Medications · Children's Nursing · Premium

Y1 Paediatric Medications Guide

The paediatric meds basics for first year: common drugs and doses, weight-based calculations with worked examples, high-risk medications and why they matter, and what examiners look for in a medicines management OSCE.

Children's nursing · Meds & Calculations · The Nurse Lab

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Student note

Medication errors are the most common cause of serious harm in paediatric nursing. This is not meant to scare you — it is meant to make you slow down, check twice, and always use the BNFC. Confidence in meds comes from doing the process correctly every time, not from doing it quickly.

Always weight-based

Every paediatric dose is calculated per kilogram. Use the most recent weight, measured in kg, before any calculation.

BNFC is your reference

The British National Formulary for Children is the definitive source. Check it every time — do not rely on memory for paediatric doses.

Double-check always

Two people must independently check high-risk medications. Never skip the second check because you are busy or confident.

Therapeutic window is narrow

Children have less margin for error than adults. A small miscalculation in a neonate can cause serious harm. Work slowly and precisely.

Common Paediatric Medications

What are the drugs you will see most on placement?

Analgesia

Paracetamol: 15 mg/kg every 4–6 h (max 4 doses/24 h)
Ibuprofen: 5–10 mg/kg every 6–8 h (max 30 mg/kg/24 h)
Avoid ibuprofen under 3 months, asthma, or dehydration
Morphine: 0.1–0.2 mg/kg — titrate carefully, monitor resp rate

Antibiotics

Amoxicillin: 30–50 mg/kg/day in 3 divided doses
Co-amoxiclav: 30 mg/kg/day (amoxicillin component)
Gentamicin: dose and interval depend on age/weight/renal — always check BNFC
Metronidazole: 7.5 mg/kg three times daily

Respiratory

Salbutamol inhaler: 1–2 puffs (100 mcg each) via spacer
Salbutamol nebuliser: 2.5 mg (<5 years), 5 mg (≥5 years)
Prednisolone: 1–2 mg/kg/day (max 40 mg) for acute asthma
Ipratropium: added to salbutamol in severe wheeze

Fluids & other

Oral rehydration: 50 ml/kg over 4 h for mild dehydration
IV maintenance (Holliday-Segar): 100 ml/kg/day for first 10 kg
Dextrose: 2 ml/kg of 10% for hypoglycaemia (<2.6 mmol/L)
Adrenaline IM (anaphylaxis): 0.01 mg/kg (max 0.5 mg)

Clinical pearl

Always use oral syringes (not spoons) for liquid medicines in children. Spoon measurements are inaccurate. For neonates, draw up in a 1 ml syringe for precision.

Drug Calculations

The formulas and worked examples for paediatric meds.

Basic formula

What you want ÷ What you have × Volume
Example: need 250 mg, have 500 mg in 10 ml
= 250 ÷ 500 × 10 = 5 ml
Write units clearly at every step
Never round mid-calculation — round at the end

Weight-based

Dose (mg/kg) × weight (kg) = total dose (mg)
Example: 15 mg/kg paracetamol for 12 kg child
= 15 × 12 = 180 mg
Always verify the weight is recent and accurate
Max dose caps apply — check BNFC

IV rate (ml/hr)

Volume (ml) ÷ Time (hours) = rate (ml/hr)
Example: 100 ml over 4 hours
= 100 ÷ 4 = 25 ml/hr
Most pumps take ml/hr — confirm with device

Infusion & drips

Drip rate (drops/min): Volume × drop factor ÷ time (min)
Standard giving set: 20 drops/ml
Paediatric giving set: 60 drops/ml (microdrip)
Example: 120 ml over 60 min, 20 drop factor
= 120 × 20 ÷ 60 = 40 drops/min

Clinical pearl

Unit conversions cause the most errors. 1 g = 1000 mg. 1 mg = 1000 mcg. If a calculated dose looks unusually large or small for a child, stop and recheck before giving anything.

High-Risk Medications

Which drugs need the most care, and why?

