l.v.
---
O.O
S-I.S
mg/
kg --
2.S
mg
Sm
g
Sup
rave
ntri
cula
r dy
srhy
thm
ias.
Rep
eat
(Cor
dilo
x)
slow
af
ter
S-l
Om
in i
f ne
cess
ary.
D
osag
e pe
r do
se g
iven
NOMOGRAM
HEIGHT !eml SA WE IGHT Ikgl
1 1 1 80
70 2.0 60 1.9 240 1.8
220 1.7 SO 1.6
200 L5 40 1.4
190 1.3 180 1.2 30 170 1.1 160 1.0 25
ISO 0.9 140 20
0.8 130
0.7 15 120
110 0.6
100 10 0.5 9.0
90 8.0
0.4 7.0 80 6.0
70 0.3 5.0
4.0
60
3.0
0.2 2.5 SO
2.0
40 I.S
0.1 1.0 30
Nomogram to calculate the surface area of a child
APPENDIX
Table 2 Doses of antibiotics in neonates (born at term)
0-7 days old 7-14 days old
Drug Route Times Dose Times Dose Remarks daily daily
Amikacin i.m. 2 7.5mg/kg 3 7.5mg/kg Side-effects and i.v. monitor serum
levels as for Gentamicin.
Amoxycillin i.v. 2 25mg/kg 3 25mg/kg i.m. 2 50mg/kg 4 50mg/kg For Group B
streptococcal sepsis or meningitis.
Ampicillin i.v. 2 25mg/kg 3 25mg/kg i.m. 2 50mg/kg 4 50mg/kg For Group B
streptococcal sepsis or meningitis.
Azlocillin i.v. 2 lOOmg/kg 3 100mg/kg if <2.0kg
4 100mglkg if >2.0 kg
Carbenicillin i.v. 2 100mg/kg 3 100mg/kg if <2.0kg
4 100mgjkg if >2.0kg
Cefuroxime I.V. 2 20mgjkg 3 20mgjkg i.m.
Cephalothin i.v. 2 20mg/kg 3 20mgjkg i.m.
Chloramphenicol i.v. 2 12.5 2 12.5-25 Monitor serum mg/kg mg/kg levels. May cause
the 'grey-baby syndrome'.
Co-trimoxazole i.v. 2 24 mg/kg 2 24 mg/kg Avoid if baby is (Septrin, jaundiced. Bactrim)
Flucloxacillin I.V. 2 25 mg/kg 3 25mg/kg or cloxacillin
315
PAEDIATRIC EMERGENCIES
0--7 days old 7-14 days old
Drug Route Times Dose Times Dose Remarks daily daily
Gentamicin i.m. 3 2mg/kg 3 2.5mg/kg May be ototoxic i.v. or nephrotoxic.
Monitor serum levels.
Isoniazid oral Single 10 mg/kg Single 10 mg/kg
Methicillin i.v. 2 25mg/kg if 2 25mg/kgif <2.0kg <2.0kg
3 25 mg/kg if 3 25mg/kg if >2.0kg >2.0kg
Penicillin G l.v. 2 15mg/kg 3 15mg/kg (benzyl i.m. penicillin) 2 30-45 mg/kg 4 25-35mg/ For group B
kg streptococcal sepsis or meningitis.
Tobramycin i.m. 2 2 mg/kg 3 2mg/kg Side-effects and i.v. monitor serum
levels as for Gentamicin
Further details may be found in Antimicrobial Therapyfor Newborns by McCracken. G .. and Nelson. 1. D .. 1977. Grune and Stratton. New York.
