“Basic Paediatrics”

for Young Doctors

Compiled by:
Dr. Hammad Muhammad
Dr. Talat Mahmood
Dr. Hameed Ullah
Dr. Muhammad Shahan Jan

Khyber Medical College Batch of 2019

House Officers, KTH Peshawar 2019-2020

Reviewed by:
Dr. Afzal Ahmad
Registrar, Children B Ward
KTH Peshawar
Basic Paediatrics Hammad Muhammad

(Errors and omissions excepted. For any suggestions contact:

[email protected])

ESTIMATIING WEIGHT: (in Kg)

 <1 Year = (Age in months + 9)/2
 1 to 6 Years = 2 * (Age in years + 5) 1-6yr=(age*2)+8
 >6 Years = 4 * Age in years 7-12yr=(age*7)-5 all decided by 2

CONVERTING DOSE:

(From mg/Kg to ml)

Dose in ml = (Weight in Kg * Dose in mg/Kg) / Strength

per day VS per dose

For some drugs (e.g. Antibiotics), the dose is calculated as mg /day or ml /day, and then either
given as a single dose daily or divided into 2, 3, or even 4 doses.

While for other drugs, the dose is calculated as mg /dose or ml /dose. So it is not divided and
the amount is given at every dose.

Keep this fact in mind while memorizing the doses.

Basic Paediatrics Hammad Muhammad

ANTIBIOTICS:
(The format is as follow)

 ANTIBIOTIC:
(Brand names)
Dose in mg
Strength = Dose in ml

(Compare the dose in ml of Co-amoxiclav, Amoxicillin, Cefaclor & Ciprofloxacin)

(Similarly compare Cefixime, Azithromycin & Cepfodoxime)

1. CO-AMOXICLAV:
(Susp. Augmentin, Amclav, Calamox)
Dose: 30mg /Kg /Day in 2 or 3 divided doses (80-90mg /Kg /Day in Otitis Media)
Plain: 156.25mg /5ml = 1ml /Kg /Day
DS: 312.50mg /5ml = 0.5ml /Kg /Day
BD: 457mg /5ml = 0.3ml /Kg /Day
Drops: 62.5mg /ml

2. AMOXICILLIN: 125 and 250

(Susp. Amoxil, Ospamox)
30mg /Kg /Day (upto 90mg /Kg /Day) in 2 or 3 divided doses
125mg /5ml = 1ml /Kg /Day
250mg /5ml = 0.5ml /Kg /Day

3. CEFIXIME: 100 and 200

(Susp. Magnett, Cefim, Cefspan)
10mg /Kg /Day (Once Daily) (2x dose in Enteric Fever)
Plain = 100mg /5ml = 0.5ml /Kg /Day
DS = 200mg /5ml = 0.25ml /Kg /Day

4. CLARITHROMYCIN: 125 and 250

(Susp. Claritek, Rithmo, Klaricid)
15mg /Kg /Day given in 2 divided doses
Plain = 125ml /5ml = 0.6ml /Kg /Day
DS = 250ml /5ml = 0.3ml /Kg /Day
Basic Paediatrics Hammad Muhammad

5. AZITHROMYCIN: 200
(Susp. Azomax)
10mg /Kg /Day (2x dose in Typhoid)
200mg /5ml = 0.25ml /Kg /Day

6. CEFPODOXIME: 40
(Susp. Orelox)
10mg /Kg /Day OD or BD
40mg /5ml = 0.25ml /Kg /Day 1.25 ml/kg/day
7. FOSFOMYCIN: 250 and 500
(Susp. Focin)
100-200mg /Kg /Day in 3 or 4 divided doses
250mg /5ml = 2-4ml /Kg /Day
500mg /5ml = 1-2ml /Kg /Day

8. CIPROFLOXACIN: 125 and 250

(Susp. Novidat, Cipesta,)
20-30mg /Kg /Day
125mg /5ml = 1ml /Kg /Day
250mg /5ml = 0.5ml /Kg /Day