Insulin

Risk of hypoglycaemia — double-check dose and route
Units must be written in full, not abbreviated "U" (misread as 0)
Never drawn up in a standard syringe — use insulin syringe only
Blood glucose check before and after administration

Opioids

Morphine: risk of respiratory depression
Titrate slowly — start at lowest effective dose
Monitor respiratory rate closely after each dose
Naloxone must be available and staff must know how to use it
Constipation is near-universal — always prescribe a laxative

Aminoglycosides

Gentamicin: nephrotoxic and ototoxic
Dosing depends on age, weight, and renal function
Drug levels must be checked (trough before dose, peak after)
Dose interval extended in neonates and renal impairment
Always check BNFC — do not estimate

IV fluids

Risk of fluid overload, hyponatraemia, or hypernatraemia
Calculate maintenance requirements carefully (Holliday-Segar)
0.9% saline + 5% glucose most common maintenance solution
Boluses: 10 ml/kg (not adult 250 ml) — reassess after each
Strict fluid balance chart mandatory

Never do this

Insulin in wrong syringeOpioid without resp monitoringGentamicin without levelsIV bolus at adult doseUnits abbreviated as "U"

Medicines Management OSCE

What do examiners actually look for?

Before you start

Wash hands — both at the start and the end
Check the prescription: name, DOB, drug, dose, route, time
Check allergies — even for familiar drugs
Check expiry date and integrity of packaging
Ask about swallowing ability before giving oral medication

9 Rights check

Right patient — ID band, state name and DOB
Right drug — check prescription and indication
Right dose — calculate if needed, check appropriateness
Right route — oral, IV, IM, SC, topical
Right time — frequency and when last given
Right documentation — sign after administration
Right reason, right response, right to refuse

Calculations in OSCE

Talk through your process out loud — examiners mark what they hear
Write the formula, the substitution, and the answer
Check your answer makes clinical sense
State the answer with units: "I would give 5 ml"
If unsure, say so and ask for a second check

Common mistakes

Not checking allergies for "simple" drugs like paracetamol
Leaving medications unattended at the bedside
Decimal errors: write "1 mg" not "1.0 mg"
Crushing modified-release tablets
Not documenting after administration
Failing to acknowledge an error if spotted

Never do this

Not checking allergiesSkipping the second checkerDecimal point errorGiving without documentingCrushing modified-release tablet

Clinical pearl

If you make a mistake in an OSCE, acknowledge it clearly: "I have identified an error — I would stop, inform the senior nurse, and complete an incident report." Examiners mark professional response to error, not just error-free performance.

Safety, Consent & Documentation

What wraps around every medicines administration?

Consent

Children under 16 may have Gillick competence to consent to medication
Parental consent usually needed under 16 if not Gillick competent
Parents can refuse treatment — escalate if this puts the child at risk
Document consent discussions clearly

Covert administration

Giving medication hidden in food without the patient's knowledge
Only permitted if the patient lacks capacity AND it is in their best interests
Requires a best interests decision and MDT agreement
Must be documented fully — never done informally

Documentation

Sign the drug chart immediately after administration — never before
Record dose given, route, time, and batch number for vaccines
Document refusals and reasons
Record any adverse reactions and report via datix/incident form
Controlled drugs: two signatures always required

Error management

If you make a medication error, tell a senior immediately
Complete an incident report (datix or local equivalent)
Monitor the patient for any adverse effects
Be honest — covering up an error is a serious professional breach
Reflect: what led to the error and what would prevent recurrence

Clinical pearl

Controlled drugs must be counted and signed by two registered practitioners at every administration and at every shift handover. The CD register and the patient's drug chart must both be completed before the CD cupboard is locked.

Quick Reference: Common Doses

Drug	Route	Dose	Frequency	Key safety point
Paracetamol	Oral / IV / PR	15 mg/kg	Every 4–6 h (max 4 doses/24 h)	Check weight; IV dose differs from oral in neonates
Ibuprofen	Oral	5–10 mg/kg	Every 6–8 h (max 30 mg/kg/24 h)	Avoid <3 months, asthma, dehydration, renal impairment
Amoxicillin	Oral / IV	30–50 mg/kg/day	3 divided doses	Penicillin allergy — always check
Salbutamol	Inhaler / nebuliser	2–10 puffs or 2.5–5 mg	As needed / every 20–30 min in acute wheeze	Spacer device for inhaler in children <8 years
Prednisolone	Oral	1–2 mg/kg/day (max 40 mg)	Once daily for 3–5 days	Not for routine mild asthma — for acute exacerbation
Morphine	Oral / IV / SC	0.1–0.2 mg/kg	Every 4 h (IR) — titrate	Monitor respiratory rate; have naloxone available
Adrenaline (anaphylaxis)	IM (anterolateral thigh)	0.01 mg/kg (max 0.5 mg)	Repeat after 5 min if no response	Always IM — never IV unless experienced team
Oral rehydration	Oral	50 ml/kg over 4 h (mild); 100 ml/kg (moderate)	Continuous sips	NG route if unable to tolerate oral

Always verify

Doses in this guide are for reference only. Always check the current edition of the BNFC before prescribing or administering any paediatric medication. Local guidelines may differ.