316
Index
abdominal pain see pain accidents 56, 223-8
see also burns, head injury, poisoning N-acetyl cysteine and paracetamol
poisoning 236 acidosis 17, 20 I
bicarbonate 129, 132 breathing 123 cardiac arrest, treatment 27, 129, 132 dehydration 81 diabetes 120,122
ACTH and infantile spasms 161 acyclovir 152 adrenaline
anaphylaxis 194 asystole 29 dose in cardiopulmonary arrest 28 indication 16 infusion and cardiac output 31,191 intracardiac 29 racemic aerosol in laryngotracheo
bronchitis 42 resuscitation 9
airway anaphylaxis 194 coma 171 establishment in cardiopulmonary
arrest 21, 24 airway obstruction 5
common sites 51, 52 lower 51,52 over-distension 52 relief, Medicut 50 upper 49-51
alcohol poisoning 240 alkali poisoning and ulcers 240 allergens causing anaphylaxis 193, 194 aminophylline
acute asthma 71-3 anaphylaxis 194 blood level monitoring 75 dose in asthma 72
amitryptyline 238 amoxycillin 143,203
r"'~umonia 65 ampicillin 151,201
epiglottitis 47 and pneumonia 65
analgesia maternal and fetus 14 and naloxone 17
anaphylaxis see shock antibiotics 143, 144
diabetic ketoacidosis 132 dosages 315-16 epiglottitis 44-6 gastroenteritis 92 meningitis 142,151
317
INDEX
antibiotics-cont. osteomyelitis 145 pneumonia 65 septic arthritis 146
antidepressants, poisoning by tricyclic 238, 239
clinical features 239 antiemetics 92 Apgar score
intubation II neonatal assessment 7, 8 response 10
apnoea 18,211,212 bronchiolitis 59 clinical features 3 colour and heart rate 3 events in rhesus monkeys I, 2 intubation 10, II monitoring 271 pertussis 67 primary 1-4 secondary 1-4 sudden infant death syndrome 267,
271 ventilation 10
appendicitis 108-111, 116 arterial blood sampling 278-82
catheter, radial artery 281, 282 exsanguination 282 oxygen tension 278 radial artery puncture 279-81
arthritis, septic 146; see also Still's disease
aryepiglottic folds 37 in epiglottitis 45
asphyxia, need for resuscitation 4 asplenism 152 aspiration, food and fluid 9,68 aspirin, side-effects in fever 139 asthma 60, 61, 68
acute 70-6 blood gas analysis 74 drug doses 72 drugs 71,72 hospital 70, 71, 73 hydration 75 incidence 70 intensive care 75,76 intravenous drugs 73, 74
long-term management 76 management, acute 70, 71 mortality 70 nebulizer 72 peak flow measurement 72, 73 precipitating factors 76 ventilation 76 wheezing 68
asystole duration 32 treatment 29
atopy 60,69 atropine 191,237,238
dose in cardiopulmonary arrest 28
bacterial infections antibiotics 142 babies, hazard 141 meningitis 148-52 septic shock 192, 193 see also infections
barbiturates and oxygen utilization 32 barium swallow 93
intussusception treatment 104-6 barrier nursing 92 bicarbonate 9, 15
in acidosis, disadvantages 129,132 dose in cardiopulmonary arrest 28,
29 hazards 29, 132 indications in resuscitation 16 tissue damage 286
birth, high-risk 6 blood gas measurement 57
arterial samples 278 bronchiolitis 59 hyperoxia test 210,211 in laryngotracheobronchitis 41 respiratory distress 74 shock 190
blood pressure measurement 294 normal systolic 294
blood samples arterial see arterial sampling capillary, heel prick sites 275,276 venous, sites and procedure 277, 278
brain damage
318
and asphyxia at birth 4 cardiopulmonary arrest 21
epilepsy 68 febrile convulsions 163 nonaccidental injury 256 pertussis 174
brain stem trauma 5 breath-holding 167
cyanotic and pallid 167 breathing
abnormal and diagnosis 122-4 artificial in cardiopulmonary
arrest 24 reasons for abnormal at birth 5 ventilation position 24
bronchiectasis 68 bronchiolitis 68
and asthma 60, 61 cardiac failure 60 clinical features 59 cough 59 drugs 60 hydration 60 incidence and age 57, 58 management 59, 60 pathophysiology 58 recovery 60 ventilation hazard 59 viral cause 58
bronchopneumonia 68 bronchoscopy 52 burns and scalds 226, 227
assessment 226 fluid replacement 226 hospital admission 227 nonaccidental 256, 257
Caesarean section and apnoea 18 calcium chloride
asystole 29 dose in cardiopulmonary arrest 28 indications in neonatal
resuscitation 16 Campylobacter spp.
