What is the recommended dosing for Benadryl (diphenhydramine) in pediatric patients?

Pediatric Benadryl (Diphenhydramine) Dosing Guidelines

For pediatric patients, diphenhydramine should be dosed at 1-2 mg/kg/dose with a maximum of 50 mg per dose, administered every 4-6 hours as needed, with children under 6 years of age requiring physician guidance before administration. 1

Age-Based Dosing Recommendations

• Children under 6 years of age: Not recommended for over-the-counter use. Should only be used under physician guidance 2
• Children 6 to under 12 years of age: 10 mL (25 mg) every 4-6 hours 2
• Children 12 years and older and adults: 10-20 mL (25-50 mg) every 4-6 hours 2

Important Administration Guidelines

• Do not exceed 6 doses in 24 hours 2
• Liquid formulations are more readily absorbed than tablets and are preferred for children 1
• When prescribed by a physician for children under 6 years, the weight-based dosing of 1-2 mg/kg/dose should be followed 1

Parenteral Administration

For situations requiring intravenous administration:

• Dose: 1-2 mg/kg per dose
• Maximum dose: 50 mg
• Used in emergency situations such as anaphylaxis management 1

Clinical Considerations

• Diphenhydramine is considered a second-line therapy in anaphylaxis management and should never be administered alone for anaphylaxis (epinephrine is first-line) 1
• In children under 2 years, medication dosing requires special consideration due to immature elimination pathways 3
• For children 2 years and older, dosing is more similar to adults (adjusted for size) 3

Common Pitfalls to Avoid

• Do not simply scale down adult doses based on weight alone, especially for very young children and infants 3, 4
• Avoid exceeding the maximum dose of 50 mg per dose regardless of weight
• Do not administer more frequently than every 4 hours
• Never use diphenhydramine as first-line therapy for anaphylaxis 1
• Be aware that sedation is a common side effect that may affect school performance or activities requiring alertness

Following these guidelines will help ensure safe and effective use of diphenhydramine in pediatric patients while minimizing adverse effects.