What is the recommended dose of albuterol (bronchodilator) for a 4-year-old child?

Albuterol Dosing for a Four-Year-Old Child

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

Nebulizer Administration

• Standard nebulizer solution (0.083% or 0.5%):

  • Initial treatment: 2.5 mg (0.5 mL of 0.5% solution or 3 mL of 0.083% solution) every 20 minutes for 3 doses
  • Maintenance: 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 1

• Dilution: Dilute in a minimum of 2-3 mL of saline solution for adequate nebulization 1

• Administration time: Typically 5-15 minutes per treatment 2

Metered-Dose Inhaler (MDI) Administration

• With spacer/valved holding chamber and face mask:
  • 1-2 puffs (90 mcg/puff) every 4-6 hours as needed 1
  • For acute exacerbations: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1

Important Clinical Considerations

Delivery Method Selection

• Nebulizer: Preferred for acute exacerbations or when higher doses are needed
• MDI with spacer: Effective for maintenance therapy and mild symptoms
  • Must use a spacer with face mask for children under 4 years 1
  • Face mask should fit snugly over nose and mouth 1

Monitoring and Safety

• Potential adverse effects:

  • Tachycardia, skeletal muscle tremor, hypokalemia
  • Increased lactic acid, headache, hyperglycemia 1

• Monitoring parameters:

  • Heart rate and blood pressure
  • Clinical response (work of breathing, oxygen saturation)
  • Potassium levels if receiving frequent or continuous treatments

Special Considerations

• Oxygen source: Oxygen is the preferred gas source for nebulization 1
• Levalbuterol alternative: If using levalbuterol instead of racemic albuterol, use half the dose (0.075 mg/kg) 1, 3
• Increasing use warning: An increasing need for albuterol or lack of expected effect indicates diminished asthma control 1

Practical Tips

• For nebulizer treatments, ensure proper fit of mask over nose and mouth
• Clean the child's face after each treatment to prevent local side effects 1
• MDI administration requires proper technique and coaching by trained personnel 1
• Periodically clean HFA actuator as drug may plug orifice 1

This dosing recommendation is based on national guidelines for pediatric asthma management and is appropriate for a 4-year-old child requiring bronchodilator therapy.