abdominal pain 113 antibiotics 92 gastroenteritis features 79, 80
cardiac failure age and digitalization 214-16 bronchiolitis 60 causes 212,213
INDEX
chest radiograph 215 drugs 214,215 heart lesions 208, 213 investigations 214 management 214-16 patent ductus 214 presentation 212
cardiac output, drugs increasing 191 cardiorespiratory arrest 21-32
airway and breathing 24,25 asystole treatment 29 brain damage 21 drug doses 28 drug use 26-9 equipment needed 22,23 follow-up 32 inotropic agents 30, 31 intubation 25 management 23 resuscitation 21-3 sequence mnemonic 23 team 22
cardiovascular emergencies 207-17 age of onset 208 congenital disorders 207, 208, 211,
213 see also cardiac failure, cyanosis
catheter, central venous 288-91 ascepllc msertlOn 291 complications 289 infusion sites 289 insertion site, jugular vein 290
central venous pressure line 190, 191, 290,291
cerebral oedema 184, 225 drugs reducing 183
cerebrospinal fluid meningitis 149 normal neonate 141
child abuse (nonaccidental injury, NAI) age 248
319
assessment and investigations 260 background factors 248, 249 bites 255, 256 black eyes 253, 255 bruise examination 252-5 burns and scalds 256, 257 case conference 261, 262 child personality 250
child abuse-conI. ear bruise 253 head injury 256 history 251, 252 hospital admission 259-61 incidence 247 parental factors 249, 250 poisoning 258 radiological evidence 257, 258 types 258
chloral hydrate 109 chloramphenicol
epiglottitis 44, 45 meningitis 142,151
chlorpheniramine in anaphylaxis 193, 194
circulation, fetal 4 clonazepam 161 cloxacillin in pneumonia 65 coarctation of the aorta 208,211,213 coma 171-84
abscess 172 assessment 180, 181 causes 172 cerebral oedema 183, 184 drugs 177, 178 encephalopathy 179, 180 eye movements 181 infections 171-4 investigations 181, 182 management 182-4 Reye's syndrome 175-7 scale 181 subdural haematoma 178, 179 viral encephalitis 173, 174
congenital abnormalities 66 endocarditis 145 heart 207,208,211,213
congenital adrenal hyperplasia 96-8 constipation and abdominal pain 116 convulsions 159-70
and coma 175 intravenous infusion 168 see also spasms, febrile; status
epilepticus cot death see sudden infant death
syndrome co-trimoxazole
pneumonia 143,203
65
INDEX
croup 36; see also laryngotracheobronchitis
croupette 39,40 CTscan 172
cerebellar abscess 173 coma 182 cranial haemorrhage 225, 226
cyanosis cardiac lesions 208 central, causes in neonate 209 clinical identification 207,210 investigations 210,211 management 211, 212 peripheral 209 prostaglandin infusion 211,212
cyanotic attacks and surgery 216 cystic fibrosis
chest radiograph 66 wheezing 68
cystourethrogram, micturating 204
defibrillation 31-2 dehydration
deficits 91 diabetes 122, 127, 180 electrolyte requirements 87 eyes sunken 82,83 feeding 84 fever 89 fluid replacement 86, 87,90 hospital admission 85, 86 hypernatraemic 90, 91 intravenous infusion regimen 86-9 investigations 86 oral rehydration fluids 83-5 pyloric stenosis 95 severe, clinical features 81, 82 signs and loss of weight 81 skin recoil 81 - 3
delivery 8 deoxycortone pivalate and congenital
adrenal hyperplasia 98 dexamethasone, cerebral oedema 183 dextrose
asystole 29 cardiopulmonary arrest 28 indications in resuscitation 16, 28
diabetes 119, 120
320
INDEX
diabetic ketoacidosis 119-34 acute abdomen 124 blood and urine glucose
monitoring 134 differential diagnosis 122-4 fluids and electrolytes 120,124,188 fluid replacement calculation 125-8 insulin deficiency 119,121 insulin dose and administration 126,
