Age-Banded Vitals, the 4-2-1 Rule and the Dose Ceiling
There is no single paediatric normal, and there is no paediatric dose that is simply a number. Read a set of observations against the right age band, then work maintenance fluid with the 4-2-1 rule and a resuscitation bolus beside it, then run a weight-based order and perform the step that is skipped most often — comparing it with the maximum adult dose.
Set up the child
Rates are for the awake, afebrile, uncrying child. Sleeping rates run lower, and every degree Celsius of fever adds roughly 10 beats a minute.
Weigh nappies as part of the other half of the ledger: 1 gram equals 1 millilitre.
Write the multiplication out so a second nurse can follow it, then say the maximum aloud. A heavy adolescent on a milligram-per-kilogram formula can generate a number no adult would ever receive.
Enter a set of observationsCompare against the band, never against an adult range
Waiting
Choose a mode on the left.
Every range, threshold and dose on this page is the chapter’s. When a calculated dose and a stated maximum disagree, the safe dose is the lower of the two and the discrepancy is documented and communicated.