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Medications · Children's Nursing · Premium

Y1 Paediatric Medications Guide

Children's nursing · Meds & Calculations · The Nurse Lab

Save for later

Student note

Always weight-based

Every paediatric dose is calculated per kilogram. Use the most recent weight, measured in kg, before any calculation.

BNFC is your reference

The British National Formulary for Children is the definitive source. Check it every time — do not rely on memory for paediatric doses.

Double-check always

Two people must independently check high-risk medications. Never skip the second check because you are busy or confident.

Therapeutic window is narrow

Children have less margin for error than adults. A small miscalculation in a neonate can cause serious harm. Work slowly and precisely.

Common Paediatric Medications

What are the drugs you will see most on placement?

Analgesia

Paracetamol: 15 mg/kg every 4–6 h (max 4 doses/24 h)
Ibuprofen: 5–10 mg/kg every 6–8 h (max 30 mg/kg/24 h)
Avoid ibuprofen under 3 months, asthma, or dehydration
Morphine: 0.1–0.2 mg/kg — titrate carefully, monitor resp rate

Antibiotics

Amoxicillin: 30–50 mg/kg/day in 3 divided doses
Co-amoxiclav: 30 mg/kg/day (amoxicillin component)
Gentamicin: dose and interval depend on age/weight/renal — always check BNFC
Metronidazole: 7.5 mg/kg three times daily

Respiratory

Salbutamol inhaler: 1–2 puffs (100 mcg each) via spacer
Salbutamol nebuliser: 2.5 mg (<5 years), 5 mg (≥5 years)
Prednisolone: 1–2 mg/kg/day (max 40 mg) for acute asthma
Ipratropium: added to salbutamol in severe wheeze

Fluids & other

Oral rehydration: 50 ml/kg over 4 h for mild dehydration
IV maintenance (Holliday-Segar): 100 ml/kg/day for first 10 kg
Dextrose: 2 ml/kg of 10% for hypoglycaemia (<2.6 mmol/L)
Adrenaline IM (anaphylaxis): 0.01 mg/kg (max 0.5 mg)

Clinical pearl

Always use oral syringes (not spoons) for liquid medicines in children. Spoon measurements are inaccurate. For neonates, draw up in a 1 ml syringe for precision.

Drug Calculations

The formulas and worked examples for paediatric meds.

Basic formula

What you want ÷ What you have × Volume
Example: need 250 mg, have 500 mg in 10 ml
= 250 ÷ 500 × 10 = 5 ml
Write units clearly at every step
Never round mid-calculation — round at the end

Weight-based

Dose (mg/kg) × weight (kg) = total dose (mg)
Example: 15 mg/kg paracetamol for 12 kg child
= 15 × 12 = 180 mg
Always verify the weight is recent and accurate
Max dose caps apply — check BNFC

IV rate (ml/hr)

Volume (ml) ÷ Time (hours) = rate (ml/hr)
Example: 100 ml over 4 hours
= 100 ÷ 4 = 25 ml/hr
Most pumps take ml/hr — confirm with device

Infusion & drips

Drip rate (drops/min): Volume × drop factor ÷ time (min)
Standard giving set: 20 drops/ml
Paediatric giving set: 60 drops/ml (microdrip)
Example: 120 ml over 60 min, 20 drop factor
= 120 × 20 ÷ 60 = 40 drops/min

Clinical pearl

Unit conversions cause the most errors. 1 g = 1000 mg. 1 mg = 1000 mcg. If a calculated dose looks unusually large or small for a child, stop and recheck before giving anything.

High-Risk Medications

Which drugs need the most care, and why?