127, 129, 130 intravenous infusion 124-6. 128.130 investigations 122, 123, 134 management programme 127 mechanism 119 metabolic acidosis 120,122 potassium replacement 129 rehydration effects 129 therapy chart 132 thirst and symptoms 122 treatment 124-34
diarrhoea 77-98, 188; see a/so gastroenteritis
diazepam in convulsions 166, 168, 20 I sedative 274 side-effects 169
diazoxide 180 dimercaprol (British Anti
Lewisite) 243 diphenoxylate, danger in infants 91,
92,237,238 diphtheria 52, 53 disseminated intravascular coagulation
(DIC) 192 dobutamine, myocardial effects 31 dopamine
cardiac output 30, 191, 192 doses in cardiopulmonary arrest 28,
30 infusion regime 30, 31
drowning, cold-water 32 drugs
asthma 71, 72 cardiac failure 214, 215 cardiorespiratory arrest 23, 26-31 cerebral oedema 183 child-resistant containers 229 dosages 298- 315 lead chelation 243
neonatal resuscitation 15, 16 status epilepticus 169 fiz-sympathomimetic 71,73
ductus arteriosus patency and drugs 211, 214
duodenal atresia, double bubble 96
electrocardiogram analysis in children 219-22 cardiorespiratory arrest 29-32 Q RS axis calculation 220, 221 ventricular hypertrophy 221, 222
encephalitis incidence and measles 174 mortality of viral 173
encephalopathy hypertensive, retina 179 lead 244 post-anoxic 179, 180
endocarditis, infective and congenital disorders 145
endotracheal intubation 9, 10 asthma 77 cardiorespiratory arrest 25 difficulties 14, 15 glottis visualization 12 laryngotracheobronchitis 39-42 in position 13 positioning 15 size and vocal cords 13, 25 technique 11-14
epiglottis 37 in epiglottitis 42-4 long 53
epiglottitis age and mortality 43 airway obstruction 43 antibiotic use 44-6 appearance at presentation 46 clinical features 43, 44 differences to
laryngotracheobronchitis 44 intubation 46 lateral neck 38 management 43-8 nasotracheal tube size 41 radiograph 44, 45 and stridor 35, 42-8 viral cause 43
321
epilepsy and febrile convulsions 163, 164
erythromycin and pertussis 68 and pneumonia 66
Escherichia coli 192 features of gastroenteritis 80 in infants 61, 141 meningitis, postmortem 142 urinary tract 203
external cardiac massage 22 diagram 16 heart rate 9, 15 monitoring 25 technique 25
febrile convulsions age 162 drug prophylaxis 166 fever source 163 prognosis and epilepsy 163-5 prophylaxis 164-7 sponging 162, 163
fetus monitoring 5 fever 139-57
age, over 2 months 143-52 age, under 2 months 139-43 convulsions 139,162-7 CSF 141 hospital role 139 investigations 140, 141 paracetamol 139 see also infections
fluid, normal intake 77 foreign bodies 35,48-52, 66
chest massage techniques 49 examples 48, 49 lower airways obstruction 51, 52 symptoms 48, 49 upper airway obstruction 49-51 wheezing 68
frusemide 215
gastroenteritis 78-93 agents causing 78-80 antibiotics 92 dehydration danger 81-90 drug use 91, 92
INDEX
fluid intake 77 isolation 92 mortality 78 pain 113 recurrence 92, 93 rehydration 83, 84
gastro-oesophageal reflux 70 gentamicin 65,201 glucagon
in hypoglycaemia 136 intussusception 106
glucose-electrolyte mixture 83, 84, 85
haemolytic-uraemic syndrome 198, 200
features and management 202 Haemophilus influenza 143, 144, 146
antibiotics and 47, 143 epiglottitis 43,44 meningitis 149-52 pneumonia 61 sensitivity 47
head injury 224-6 cerebral oedema 225 cranial haemorrhage 225, 226 hospital admission role 224, 225 nonaccidental 256
heart rate 3, 8 age 219 resuscitation procedure 9
Heimlich manoeuvre, technique and visceral damage 49
Henoch-Schonlein purpura 114, 115 hernia, diaphragm 14 Hirschprung's disease 95
abdominal distension 97 hydralazine 180 hydration
asthma 75 bronchiolitis 60
hydrocortisone acute asthma 71-3 congenital adrenal hyperplasia 98 dose in asthma 72
hydronephrosis 113 21-hydroxylase deficiency 98 hyperkalaemia 201 hypernatraemia and dehydration 83,
