One-Pager
Pediatric Vital Signs and Drug Doses for EMS
Normal vitals by age, the hypotension rule, length-based weight and common prehospital pediatric doses
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Pediatric vital signs by age for EMS
| Age | Pulse (awake) | Resp. rate | Systolic BP |
|---|---|---|---|
| Newborn | 100-205 | 30-60 | 67-84 |
| Up to 1 year | 100-190 | 30-60 | 72-104 |
| 1-2 years | 100-190 | 24-40 | 86-106 |
| 2-3 years | 98-140 | 24-40 | 86-106 |
| 3-4 years | 80-140 | 24-40 | 89-112 |
| 4-6 years | 75-140 | 22-34 | 89-112 |
| 6-10 years | 75-140 | 18-30 | 97-115 |
| 10-12 years | 75-118 | 18-30 | 102-120 |
| 12 years and older | 60-100 | 15-20 | 110-131 |
Estimating weight
- Use a length-based tape (or your agency's system) for any child who fits on it; it gives weight, doses and equipment sizes together.
- Treat patients up to about 40 kg or 14 years as pediatric for dosing; protocols vary.
- Tapes are least accurate in heavier and overweight children; use the actual weight if a reliable one is known.
- A weight-based dose should never exceed the adult maximum.
Common prehospital pediatric doses
| Drug | Use | Dose | Max |
|---|---|---|---|
| Epinephrine 1 mg/mL IM | Anaphylaxis | 0.15 mg under 25 kg; 0.3 mg 25 kg or more (0.01 mg/kg) | 0.3 mg; repeat q5-15 min |
| Epinephrine 0.1 mg/mL IV/IO | Cardiac arrest | 0.01 mg/kg (0.1 mL/kg) | 1 mg; q3-5 min |
| Dextrose | Glucose 60 mg/dL or less | 0.5-1 g/kg: D10 5-10 mL/kg (newborn 2 mL/kg) | Adult 25 g |
| Glucagon IM/IN | Low glucose, no IV | 0.5 mg under 20 kg; 1 mg 20 kg or more | 1 mg |
| Naloxone | Opioid overdose, slow breathing | 0.1 mg/kg IV, IM or IN | 2 mg IV/IM; 4 mg IN |
| Midazolam | Active seizure | 0.2 mg/kg IM or IN; 0.1 mg/kg IV/IO | 10 mg IM/IN; 4 mg IV |
| Fentanyl | Moderate to severe pain | 1 mcg/kg IN, IM, IV or IO | 100 mcg first dose |
| Adenosine | Stable SVT | 0.1 mg/kg rapid push, then 0.2 mg/kg | 6 mg, then 12 mg |
| Amiodarone | VF/pulseless VT | 5 mg/kg IV/IO | 300 mg |
| Isotonic fluid | Shock | 20 mL/kg bolus, reassess (10 mL/kg if cardiogenic) | 60 mL/kg, then call medical direction |
Worked example: a 15 kg child
- Arrest epinephrine: 0.01 x 15 = 0.15 mg = 1.5 mL of 0.1 mg/mL.
- Seizure midazolam IN: 0.2 x 15 = 3 mg.
- Dextrose 0.5 g/kg: 7.5 g = 75 mL of D10.
- Fluid bolus: 20 x 15 = 300 mL, then reassess.
- First shock: 2 x 15 = 30 J.
In depth
The one-page summary above is what the PDF prints. These sections go further.
Reading pediatric vitals
- Count respirations and pulse for a full 30 to 60 seconds; children breathe irregularly.
- Crying, fever and fear raise the pulse; compare with the child at rest.
- Bradycardia in a sick infant usually means low oxygen; ventilate first.
- A respiratory rate that falls without the child improving is a sign of tiring, not recovery.
Dextrose concentrations
Percent means grams per 100 mL: D10 has 10 g in 100 mL (0.1 g/mL), D25 has 25 g in 100 mL and D50 has 50 g in 100 mL. So 0.5 g/kg is 5 mL/kg of D10 or 2 mL/kg of D25. National guidance prefers D10 when available; D25 is listed for children over 8 years, and D50 is for adults.
More doses, with the cautions
- Oral glucose 0.5-1 g/kg only if the child is awake and can swallow.
- Nebulized epinephrine (1 mg/mL, 5 mL) is used for stridor in croup and anaphylaxis per protocol.
- IM epinephrine 0.01 mg/kg (max 0.3 mg) is an add-on for severe asthma near respiratory failure.
- Stable wide-complex tachycardia: amiodarone 5 mg/kg (max 150 mg) given slowly; NASEMSO says over 10 minutes and other guidelines over 20 to 60 minutes.
- Newborns in resuscitation: epinephrine 0.01 to 0.03 mg/kg IV/IO if the heart rate stays under 60 despite ventilation and compressions; volume 10 to 20 mL/kg for suspected blood loss (NASEMSO lists 20 mL/kg for shock).
Exam pearls
- Know the hypotension rule: 70 + 2 x age.
- Arrest epinephrine is 0.01 mg/kg; a tenfold error (0.1 mg/kg) is the classic pediatric mistake.
- Work out mg first, then mL; check the concentration on the label every time.
- Pediatric doses stop at the adult maximum.
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Calculators for this topic
Sources
- National Association of State EMS Officials. National Model EMS Clinical Guidelines, Version 3.0. March 2022. Universal Care (Table 1); Anaphylaxis; Hypoglycemia; Seizures; Pain Management; Tachycardia; Shock; Opioid Poisoning; Cardiac Arrest; Neonatal Resuscitation. Link
- Lee JE, Kim M, Choi EK, et al. Updated pediatric cardiopulmonary resuscitation: a comprehensive review of the 2025 guidelines. Anesth Pain Med (Seoul). 2026;21(2):150-161. Link
- Kim DK, Kim JT, Na JY, et al. 2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 8. Pediatric advanced life support. Clin Exp Emerg Med. 2026;13(Suppl 1):S115-S141. Link
- Heo JS, Jung YH, Kim AE, et al. 2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 9. Neonatal resuscitation. Clin Exp Emerg Med. 2026;13(Suppl 1):S142-S168. Link
- Singh TK, Khan K, Thomas SRJ. Accuracy of PAWPER XL tape in estimation of body weight in pediatric emergencies. Cureus. 2025;17(8):e89775. Link