What is the dosage of lidocaine (local anesthetic) viscous for a 4-year-old child?

From the Guidelines

Lidocaine viscous solution is not recommended for routine use in 4-year-old children without specific medical supervision. The most recent and highest quality study, 1, provides guidelines for monitoring and management of pediatric patients before, during, and after sedation for diagnostic and therapeutic procedures. According to these guidelines, local anesthetic agents, including lidocaine, are cardiac depressants and may cause central nervous system excitation or depression.

Key Considerations

• Particular weight-based attention should be paid to cumulative dosage in all children.
• The maximum allowable safe dosage (e.g., mg/kg) should be calculated before administration.
• There may be enhanced sedative effects when the highest recommended doses of local anesthetic drugs are used in combination with other sedatives or opioids.
• Lower doses should be used in very vascular areas.

Dosage and Administration

If prescribed by a healthcare provider for specific conditions like mouth sores or oral pain, the typical dose is very small—usually 1/4 teaspoon (1.25 mL) of 2% lidocaine viscous applied to the affected area with a cotton swab, no more than 4 times daily. Never allow the child to swallow the medication as this can lead to serious side effects. Parents should apply it carefully to avoid numbing the throat or back of mouth, which could interfere with swallowing and potentially cause choking.

Alternative Treatments

Alternative treatments for mouth pain in children this age often include:

• Children's acetaminophen
• Ibuprofen (if over 6 months)
• Non-medicated options like cold foods, ice pops, or saltwater rinses

Important Note

Always consult with a pediatrician before using lidocaine products in young children, as they are particularly susceptible to lidocaine toxicity due to their smaller body size.

From the FDA Drug Label

For children over 3 years of age who have a normal lean body mass and normal body development, the maximum dose is determined by the child's weight or age. For example: in a child of 5 years weighing 50 lbs., the dose of lidocaine hydrochloride should not exceed 75-100 mg (3. 7 to 5 mL of Lidocaine Hydrochloride Oral Topical Solution, USP (Viscous) 2%). For infants and in children under 3 years of age, the solution should be accurately measured and no more than 1. 2 mL be applied to the immediate area with a cotton-tipped applicator.

For a 4-year-old child, the dose of lidocaine hydrochloride should be determined by the child's weight.

• The child's weight is not provided, so a specific dose cannot be calculated.
• However, as a general guideline, the maximum dose for a child over 3 years of age should not exceed 75-100 mg (3.7 to 5 mL of Lidocaine Hydrochloride Oral Topical Solution, USP (Viscous) 2%) for a child weighing around 50 lbs.
• Key consideration: the dosage should be adjusted commensurate with the patient's age, weight, and physical condition 2.
• Precaution: care must be taken to ensure correct dosage in all pediatric patients as there have been cases of overdose due to inappropriate dosing 2.

From the Research

Lidocaine Viscous for 4-Year-Old

• The use of lidocaine viscous in children is supported by a study published in 2014 3, which investigated the efficacy of 2% viscous lidocaine in increasing oral intake in children with painful infectious mouth ulcers.
• Although the study found that viscous lidocaine was not superior to a flavored gel placebo in improving oral intake, it suggests that lidocaine viscous may be considered as an option for pain management in children.
• Another study published in 2021 4 provides a comprehensive review of topical analgesics, including lidocaine, and their efficacy in treating chronic pain conditions.
• The study found that topical lidocaine has been widely studied and has been shown to reduce pain in patients with postherpetic neuralgia.
• However, there is limited data on the use of lidocaine viscous in children, and its efficacy and safety in this population need to be further studied.
• It is essential to consult with a healthcare professional before administering lidocaine viscous to a 4-year-old child, as they can provide guidance on the appropriate dosage and potential interactions with other medications.

Considerations for Use

• The safety and efficacy of lidocaine viscous in children should be carefully evaluated, considering the potential risks and benefits.
• A study published in 2017 5 highlights the importance of considering age-related changes in physiology, pharmacodynamics, and pharmacokinetics when using lidocaine in older adults, which may also be relevant when using it in children.
• The use of lidocaine viscous in children should be monitored closely, and any adverse effects should be reported to a healthcare professional.
• Other pain management options, such as ibuprofen or paracetamol, may also be considered, and their efficacy and safety in children should be evaluated based on the available evidence 6, 7.