Salbutamol MDI Dosing for Children Under 10 kg
For children weighing less than 10 kg, the recommended dose of salbutamol via metered-dose inhaler (MDI) is 2 puffs (200 mcg) with a spacer and face mask every 4-6 hours as needed for symptom relief. 1
Dosing Guidelines
The dosing of salbutamol (albuterol) for young children is primarily based on age rather than specific weight categories:
- Children <5 years of age: 1-2 puffs (100-200 mcg) every 4-6 hours as needed 1
- For acute exacerbations: 2 puffs every 20 minutes for up to 3 doses, then every 1-4 hours as needed 2
Weight-Based Considerations
While specific dosing for children under 10 kg isn't explicitly stated in most guidelines, the American Academy of Pediatrics recommends:
- Weight-based dosing of 0.15 mg/kg per dose (minimum 2.5 mg) for nebulized treatment 2
- For MDI, this typically translates to 2-6 puffs depending on the child's weight 2
Administration Technique
Proper administration is critical for effective treatment in small children:
- Always use a spacer with valve and face mask for children under 10 kg 2
- Ensure proper seal between the face mask and the child's face
- Allow 5-6 breaths per puff of medication
- Clean the spacer according to manufacturer's instructions to prevent medication buildup
Efficacy Considerations
Research shows that MDI with spacer is as effective as nebulized therapy in young children:
- Studies demonstrate that even in preterm infants, 200 mcg (2 puffs) of salbutamol via MDI with spacer improves lung function as effectively as higher doses via nebulizer 3
- In children under 2 years, MDI with spacer has shown faster clinical improvement compared to nebulized treatment 4
Safety Considerations
- Monitor for tachycardia, tremor, and hypokalemia, especially with repeated dosing 1
- For severe exacerbations requiring multiple doses, consider cardiac monitoring
- If symptoms persist despite appropriate dosing, consider adding ipratropium bromide or systemic corticosteroids 2
Alternative Delivery Methods
If MDI with spacer is not tolerated or available:
- Nebulized salbutamol: 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
- For continuous nebulization in severe cases: 0.5 mg/kg/hour 2
Follow-up and Monitoring
- Assess response to treatment within 15-20 minutes after administration
- Monitor respiratory rate, work of breathing, and oxygen saturation
- If no improvement after 3 consecutive treatments, consider escalation of care
Remember that proper technique with MDI and spacer is crucial for effective medication delivery in small children, and parents/caregivers should be educated on correct administration methods.