85,90,91
322
hypernatraemic dehydration 90,91 hyperoxia test 210 hypertension
drug use 179, 180 renal failure 201
hypoglycaemia 135~8
hyponatraemia and dehydration 91 hypothermia and preterm infants 18 hypovolaemia 27
causes 188 detection 196 indications for treatment 196, 197 investigations 190 nephrotic syndrome 195, 196 plasma expander 189, 190 renal failure 198 shock management 189~92
see also shock hypoxia relief 59
immunodeficiency 152 infections
babies 139~43
children and fever 143~52
children at risk 152, 153 coma causes 171 ~4 diarrhoea 77 incidence in infants nephrotic syndrome symptoms and signs vomiting 94
56 197,198 140
see also individual infections inguinal hernia 106, 107
strangulation and age 106 insulin
administration in diabetic acidosis 126,127,129
paediatric infusion 130,131 insulin deficiency 119~21; see also
diabetic ketoacidosis intensive care unit 32
asthma 71,72,75,76 epiglottitis 43
intermittent positive pressure ventilation (IPPV)
bronchiolitis 59, 60 resuscitation 14
intestinal atresia 95 intestinal obstruction 95,96; see also
INDEX
inguinal hernia, intussusception, pyloric stenosis
intravenous infusion 282~91
cannulae 284,288 central venous catheter 288~91
cut-down in shock 288 local anaesthetic 288 needle fixing on scalp 287 peripheral 283,284 scalp, procedure 285, 287 sites 282,283 tissue damage 285, 286 winged needles, fixing 284, 285
intravenous lines 26, 27, 282~91 intussusception
age 106 diagnosis 104 gangrenous bowel 105 incidence and site 103 pain 103~6, 110 palpation 103, 104 treatment I 04~6
ipecacuanha 231 and laryngeal spasm 42
iron tablets, poisoning 236, 237 clinical features 237 treatment 237
isoprenaline cardiac output 30, 91 dose in cardiopulmonary arrest 28
Kawasaki's disease (mucocutaneous lymph node syndrome) 154~ 7
ketone bodies 120 kidney disorders 195~202; see also
nephrotic syndrome, renal failure Kussmaul breathing 122~4
lactose intolerance test 92 Ladd's bands in malrotation 107 laryngoscope and intubation II laryngotracheobronchitis 35~42, 68
323
airflow reduction 37 anxiety 39 cause of stridor 35, 36 clinical features 36,37,44 cough 37,43,44 diagnosis 37,38 drug use 42
INDEX
laryngotracheobronchitis-cont. hospital role 39 intubation 39,40,44 investigations 44 lateral neck 38 nursing 39 viral origin 36
lead poisoning abdominal radiograph 242 chelating drugs 243, 244 clinical features 243 encephalopathy 244 lead lines in bones 241,242 screening test, free erythrocyte
protoporphyrin 241 treatment and serum lead levels 244
lignocaine dose in cardiopulmonary arrest 28
lomotil poisoning 228, 231 composition 237 treatment 238
lumbar puncture 291,292
malrotation causes 107 peritoneal bands 107, 108
mannitol in cerebral oedema 184 Meckel's diverticulum 106, 112 meCOnIum
aspiration 17 intubation 17 thick and intubation II
Medicut. insertion site in obstruction 50, 51
meningitis bacterial 148-52 coma 171 convulsions 151 CSF findings 149 difficulty to treat 142 incidence 149 origins and causes 150 prophylaxis 151, 152 symptoms 149,150 treatment 151
meningococcal septicaemia 147, 148 mesenteric adenitis
pain 110,112 infections 112
methionine and paracetamol poisoning 236
milk lactose intolerance 92 rehydration 84, 85
minoxidil 180 mucus extractor 8 Mycoplasma pneumoniae
antibiotics 66 culture and diagnosis 62 pneumonia and age 61, 62 symptoms of infection 62
naloxone and resuscitation 9, 16, 17 nasogastric tube 40,47 nasotracheal tube 40,41,47,48 nebulizer 72, 75 neck
anatomy 37 lateral, diagram and stridor 38
Neisseria meningitides 150, 192 nephrotic syndrome 195-8 nonaccidental injury (NAI) see child