9. CEFACLOR: 125 and 250

(Susp. Ceclor)
20-40mg /Kg /Day divided into 3 equal doses
125mg /5ml = 1ml /Kg /Day (calculated by taking 25mg /Kg /Day)
187mg /5ml = 0.67ml /Kg /Day
250mg /5ml = 0.5ml /Kg /Day
50mg /ml Drops

10. CEFUROXIME 125 and 250

(Susp. Zinacef)
20-30mg /Kg /Day divided into two equal doses
125mg /5ml = 1ml /Kg /Day (calculated by taking 25mg /Kg /Day)
Basic Paediatrics Hammad Muhammad

11. CEPHRADINE: 125 and 250

(Susp. Velosef)
50-100mg /Kg /Day *TDS
125mg /5ml = 2ml /Kg /Day
250mg /5ml = 1ml /Kg /Day

12. METRONIDAZOLE: 200

(Susp. Flagyl, Entamizole)
35-50mg /Kg /Day in 3 divided doses
Syp. Flagyl 200mg /5ml = 0.25ml /Kg /Dose (Calculated by taking 40mg /Kg /Day)
Syp. Entamizole = 0.5ml /Kg /Dose

13. ANTI-HELMINTHICS:

 Syp. Vermox/ Tab. Vermox (Mebendazole)

(Should not be given in less than 2 years of age)
(Same dose for adults and children over 2 years)
1 TSF or 1 Tablet BD for 3 days

 Syp. Zentel (Albdenazole)

1 TSF stat in age 1-3 years
2 TSF stat in age more than 3 years

 Syp. Ketress (Levimasole) : 40mg /5ml

<2 years : 5ml stat (=1 TSF)
>2 years : 10ml stat (=2TSF)
Older : 15ml stat (i.e. Full bottle)
Basic Paediatrics Hammad Muhammad

0.5ml /Kg /Dose

These drugs have a dose of 0.5ml /Kg /Dose:
1. Syp. Calpol/ Panadol
2. Syp. Brufen
3. Syp. Entamizole

0.25 ml /Kg /Dose

These drugs have a dose of 0.25ml /Kg /Dose:

1. Anti-allergics (e.g. Syp. Rigix, Tempramine, Zyrtec, Lorin-NSA)
2. Anti-Tussives (e.g. Syp. Acefyl, Coferb, Ofylin, Britanyl, Combinol Junior)
3. Syp. Motilium/ Gravinate
4. Syp. Flagyl
5. Syp. Calpol 6-Plus
6. Syp. Brufen DS

Note:
a. Syp. Tempramine also have Paracetamol, in addition to Chlorpheniramine
b. Syp. Acefyl Cough and Brophyl-D are both anti-allergic and anti-tussive while
Syp. Acefyl, without the cough in it, is just anti-tussive

0.1ml /Kg /Dose

1. Muconyl Expectorant
Basic Paediatrics Hammad Muhammad

MULTI-VTIAMINS
1. IRON:
Dose is 5mg /Kg /Day
 Syp. Bisleri /Maltofer /Ferricure: Strength = 50mg /5ml, Dose = 0.5ml /Kg *OD
 Syp. Iron one: Strength = 100mg /5ml, Dose = 0.25ml /Kg *OD

2. SYP. CALCIUM-P
Infants = ¼ to ½ TSF
Children <6 Years = ½ TSF
>6 Years = 1TSF

3. SYP. VIDAYLIN, EPLACHERRY, LYSOVIT, TRES-ORIX, TRIMETABOL

Dose similar to Calicum-P

4. SYP. ZINCAT-OD
½ TSF if age is less than 1 year
1 TSF if age is more than 1 year
(Given in Acute Gastroenteritis for 14 days)
(Don’t give if there is active vomiting. Start after vomiting subsides)

ORAL REHYDRATION
1. LOW OSMOLAR ORS: This is the type of ORS used in Paediatrics.
To be made in 2 glasses of water in contrast to 4 glasses in the normal ORS.
2. PEDIALYTE: Available as readymade

