Chloral Hydrate Dosing for Pediatric Sedation
The recommended dose of chloral hydrate for pediatric sedation is 50-75 mg/kg orally, with additional doses of 25-50 mg/kg up to a maximum of 100 mg/kg as needed. 1
Age-Based Dosing Recommendations
Infants (<18 months)
- Initial dose: 50 mg/kg orally
- Reduced dose option: 40 mg/kg if child appears quiet or sleepy on arrival 2
- Maximum total dose: 100 mg/kg (not to exceed 1,000 mg) 1, 3
Children (>18 months to 4 years)
- Initial dose: 75 mg/kg orally
- Reduced dose option: 60 mg/kg if child appears quiet or sleepy on arrival 2
- Maximum total dose: 100 mg/kg (not to exceed 2,000-2,500 mg) 4, 5
Administration Protocol
- Timing: Administer 30-60 minutes before the procedure
- Monitoring requirements:
- Continuous pulse oximetry
- Regular vital sign assessment
- Dedicated individual monitoring throughout the procedure 1
- Augmentation strategy:
Efficacy and Safety Profile
- Success rate: 91-99% overall, with higher success in younger children 4
- 98.3% success rate in infants
- 95.3% success rate in children >1 year 2
- Time to sedation: 16 ± 11 minutes on average 6
- Duration of action: Variable, typically 60-120 minutes 5
Common Adverse Effects
- Respiratory: Transient oxygen desaturation (4-9% of cases) 3, 4
- Gastrointestinal: Vomiting (4-4.3% of cases) 4, 5
- Neurological: Hyperactivity/paradoxical reactions (6% of cases) 4
Important Considerations and Cautions
- Age limitations: Efficacy decreases significantly in children older than 48 months 4
- Black box warning: Fatal respiratory depression has been reported in children younger than 2 years 1
- Availability note: The liquid formulation is no longer commercially available from manufacturers but may be compounded by hospital pharmacies 1
- Monitoring duration: Continue monitoring until discharge criteria are met, as re-sedation can occur after apparent recovery, particularly in infants and toddlers transported in car safety seats 1
Alternative Sedatives When Chloral Hydrate Is Not Appropriate
- Oral pentobarbital: 4-8 mg/kg (similar efficacy profile to chloral hydrate) 6
- IV pentobarbital: 2-6 mg/kg if IV access is already established 6
- Ketamine: 0.25-0.5 mg/kg IV for more invasive procedures requiring deeper sedation 6
Remember that the combination of multiple sedatives significantly increases the risk of adverse events, so avoid combining chloral hydrate with other sedative medications unless specifically indicated and with appropriate monitoring.