What is the Broselow tape and how accurate is it?

The Broselow Pediatric Emergency Tape is a color-coded length-based weight estimation system developed in the 1980s and validated in multiple studies. It estimates weight from crown-heel length measurement while the child is supine. Studies show it predicts weight within 10% of actual weight in approximately 50 to 70% of normal-weight children, with accuracy decreasing significantly in obese children. For obese children, the Broselow tape consistently underestimates weight, which can result in underdosing. A modified estimate using the PAWPER tape or length-based estimation with an obesity correction factor may be more accurate in overweight pediatric patients.

Should I use the cuffed or uncuffed ET tube formula for children?

Current PALS guidelines and the [AAP/ACEP guidelines](https://publications.aap.org/pediatrics/article/142/6/e20182413/38605) support the use of cuffed endotracheal tubes for infants and children beyond the neonatal period, including in pre-hospital and emergency settings, when correct sizing is confirmed. Cuffed tubes allow for precise tidal volume delivery and reduce the need for tube exchange. The cuffed tube formula (Age/4 + 3.5) should be used when a cuffed tube is intended. Verify cuff inflation pressure with a manometer to avoid tracheal mucosal ischemia; keep pressure below 25 cmH2O.

How do I handle dosing for a child whose weight is unknown and who cannot be measured?

If neither scale weight nor Broselow measurement is available, use the age-based Luscombe-Owens formula as a last resort: weight (kg) = (0.176 × age in months) + 7.241 for children under 12 months, or (3 × age in years) + 7 for children 1 to 12 years. These formulas carry more estimation error than the Broselow tape and should only be used when no other option is available. Document the estimation method used in the medical record. Update all dosing calculations as soon as a measured weight is available.

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Pediatric Weight-Based Dosing Calculator

Calculate mg/kg dosing for common pediatric medications including amoxicillin, ibuprofen, acetaminophen, and more with weight/age inputs, liquid volume calculations, and maximum daily dose caps.

CRITICAL MEDICAL DISCLAIMER

This calculator is for educational and clinical reference only. Pediatric dosing requires independent verification by a licensed healthcare professional. Dose ranges vary by indication, patient age, renal/hepatic function, and institutional protocols. Incorrect pediatric dosing can cause serious injury or death. Always cross-reference with current drug references and follow institutional guidelines.

Patient and Medication Details

Patient Weight

Patient Age (years, optional)

Medication

Liquid Concentration (mg/mL) - optional

Enter mg per mL (e.g., 250 mg/5 mL = 50 mg/mL)

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Introduction

When a child arrives in the emergency department without a known weight, clinicians do not have the luxury of waiting for a scale. They estimate. The problem is that visual weight estimation by experienced providers is accurate within 10% only about half the time, and errors above 20% are common in children with atypical body habitus. The Broselow Pediatric Emergency Tape standardized the approach by using measured patient length as a weight proxy, a method validated across multicenter studies to reduce dosing errors during resuscitations. For non-emergency settings, this calculator performs the inverse: using an actual or estimated weight in kilograms to generate a full weight-based dosing reference table for the most commonly needed pediatric emergency drugs, resuscitation agents, IV fluid boluses, and equipment size estimates. This approach mirrors the functionality built into most pediatric resuscitation software (e.g., Peds Dosing Quick Reference, PedsEM) and is designed to support the charge nurse's pre-shift setup, the pediatric rapid sequence intubation (RSI) checklist, and the family medicine provider managing acutely ill children in under-resourced settings.

What This Calculator Does

This calculator takes a child's weight in kilograms (or length in centimeters for Broselow-based estimation) and generates a weight-based dosing reference for common pediatric emergency medications including epinephrine, atropine, adenosine, dextrose, fluid bolus volume, and selected RSI agents. It also outputs equipment size recommendations (ET tube size and depth, laryngoscope blade, NG tube, urinary catheter) using published pediatric sizing formulas. The output is a ready-to-use bedside reference card formatted for emergency use.