FORMULA MILK
<6 Months: Lactogen 1 or Morinaga BF-1 or Meiji 1/FM-T

6 Months to 1 Year : Lactogen 2 or Morinaga BF-2 or Meiji 2/FU

>1 Year : Lactogen 3 or Morinaga BF-3 or Meiji 3/BIG

In case of Lactose Intolerance : Meigi Lactoless or Morinaga NL-33

For Premature Babies: PreLactogen or Morinaga BF-P or Meiji PRE

Basic Paediatrics Hammad Muhammad

NASAL BLOCKADE
1. NORSALINE/ SALINASE Nasal Drops:
Given in less than 6 years of age
2 drops QID in both nostrils

2. XYNOSINE:
In greater than 6 years of age
2drops QID for 3 days

3. XYNOSIN-CF:
(CF = Children’s Formula)

ORAL TOPICALS DRUGS

1. Nilstat Oral Drops (for Oral Trush)
2. Somogel
3. Daktarin Oral gel (for Oral Thrush)
4. Kenalog Ointment (for apthous ulcers)
5. Solophar spray (antibacterial, antifungal, antiviral) (Expensive but
very effective in severe cases)

DRUGS FOR ABDOMINAL PAIN

1. Colo-rest/ Colic Drops:
Infants: 5-10 drops *BD

2. Spasler-P
1 Month to 2 Years : 0.3-0.5mg = 0.3-0.5ml /dose *TDS
2 Years to 5 Years : 1 TSF *TDS
>5 Years : 2 TSF *TDS

3. Syp. Bonnisan
<1 month = ½ TSF TDS
1-6 months = 1 TSF
>6 months = 2TSF

4. Syp. Digex MP
<6 Years = ½ to 1 TSF
>6 Years = 1 to 2 TSF
Basic Paediatrics Hammad Muhammad

DRUGS USED FOR CONSTIPATION

1. Skilax Drops:
2-5 Drops at bed time

2. Syp. Prulax Jr.

<6 Years = ½ to 1 TSF
>6 Years = 1 to 2 TSF

3. Glycerine Suppositories
1 per rectal

4. Micro Enema
Half to full per rectal

5. Syp. Duphalac
6 months to 1 Year = ½ TSF per dose
1-6 Years = 1 TSF
>6 Years = 2 TSF

6. Movicol Sachet (13.8g per sachet)

1.5g /Kg for 3 days *OD then
0.7g /Kg for 1 month *OD

PROBIOTICS
1. Enterogerminna ampule
2. Smecta/ Gutcare sachet

NAPPY RASH
1. Rashnil Cream
2. Hydrozole Cream
3. Canesten Cream

ORAL STEROID
Prednisolone:
(Syp. Steron)
a. 1 Month to 11 Years: 2mg /Kg *OD (Max. per dose = 60mg)
b. 12 Years to 17 Years: 40-50mg daily
Basic Paediatrics Hammad Muhammad

ANTI-MALARIALS

1. ARTEMETHER + LUMIFANTRINE
(Susp. & Tab. Gen-M, Arceva, Artem, Artheget)
Dose according to weight is as follow:
 <10 Kg
Susp. Gen-M 15/90 mg/5ml = 1.4ml /Kg /Day in 2 divided doses for 3 days

 10-15 Kg
Susp. Gen-M DS 30/180 mg /5ml = 0.7ml /Kg /Day in 2 divided dose for 3
days

 15-20 Kg
Tab. Gen-M 20/120 mg = 1 Tablet BD for 3 days

 20-25 Kg
Tab. Gen-M 20/120 mg = 1 ½ Tablets BD for 3 days

 25-30 Kg
Tab. Gen-M 40/240 mg = 1 Tablet BD for 3 days

 30-35 Kg
Tab. Gen-M 40/240 = 1 ½ Tablets BD for 3 days

 >35 Kg
Tab. Gen-M 80/480 = 1 Tablet BD for 3 days

2. PRIMAQUINE: (Tab. Primaquine 7.5 & 14mg)

Before prescribing Primaquine, must do G6PD levels especially in males.
 If G6PD levels are normal
Tab. Primaquine = 0.3-0.5mg /Kg /Day for 14 days

