From the FDA Drug Label
For sedation/anxiolysis/amnesia prior to and during procedures or prior to anesthesia USUAL PEDIATRIC DOSE (NON-NEONATAL) Pediatric patients 6 months to 5 years of age: Initial dose 0. 05 to 0.1 mg/kg. A total dose up to 0.6 mg/kg may be necessary to reach the desired endpoint but usually does not exceed 6 mg. Pediatric patients 6 to 12 years of age: Initial dose 0.025 to 0.05 mg/kg; total dose up to 0. 4 mg/kg may be needed to reach the desired endpoint but usually does not exceed 10 mg. Pediatric patients 12 to 16 years of age: Should be dosed as adults
The recommended dosage of midazolam for pediatric sedation is as follows:
- 6 months to 5 years of age: Initial dose of 0.05 to 0.1 mg/kg, with a total dose up to 0.6 mg/kg
- 6 to 12 years of age: Initial dose of 0.025 to 0.05 mg/kg, with a total dose up to 0.4 mg/kg
- 12 to 16 years of age: Should be dosed as adults, with a total dose usually not exceeding 10 mg 1 1
From the Research
The recommended dosage of midazolam for pediatric sedation is 0.3-0.6 mg/kg for intranasal administration, with a maximum dose of 10 mg, as supported by the most recent study 2.
Dosage Considerations
When considering the dosage of midazolam for pediatric sedation, it is essential to take into account the route of administration.
- For oral administration, a dose of 0.25-0.5 mg/kg (maximum 20 mg) is typically given 30-45 minutes before a procedure, as reported in previous studies 3.
- Intranasal dosing is 0.2-0.3 mg/kg, while intravenous administration is 0.05-0.1 mg/kg titrated slowly to effect, with a maximum total dose of 0.4-0.6 mg/kg.
- Intramuscular dosing is 0.1-0.15 mg/kg, as noted in older studies 4. These doses should be reduced in patients with cardiac or respiratory compromise, and when used with other sedatives.
Mechanism of Action and Monitoring
Midazolam works by enhancing the effect of GABA, an inhibitory neurotransmitter, producing anxiolysis, sedation, and amnesia.
- Onset of action is rapid but varies by route: 10-30 minutes for oral, 5-15 minutes for intranasal, and 2-3 minutes for IV administration.
- Patients should be monitored for respiratory depression, hypotension, and paradoxical reactions, especially in younger children.
- Flumazenil should be available as a reversal agent for emergency situations, as recommended in various studies 5, 6.
Clinical Considerations
In clinical practice, the choice of midazolam dosage and route of administration should be individualized based on the patient's age, weight, and medical history.