The Formula

Epinephrine (cardiac arrest): 0.01 mg/kg IV/IO (max 1 mg) | Atropine: 0.02 mg/kg IV (min 0.1 mg, max 0.5 mg child / 1 mg adolescent) | Dextrose 10%: 5 mL/kg IV (neonates 2 mL/kg D10W) | Normal Saline bolus: 20 mL/kg IV over 5-20 min | ET Tube size (uncuffed): (Age in years / 4) + 4 | Cuffed ET tube: (Age / 4) + 3.5 | ET tube insertion depth (cm): (Age / 2) + 12

Each formula produces a dose or size metric directly from patient weight (for drug doses) or age (for equipment). Drug doses are weight-based per published PALS (Pediatric Advanced Life Support) and ACLS guidelines, rounded at the manufacturer-recommended maximum doses. Equipment sizing formulas use age because anatomical airway dimensions correlate more consistently with age than weight. The ET tube depth formula estimates the lip-to-carina distance. All drug doses should be double-checked against the current PALS provider manual from the [American Heart Association](https://www.heart.org/en/cpr/resuscitation-science/pals) before use in a live resuscitation.

Step-by-Step Example

Obtain or estimate patient weight

Weigh the child if possible. For an unresponsive child where weighing is not practical, measure crown-heel length with the Broselow tape and enter the corresponding Broselow weight estimate in kilograms. Example: measured length 90 cm on Broselow tape corresponds to an estimated weight of approximately 13 kg (green zone). Enter 13 kg as the working weight.

Generate the emergency drug dose table

For a 13 kg child: Epinephrine (cardiac arrest) = 0.01 × 13 = 0.13 mg IV. Using 1:10,000 concentration (0.1 mg/mL): volume = 0.13 / 0.1 = 1.3 mL. Atropine = 0.02 × 13 = 0.26 mg, minimum 0.1 mg, maximum 0.5 mg (child). 0.26 mg falls within range; use 0.26 mg. Adenosine (SVT) = 0.1 mg/kg first dose = 1.3 mg. Second dose: 0.2 mg/kg = 2.6 mg. Maximum single dose: 6 mg.

Calculate fluid and glucose bolus volumes

Normal saline bolus: 20 × 13 = 260 mL. Administer over 5 to 20 minutes depending on clinical urgency. For septic shock, reassess after each 20 mL/kg bolus for fluid responsiveness. Dextrose for hypoglycemia: D10W = 5 × 13 = 65 mL; or D25W = 2 × 13 = 26 mL. Target blood glucose above 70 mg/dL. Recheck glucose 15 to 30 minutes after treatment.

Confirm equipment sizes

Age from weight estimate (Broselow 13 kg zone): approximately 3 to 4 years. ET tube uncuffed = (4/4) + 4 = 5.0 mm. ET tube cuffed = (4/4) + 3.5 = 4.5 mm. Insertion depth = (4/2) + 12 = 14 cm at the lip. Laryngoscope blade: size 2 straight (Miller) for children under 6. These are starting estimates; airway anatomy varies and visualization at laryngoscopy guides final tube selection.

Real-World Use Cases

Pediatric Resuscitation Preparation in a Non-Pediatric Hospital

A community hospital emergency department receives a pulseless 8-year-old (weight 25 kg) via ambulance. The charge nurse uses the calculator pre-arrival to prepare labeled syringes: epinephrine 0.25 mg (2.5 mL of 1:10,000), atropine 0.5 mg (max; 1 mL of 0.5 mg/mL), adenosine 2.5 mg (0.25 mL of 6 mg/2 mL). The prepared reference card with drug names, doses in mg, and volumes in mL for each available concentration is taped to the code cart before the patient arrives.

Rural Clinic Pre-Shift Pediatric Safety Setup

A nurse practitioner in a rural family medicine clinic sees pediatric patients up to age 12 and must be prepared to manage acute illness without immediate pediatric backup. Each morning, she runs the weight-based dosing table for the heaviest pediatric patient scheduled that day (example: 35 kg, age 10). She confirms epinephrine availability and concentration, checks the expiration date on the emergency drug kit, and reviews the ET tube and blade sizes for the patient weight range on her schedule.