 If G6PD mild +ve

Same as for normal but explain warning signs

 If G6PD moderate to severe +ve

Give Primaquine once a week for 2 months = 8 weeks and explain
alarming signs
Basic Paediatrics Hammad Muhammad

NEBULIZATION
1. VENTOLIN (SALBUTAMOL)
a. 1 Month to 4 Years: 0.5cc in 1cc N/Saline until fumes disappears
b. > 4 Years: 1cc in 2cc N/Saline

2. ATEM/IPNEB (IPRATROPIUM)
a. 1 Month to 5 Years: 0.5cc in 0.5cc N/Saline
b. 6 Years to 11 Years: 1cc in 1cc N/Saline
c. >11 Years: 2cc in 1cc N/Saline

(1cc = 16 to 20 drops)

DROPS
1. PANADOL Drops:
½ to 1 Dropper

2. Skilax/ Colic /Colorest Drops:

(Mentioned in the respective topics)

3. INVENTIVE Drops: (For non-productive cough)

<6 months: ½ dropper *TDS
>6 months: 1 dropper *TDS

4. COLOBID Drops: (For Lactose Intolerance)

5 drops before each feed

5. VITAMIN D Drops: (e.g. D max drops)

1 drop daily (As a prophylactic dose in neonates against its deficiency)
Basic Paediatrics Hammad Muhammad

COMMON EMERGENCY DRUGS

 Inf. Provas (Paracetamol)
1.5ml /Kg (Voltral suppositories are also very effective in controlling fever)

 Inj. Toradol
1mg /Kg (Strength: 10mg/ml & 30mg/ml)

 Inj. Onset (Ondansetron)

0.06 to 0.1 ml /Kg

 Inj. Gravinate (Dimenhydrinate)

0.06 ml /Kg

 Inj. Solu Cortef (Hydrocortisone)

Strength = 100mg /2ml, 250mg /2ml, 500mg /2ml
Dose = 4mg/Kg (Max. per dose = 100mg)

 Inj. Avil (Pheniramine)

0.06ml /Kg
 Inj. Decadron (Dexamethasone)
0.06ml /Kg

 Inj. Dormicum (Midazolam)

0.1ml /Kg
 Inj. Valium (Diazepam)
0.06ml /Kg

 Tab. Diazepam (per rectal)

0.2 to 0.25 mg /Kg

 Inj. Transamine (Tranexamic Acid)

10 to 20 mg /Kg

 Inj. Aminophylline
Loading Dose = 5mg /Kg = 0.2cc /Kg *stat (Maximum per dose 500mg)
(Dilute 1mg per 1ml N/Saline in 30 mins)
Maintenace Dose = 2.5mg /Kg /Dose = 0.1cc /Kg /Dose *BD
Basic Paediatrics Hammad Muhammad

FLUID RESUSCITAION IN SEVERE DEHYDRATION:

Bolus/ Loading Dose

a. 10% Dehydration = 100ml /Kg
b. 7% Dehydration = 70ml /Kg
c. 5% Dehydration = 50ml /Kg

 Age less than 1 Year

Give in 6 hours
1/3rd in 1 hours
2/3rd in 5 hours
 Age more than 1 Year
Give in 3 hours
1/3rd in ½ hour
2/3rd in 2 ½ hours

This was bolus dose, now Maintenance Dose per day:

For 1st 10 Kg = 100ml /Kg /Day

For next 10 Kg = 50ml /Kg /Day
For 20 Kg onwards = 20ml /Kg /Day

Which Fluid to give?