abuse
osteomyelitis 145, 146 otitis media, bacteria causing and
treatment 143, 144 oxygen
asthma 74 humidified 40,59
pain, acute abdominal 101-17 appendicitis 108, 109 extra-abdominal causes 101, 102,
110 gastrointestinal causes intestinal obstruction intra-abdominal causes urine sample 112
113-16 103-8
102,110
pain, recurrent abdominal 116, 117 pancreatitis and mumps 114 paracetamol poisoning 234-6
clinical features 235 drugs 236 liver toxic effects 235 plasma levels 235,236
paraldehyde side-effects 170
324
status epilepticus 169, 170 paraquat poisoning 239, 240 parents
involvement with treatment 273 sudden infant death syndrome 268
70 paroxysmal supraventricular
tachycardia 216,217 drugs 217 electrocardiogram 216 symptoms 217
peanuts 69 irritation 48,49 wheezing 70
penicillin, intravenous 65 perinatal mortality, countries I, 2 periorbital cellulitis 144, 145 peritonitis, causes and diagnosis 112,
197 pertussis
age and mortality 67 clinical features 66-8 complications 68 cough 67 epidemic 67 immunization 66, 174, 175 nursing role 68
pethidine, effects on fetus 17 phenobarbitone in status
epilepticus 169 phenytoin in status epilepticus 169 Place of Safety Order 259,262 plasma expanders 17, 86, 189 plasma protein fraction 189 pneumatocoele 63, 64 pneumomediastinum 14 pneumonia
antibiotic choice 65 culture 65 hospital role and age 64, 65 management 64-6 monitoring 65 organisms causing 61 pain 101, 102 pneumococcal, radiograph 62, 63 respiratory rate 101,137 staphylococcal, radiograph 61-4 viral 61,62
pneumothorax 14,289
INDEX
tension 64 trocar and obstruction 51
poisoning 228-44 activated charcoal use 231, 232 aftercare 232 causes 228 emesis induction 231 gastric lavage 231 household products 240 identification 230 incidence and mortality 228 management 230 nonaccidental 258 observation 232 precautions 229 see also individual drugs and poisons
Poisons Information Service, UK centres 230
potassium loss in diabetic ketoacidosis 124,
129 in rehydration 87-9
Polter's syndrome 5, 14 prednisolone 161
dose in asthma 72-4 preterm infants, risks 18 procedures 273-94 prochlorperazine combination and
oculogyric crisis 229 prostaglandins in cyanosis 211
ductus patency 212 side effects 211,212
Pseudomonas aeruginosa 192 in infants 141
pulmonary hypoplasia 5 pyelonephritis 113 pyloric stenosis
test feed 95 treatment 95 and vomiting 94, 95
Ramstedt's operation 95 rash, purpuric 114, 115, 147 rehydration 83-5; see also dehydration renal failure, acute 198-201
325
catabolism prevention 201 classification 198 fluid balance 200 investigations 200
INDEX
renal failure~cont. management 20 I pre-and post - 198 urine features 199
respiration, fetal and maternal drugs 10 respiratory distress 21
assessment 74 bronchiolitis 59
respiratory failure epiglottitis 41 laryngotracheobronchitis 41
respiratory function assessment 57, 59 respiratory tract, congenital
malformations 5 respiratory tract infections, lower 55-
76 constitutional disturbances 55, 56 cough 68 epidemiology in infants 55-7 feeding 55 hypoxaemia 56 incidence 56 maternal smoking 56, 57 radiographs 56
resuscitaire 6 resuscitation, neonatal 1-19, 151,268,
269 anticipation, high risk deliveries
5,6 cardiorespiratory arrest 21-3 check list 7 delay and gasping 3 drugs 7,15,16 duration 19 equipment 5-7 failing, check list 14 heart rate 3,4,8,9, 14 informing parents 19 response in monkeys 4 sequence 9
retropharyngeal abscess 35, 38, 52 Reye's syndrome
cerebral oedema, management 184 clinical features 175, 176 liver function 175, 176 liver histology and fatty
infiltration 176, 177 mortality 177
rifampicin 151