EMS Protocol Reference for Pediatric Transport

Paramedics transporting a 6-year-old with status epilepticus (weight 20 kg) use the calculator to confirm midazolam IM dosing. Pediatric IM midazolam for status: 0.1 to 0.2 mg/kg IM, maximum 10 mg. Dose = 0.1 × 20 = 2 mg (conservative starting dose). Midazolam available: 5 mg/mL. Volume = 2 / 5 = 0.4 mL IM. The medic prepares a 1 mL syringe with 0.4 mL of 5 mg/mL midazolam and documents the calculation in the electronic patient care report before administration.

Comparison

Drug	Dose (mg/kg)	Max Dose	Common Concentration	Notes
Epinephrine (arrest)	0.01 mg/kg IV/IO	1 mg	1:10,000 (0.1 mg/mL)	Repeat every 3-5 min in pulseless arrest
Atropine (bradycardia)	0.02 mg/kg IV	0.5 mg child; 1 mg adolescent	0.1 mg/mL or 0.4 mg/mL	Minimum 0.1 mg to avoid paradoxical bradycardia
Adenosine (SVT)	0.1 mg/kg rapid IV push	6 mg first dose; 12 mg second	3 mg/mL	Flush with 5-10 mL NS immediately after dose
Dextrose (D10W, hypoglycemia)	5 mL/kg IV	Per glucose response	100 mg/mL (D10W)	Recheck glucose in 15-30 min
Normal Saline bolus	20 mL/kg IV	Reassess after each bolus	0.9% NaCl	Max 3 boluses before reassessing perfusion
Midazolam (seizure IM/IV)	0.1-0.2 mg/kg	10 mg	5 mg/mL IM; 1 mg/mL IV	Intranasal: 0.2 mg/kg, max 10 mg

Common Mistakes to Avoid

Using adult epinephrine concentration (1:1,000) instead of pediatric resuscitation concentration (1:10,000) for IV cardiac arrest dosing. Epinephrine 1:1,000 contains 1 mg/mL. Epinephrine 1:10,000 contains 0.1 mg/mL. For a 10 kg child needing 0.1 mg, the correct volume from 1:10,000 is 1 mL. Using 1:1,000 and drawing 1 mL delivers 1 mg, a 10-fold overdose. PALS cardiac arrest protocol specifies 0.01 mg/kg using the 1:10,000 concentration for IV/IO administration.
Applying the cuffed ET tube formula when an uncuffed tube is intended, or vice versa. Uncuffed tubes are 0.5 mm larger than cuffed tubes at the same calculated size. A cuffed 4.5 mm tube and an uncuffed 5.0 mm tube are both appropriate for the same airway; however, using the uncuffed formula and selecting a cuffed tube of that size will result in a tube that is 0.5 mm too large, increasing the risk of post-intubation subglottic injury. Confirm the tube type on the packaging before insertion.
Failing to recheck the estimated weight after resuscitation stabilization. Broselow and visual estimates are working estimates for the first minutes of a resuscitation. Once the patient is stabilized, obtain an actual scale weight if possible and recalculate all ongoing medication doses (vasopressors, antibiotics, anticonvulsants) using the measured weight. Continuing to use a Broselow estimate for a patient who is 20% heavier than estimated will result in systematic underdosing for the remainder of the hospital course.

Frequently Asked Questions

Accuracy and Disclaimer

This calculator provides weight-based pediatric emergency dosing and equipment size estimates for educational and reference purposes. All doses must be verified against the current AHA PALS provider manual, AAP publications, and your institution's formulary before use in patient care. Pediatric emergency dosing requires clinical judgment, team communication, and real-time response assessment that no calculator can replace. This tool is intended to support licensed healthcare professionals in preparation and planning, not as a sole reference during an active resuscitation. Errors in emergency drug dosing can be life-threatening; always obtain an independent second check before administering emergency medications to pediatric patients.

Conclusion

Pediatric emergency dosing calculations under time pressure are where errors occur most frequently. Generating the full dosing table before a resuscitation, during triage, or at shift start eliminates the need to calculate under acute stress. Print or save the output before you need it. For the medication volume calculations once doses are confirmed, use the Pediatric Dosage Calculator to compute specific volumes from available drug concentrations. For IV infusion rates of vasoactive agents in the pediatric ICU, use the IV Flow Rate Calculator for weight-based mcg/kg/min-to-mL/hr conversion.

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