Initially Inf. N/ Saline

Then Inf. R/ Lactate
 For Maintenance:
Inf. Plabolyte-M

 INVESTIGATIONS:
1. CBC
2. RFTs,
3. S/Electrolyes
4. RBS
5. Stool R/E
Basic Paediatrics Hammad Muhammad

STATUS ASTHMATICUS:
 Oxygen
 NBM
 Left lateral position
 Nebulization
>Ventolin nebulization stat, then at 20mins, then at 40 mins
Re-asses,
>Atem nebulization stat, then at 20 mins, then at 40 mins
>Alternate with Ventolin,
 Steroid:
Inj. Solu Cortef 4mg /Kg *stat (Max. 100mg) or
Inj. Dexa 0.06 to 0.1ml /Kg *stat
 Anti-biotics

Home Rx:
1. Avoid allergen
2. Use face mask
3. Short course of steroids
4. Anti-biotics
5. Anti-allergic
6. Montelukast Sachet

Dose of Montelukast: Sachet & Chewable Tablets (at night)

Don’t give in less than 6 months of age
6 months – 5 years = 4mg Sachet or Tablets
6 years -14 years = 5mg Sachet or Tablets
>14 years = 10mg Sachet or Tablets (not chewable)
Basic Paediatrics Hammad Muhammad

FITS (STATUS EPILEPTICUS):

 ABC
 Oxygen
 NBM/ Pass NG
 Position (Left lateral)
 Give 5ml /Kg of 10% Dextrose
 Drugs which can be given are:
1. Tab. Diazepam grind and dilute in 3 ml N/Saline and give per rectal
(per rectal dose of Diazepam is 0.2 to 0.25mg /Kg)
OR
2. Inj. Dormicum
0.1ml /Kg /Dose diluted
OR
3. Inj. Valium
0.06ml /Kg /Dose diluted

(These can be repeated after 5 minutes with upto 3 doses)

 If seizures ar not controlled, then load with Epigran or Phenobarb

1. Inj. Epigran: (Phenytoin)
Loading Dose : 0.4ml /Kg (20mg /Kg)
Maintenance Dose : 0.1ml /Kg /Day *BD (5mg /Kg /Day)
(Always dilute in at least 50ml N/Saline)
OR
2. Tab. Phenobarb 30mg: (through NG tube)
Loading Dose : 20mg /Kg
Maintenace Dose : 5mg /Kg /Day
(In neonate with HIE, 2 Tabs. stat and then ½ Tab. OD)

 Home treatment:
(I am writing the oral drugs here but I think that it is necessary to refer such patient
to a Paediatrician instead of prescribing oral treatment by yourself.)
1. Syp. Epitoin 30mg /5ml: (Oral form of Inj. Epigran)
Dose: 5mg /Kg /Day = 0.8ml /Kg /Day divided into two equal doses
OR
2. Syp. Epival 250mg /5ml
20mg to 60mg /Kg /Day = 0.4 to 1.2 ml /Kg /Day
Basic Paediatrics Hammad Muhammad

OR
3. Syp. Tegral 100mg /5ml
10mg /Kg /Day = 0.5 ml /Kg /day divided into 2 equal doses

 INVESTIGATIONS:
1. RBS
2. S. Calcium
3. S. Electrolytes
4. S. Magnesium
5. RFTs
6. Hb
7. LFTs

SHOCK:
 I/V Fluids 20ml /Kg stat
Inf. N/Saline, Dextrose Saline, R/ Lactate
 Repeat push if no improvement
 Repeat again if still no improvement

 Inj. Solu Cortef : 4mg /Kg *stat (Max. 100mg)

or Inj. Decadron : 0.06 to 0.1ml /Kg *stat

 If no improvement after 60ml /Kg of push, then start Inotropic support (It is out of
the scope of the notes)
Basic Paediatrics Hammad Muhammad

BITES:

A. GENERAL MANAGEMENT:
 Wound Care
a. Wash with Tap water or Normal saline
b. You may use anti-septic like Pyodine etc
 Analgesics
 Anti-biotics like Augmentin
 Inj. TT
 +/- Avil & Decadron
 Tornique, cuts in the wound etc are of no use and obsolete.