Insulin

Risk of hypoglycaemia — double-check dose and route
Units must be written in full, not abbreviated "U" (misread as 0)
Never drawn up in a standard syringe — use insulin syringe only
Blood glucose check before and after administration

Opioids

Morphine: risk of respiratory depression
Titrate slowly — start at lowest effective dose
Monitor respiratory rate closely after each dose
Naloxone must be available and staff must know how to use it
Constipation is near-universal — always prescribe a laxative

Aminoglycosides

Gentamicin: nephrotoxic and ototoxic
Dosing depends on age, weight, and renal function
Drug levels must be checked (trough before dose, peak after)
Dose interval extended in neonates and renal impairment
Always check BNFC — do not estimate

IV fluids

Risk of fluid overload, hyponatraemia, or hypernatraemia
Calculate maintenance requirements carefully (Holliday-Segar)
0.9% saline + 5% glucose most common maintenance solution
Boluses: 10 ml/kg (not adult 250 ml) — reassess after each
Strict fluid balance chart mandatory

Never do this

Insulin in wrong syringeOpioid without resp monitoringGentamicin without levelsIV bolus at adult doseUnits abbreviated as "U"

Medicines Management OSCE

What do examiners actually look for?

Before you start

Wash hands — both at the start and the end
Check the prescription: name, DOB, drug, dose, route, time
Check allergies — even for familiar drugs
Check expiry date and integrity of packaging
Ask about swallowing ability before giving oral medication

9 Rights check

Right patient — ID band, state name and DOB
Right drug — check prescription and indication
Right dose — calculate if needed, check appropriateness
Right route — oral, IV, IM, SC, topical
Right time — frequency and when last given
Right documentation — sign after administration
Right reason, right response, right to refuse

Calculations in OSCE

Talk through your process out loud — examiners mark what they hear
Write the formula, the substitution, and the answer
Check your answer makes clinical sense
State the answer with units: "I would give 5 ml"
If unsure, say so and ask for a second check

Common mistakes

Not checking allergies for "simple" drugs like paracetamol
Leaving medications unattended at the bedside
Decimal errors: write "1 mg" not "1.0 mg"
Crushing modified-release tablets
Not documenting after administration
Failing to acknowledge an error if spotted

Never do this

Not checking allergiesSkipping the second checkerDecimal point errorGiving without documentingCrushing modified-release tablet

Clinical pearl

Safety, Consent & Documentation

What wraps around every medicines administration?

Consent

Children under 16 may have Gillick competence to consent to medication
Parental consent usually needed under 16 if not Gillick competent
Parents can refuse treatment — escalate if this puts the child at risk
Document consent discussions clearly

Covert administration

Giving medication hidden in food without the patient's knowledge
Only permitted if the patient lacks capacity AND it is in their best interests
Requires a best interests decision and MDT agreement
Must be documented fully — never done informally

Documentation

Sign the drug chart immediately after administration — never before
Record dose given, route, time, and batch number for vaccines
Document refusals and reasons
Record any adverse reactions and report via datix/incident form
Controlled drugs: two signatures always required

Error management

If you make a medication error, tell a senior immediately
Complete an incident report (datix or local equivalent)
Monitor the patient for any adverse effects
Be honest — covering up an error is a serious professional breach
Reflect: what led to the error and what would prevent recurrence

Clinical pearl

Quick Reference: Common Doses

Drug	Route	Dose	Frequency	Key safety point
Paracetamol	Oral / IV / PR	15 mg/kg	Every 4–6 h (max 4 doses/24 h)	Check weight; IV dose differs from oral in neonates
Ibuprofen	Oral	5–10 mg/kg	Every 6–8 h (max 30 mg/kg/24 h)	Avoid <3 months, asthma, dehydration, renal impairment
Amoxicillin	Oral / IV	30–50 mg/kg/day	3 divided doses	Penicillin allergy — always check
Salbutamol	Inhaler / nebuliser	2–10 puffs or 2.5–5 mg	As needed / every 20–30 min in acute wheeze	Spacer device for inhaler in children <8 years
Prednisolone	Oral	1–2 mg/kg/day (max 40 mg)	Once daily for 3–5 days	Not for routine mild asthma — for acute exacerbation
Morphine	Oral / IV / SC	0.1–0.2 mg/kg	Every 4 h (IR) — titrate	Monitor respiratory rate; have naloxone available
Adrenaline (anaphylaxis)	IM (anterolateral thigh)	0.01 mg/kg (max 0.5 mg)	Repeat after 5 min if no response	Always IM — never IV unless experienced team
Oral rehydration	Oral	50 ml/kg over 4 h (mild); 100 ml/kg (moderate)	Continuous sips	NG route if unable to tolerate oral

Always verify

Doses in this guide are for reference only. Always check the current edition of the BNFC before prescribing or administering any paediatric medication. Local guidelines may differ.