salbutamol acute asthma 71, 72 dose in asthma 72 wheezing 70
salicylate overdose 123 clinical features 233, 234 serum levels 233, 234
Salmonella sp. abdominal pain 113 carrier and antibiotics 92 features of gastroenteritis 80
scalded skin syndrome (toxic epidermal necrolysis) 227, 228
synonyms 227 sedation 109
painful procedures 274 Shigella sp, features of
gastroenteritis 79,80 shock 187-94
aetiology, types 188, 189 anaphylaxis, causes and
treatment 193, 194 clinical signs 187 definition 187 and dehydration 81, 86 hypovolaemic 189-92; see also
hypovolaemia management 189 resuscitation 14, 17 septic, pathogens and
antibiotics 192, 193 symptoms and treatment 17, 187
smoking and infant respiratory tract infections 55
social worker nonaccidental injury 261,262 sudden infant death 270
sodium in rehydration 87 sodium bicarbonate, see bicarbonate sodium nitroprusside 180,191 spasms, infantile 159-62
associated disorders 160, 161 drug therapy 161, 162 electroencephalogram 159, 160
spironolactone 215 Staphylococcus spp. infections 56 Staphylococcus aureus 52, 146
antibiotics 65 pneumonia 61
326
INDEX
toxin and scalded skin syndrome 227,228
status epilepticus 167-70 management and drugs 168, 169
Still's disease (systemic juvenile chronic arthritis)
fever pattern 154 stools
features 77 red currant jelly 103 reducing substances 93
Streptococcus spp" group B, J1-haemolytic in infants 141
Streptococcus pneumoniae 150 Streptococcus pyogenes 146 stridor
causes 35, 52, 53 causes, acute and chronic 35, 36 congenital laryngeal 53 definition 35, 36 epiglottitis 42-8 foreign bodies 35,48-52 laryngotracheobronchitis 36-42 timing 36
subdural haemorrhage and coma 178, 179
radiograph and suture separation 178
subglottic stenosis 42 sudden infant death syndrome (cot
death) 263-71 age 263,265 autopsy findings 265,266 coroners role 268, 270 and disease 265 incidence 263 informing and managing
parents 268-'70 paediatrician and parents 270, 271 resuscitation 267,268 sibling risk 271 theories 265-7 ventilatory control 267
supraglottis 42 location 37
suprapubic aspiration of urine 292-4
tachypnoea and dehydration 81 terbutaline in acute asthma 71,72
tissue turgor and dehydration 81-3 tracheostomy
diptheria 53 epiglottitis 46 laryngotracheobronchitis 42
transposition of the great arteries 208, 209
trimeprazine 109 trunk, colour 3, 8 tuberose sclerosis, diagnosis and
depigmentation 161
urinary tract infection 147 antibiotics 202,203 baby 140, 141 clinical features 203 incidence 202 investigations 203,204 organisms 202 pain llO, 112, 1l3, 147 two year follow-up 205
urine data in renal failure 199 suprapubic aspiration 292-4
urogram 113, 203 hydronephrosis 113 vesicoureteric reflux 204
urticaria 56
vaccine neurological side effects 174, 175 pneumococcal 152, 153
ventilation bag and mask 10,23 mouth-to-mouth 23, ~4
ventricular fibrillation, defibrillation 31, 32
vesicoureteric reflux 203 ViruS
327
adenovirus 61, 62 bronchiolitis 58 encephalitis 173, 174 influenza 61,62 measles 36 parainfluenza 36,44,61,62 pneumonia 61 respiratory syncitial 58, 61, 62, 66 rhinovirus 61
virus-conI. rota virus and gastroenteritis 78-80
vocal cords and intubation 12, 13 vomIting 77,93·8, 103
appendicitis III bile 95 causes 93,94 congenital adrenal hypoplasia 97 failure to thrive, tests 93 Henoch-Schiinlein purpura 114 induced in poisoning 231 intestinal obstruction 94-6 management 93 reduction 83
INDEX
in rotavirus gastroenteritis 78 see also diarrhoea
Waterhouse-Friderichsen syndrome 148
wheezing age and asthma 69,70 causes in children 68-70 peanut choking 69
wheezy bronchitis antibiotics 70 and asthma 69,70
whooping cough 56 Wright peak flow meter 72, 73
328