B. SPECIFIC MANAGEMENT:
 For Rabid Animals (animals that have canine teeth): Anti-rabies vaccination
 For Venomous Animals:
1. Non-snakes bites:
a. Scorpoin: Local anesthetic around the wound
b. Bee Sting: Local anesthetic around the wound if pain is severe
c. Spider Sting: Local anesthetic around the wound if pain is severe
2. Snake bites:
a. Neurotoxic snake (symptoms related to nervous system): Refer immediately
b. Hemotoxic: Mark the wound site. And do CBC, PT/aPTT & S/Electrolytes or 10
mins WBCT (Whole Blood Coagulation Test). If deranged then give Inj.
Vitamin K (0.1ml /Kg) I/V and/or Transamine and/or FFPs transfusion.
c. Anti-venom (4-6 vials in 1 liter N/Saline) slow. (Always be prepared for
anaphylaxis. Keep emergency drugs ready in hand: Inj. Avil, Decadron,
Solu Cortef, Adrenaline)
d. Fluids, N/Saline, Hemaccel etc
Basic Paediatrics Hammad Muhammad

POISONING:
A. GENERAL MANAGEMENT:
1. ABC
2. Remove from the source
3. +/- NBM
4. Semi-prone position, esp. if unconscious
5. Monitor vitals
6. PPI, antibiotics, Fluids

 If poison is ingested: Either to do lavage or not?

1. GASTRIC LAVAGE WITH N/SALINE:
Do in the following:
a. Organophosphates
b. Opiods
c. Benzodiazapines
d. Atropine (Atropa belladonna)
e. Rat pills (Warfarin)

2. NO GASTRIC LAVAGE:
Don’t do gastric lavage in the following:
a. Wheat Pills
b. Corrosives
c. Petroleum Products

 Give specific antidote

Basic Paediatrics Hammad Muhammad

INJECTABLES ANTIBIOTICS
1. INF. FLAGYL (METRONIDAZOLE)
Strength: 500mg /100ml
1.5ml/ Kg / Dose *TDS

2. INJ. CEFTRIAXONE
(Oxidil, Titan, Rocephin, Cefxone)
250mg, 500mg, 1g, 2g)
Dose: 50-75mg /Kg /Day *OD or BD
Meningitis: Upto 100mg /Kg /Day
(Don’t use Ceftriaxone in Noenates)

3. INJ. AUGMENTIN
Strengths: 600mg, 1.2g
Dose: 30-100mg /Kg /Day in 2 to 3 divided doses

4. INJ. ZINACEF
Strengths: 250mg, 750mg, 1.5g
Dose: 20mg /Kg /Dose *TDS
(In severe infections: 50-60mg /Kg /Dose)

5. INJ. AMPICILLIN
Strengths: 250mg, 500mg, 1g
Dose: 150mg /Kg /Day *TDS or QID

6. INJ. GEN-M:
Strengths: 30mg /3ml, 60mg /6ml, 120mg /12ml
Dose: 2.4mg /Kg /Dose
Stat, 12 hours apart, then OD for 5 days I/V

7. INJ. QUININE:
Must give in 30-50ml of 10% dextrose water
20mg /Kg stat, then 10mg /Kg /Dose TDS
i.e. 0.06ml /Kg stat, then 0.03ml /Kg /Dose TDS
Basic Paediatrics Hammad Muhammad

INJECTABLE ANTIBIOTICS USED IN NURSERY

 The following 4 drugs are more commonly used in Nursery.
1. Inj. Ampin (Ampicillin)
2. Inj. Claforan (Cefotaxime)
3. Inj. Fortum (Ceftazidime)
4. Inj. Grasil (Amikacin)
Ampin & Claforan are the 1st line.
While Fortum & Grasil are 2nd line.
 The usual dose of Ampin, Claforan & Fortum in Nursery is 150mg /Kg /Day while
that of Grasil is 15mg /Kg /Day divided into 2 or 3 doses.
 Inj. Vancomycin and Tanzo are 3rd line.