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Dosing Safely


Pediatric dosing can be intimidating. Don't let this prevent you from appropriately treating your pediatric patients! Remember that pediatric dosing is weight-based, using the child's weight in kilograms. Here are some tools to help you determine a child's weight in kilograms to improve your dosing accuracy. 

Just in Time!

  • Pounds to Kilograms conversion

          pounds ÷ 2.2 = kilograms 
            online conversion here


  • Age to Kilograms estimate



**If your site needs resources like a length-based tape or this age to weight conversion chart, please email NH EMSC**

Policy statement

  • Sites should define age range for pediatric population

  • Weight should be recorded at every ED encounter

  • Ensure that either an actual weight (i.e., gurney weight) or weight based on patient length (i.e., using the length-based tape) is used for all resuscitations

  • Frequency that ED pharmacists attend a pediatric resuscitation and assist with medication administration

Infrastructure changes

  • Utilize a scale that only weighs pediatric patients in kilograms or can be locked in kilograms

  • Utilize gurney weights on all patients for whom staff are unable to get a scale weight

  • Utilize a length-based tape and ensure that it is available

  • Utilize a single formulation for each medication

Electronic medical record (EMR) optimization

  • EMR alerts care team when weight is not recorded in correct unit

  • EMR alerts care team that weight does not coincide with patient’s height and age

  • For resuscitation, weight is a required entry in the patient’s medical record

  • Consider using standard weight nomograms (e.g., World Health Organization)

  • EMR automatically calculates medication dosing based on weight recorded in kilograms in medical record


  • Integrate ED pharmacists into the healthcare team

  • Develop training/educational content for care team

    • Learning objectives should include: proper use of length-based tape, necessity of weight measurement required in cases of resuscitation, safety issues (e.g., number of reported medication errors), methods of measuring weight, nomograms, family engagement, your site’s policy; PRQC change strategies)

    • Identify training modality (e.g., online, in-person, staff-meetings, peer to peer, EMR alerts)

  • Identify strategies to increase families’ engagement

  • Weight should not be estimated but measured


Knowledge reinforcement for care team

  • Posters in triage and clinical care areas

  • Direct feedback to care team following chart audits

  • Develop script for use by triage nurse

Patient & Family Engagement

  • Offer families a preprinted chart with their child’s measured weight in kilograms and corresponding pounds. Template here.

  • Disseminate weight infographic/conversion chart to empower caregiver engagement. Template here. 

Prescribing Patterns (deep dive for outcome measure)

  • Manually track the number of incidences when an incorrect dose of a medication was ordered for a patient based on their weight

  • Track high risk conditions with common errors in prescribing and administration medication administration (deep dive for outcome measure)

  • Integrate a tool that nurses can reference to ensure that medication dosing is appropriate (use standard nomograms as reference)

  • Integrate a nurse-to-nurse cross-check to ensure that medication dosing is appropriate. If site has bandwidth to accommodate this effort, consider cross-check for high-risk patients/medications or cross-checks during off-peak hours in the ED.

  • Work with pharmacy team to develop notification system in the event that a prescribed medication does not coincide with standard practice

Additional content

  • Collated content and resources

EIIC PRQC Weight in Kg Intervention Bundle (2016)

EIIC PRQC Weight in Kg Intervention Bundle (2023, in process)

  • Infographic

            Weight in kg only infographic

  • Videos 


  • Publications, Position Statements

ENA Position Statement

NAEMSP Position Statement

NEMSQA Pediatrics-03b Measure Package

System improvement (adapted from EIIC PRQC, full content linked below)

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