What is the recommended dose of Ventolin (albuterol) for a 9-year-old child?

Ventolin (Albuterol) Dosing for a 9-Year-Old Child

For a 9-year-old child with asthma, the recommended dose of Ventolin (albuterol) via nebulizer is 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed. 1

Dosing by Administration Method

Nebulizer Solution

• Initial treatment: 0.15 mg/kg (minimum 2.5 mg) in 3 mL of saline
• Subsequent doses: 0.15-0.3 mg/kg up to 10 mg every 1-4 hours as needed
• For continuous nebulization: 0.5 mg/kg/hour up to 10-15 mg/hour

Metered-Dose Inhaler (MDI)

• Initial treatment: 4-8 puffs (90 mcg per puff) every 20 minutes for 3 doses
• Subsequent doses: 4-8 puffs every 1-4 hours as needed
• Important: Always use a spacer/holding chamber when administering MDI treatments to children 1

Practical Application

For a typical 9-year-old weighing approximately 30 kg:

• Nebulizer dose: 4.5 mg (0.15 mg/kg × 30 kg) in 3 mL saline
• MDI dose: 4-8 puffs via spacer

Special Considerations

1. Oxygen Source: Oxygen is the preferred gas source for nebulization. Supplemental oxygen may be needed when compressed air-driven nebulizers are used 1

2. Levalbuterol Option: If using levalbuterol (R-albuterol), the dose is half of the racemic albuterol dose listed above 1

3. Monitoring: Watch for potential side effects including:

   • Tachycardia
   • Tremor
   • Hypokalemia
   • Hyperglycemia

4. Treatment Escalation: For bronchospasm resistant to adequate doses of albuterol, consider:

   • Adding ipratropium bromide
   • Systemic corticosteroids
   • Continuous nebulization 1

Dosing Pitfalls to Avoid

1. Underdosing: The minimum nebulizer dose should be 2.5 mg even if the weight-based calculation yields a lower value 1

2. Improper MDI Technique: Always ensure proper MDI technique with spacer/holding chamber for children 1

3. Inadequate Dilution: Ensure nebulizer solution is diluted in a minimum of 2-3 mL of saline for adequate nebulization 1

4. Monitoring Limitations: Don't rely solely on symptom improvement; monitor objective measures like respiratory rate, work of breathing, and oxygen saturation when possible

Recent evidence suggests that lower doses of albuterol via MDI are effective, and higher doses remain safe in the pediatric population 2, but the guidelines still recommend the dosing schedule outlined above for standard care.