What is the recommended dose of salbutamol (albuterol) for nebulization in a 1-year-old child?

Recommended Dose of Salbutamol for Nebulization in a 1-Year-Old Child

For a 1-year-old child, the recommended dose of salbutamol (albuterol) for nebulization is 0.15 mg/kg per dose (minimum 2.5 mg) administered every 20 minutes for up to 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed. 1

Dosage Calculation and Administration

• For a typical 1-year-old child (approximately 10 kg):

  • Initial dose: 0.15 mg/kg × 10 kg = 1.5 mg
  • Since this is below the minimum recommended dose, use 2.5 mg
  • For severe cases: Can increase to 0.3 mg/kg (3 mg) for subsequent doses

• Administration method:

  • Use an oxygen-driven nebulizer when possible 2
  • For very young children, use a face mask with the nebulizer 2
  • Ensure proper seal between face mask and child's face 1
  • Allow 6-8 breaths per actuation when using a spacer 1

Treatment Protocol for Acute Asthma/Wheezing

Initial Treatment

• First assess severity:

  • Mild-moderate: Respiratory rate <50/min, pulse <140/min
  • Severe: Too breathless to feed, respiratory rate >50/min, pulse >140/min 2
  • Life-threatening: Cyanosis, silent chest, poor respiratory effort, agitation or reduced consciousness 2

• For severe symptoms:

  • Give high-flow oxygen via face mask
  • Administer salbutamol 2.5 mg (half the adult dose) via oxygen-driven nebulizer 2
  • Consider adding ipratropium 100 μg nebulized every 6 hours 2

Subsequent Management

• If improving:

  • Continue salbutamol nebulization every 4 hours 2
  • Consider oral prednisolone 1-2 mg/kg daily (maximum 40 mg) 2

• If not improving after 15-30 minutes:

  • Continue oxygen and steroids
  • Give nebulized salbutamol more frequently (up to every 30 minutes) 2
  • Add ipratropium to nebulizer and repeat every 6 hours until improvement starts 2

Alternative Delivery Methods

• Consider MDI with spacer as an alternative:
  • A metered dose inhaler with spacer (with face mask) is often more convenient and equally effective as nebulization 2
  • For MDI with spacer: 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1
  • Only use nebulizer if child cannot tolerate face mask and spacer 2

Monitoring and Safety

• Monitor for:

  • Clinical response: Improvement in respiratory rate, work of breathing
  • Side effects: Tachycardia, tremors, potential hypokalemia with repeated dosing 1
  • Oxygen saturation: Maintain SaO₂ >92% 2

• Common pitfalls to avoid:

  • Underdosing in severe cases
  • Not using oxygen as driving gas when available
  • Not considering adding ipratropium for severe cases
  • Not providing sufficient monitoring after administration

Special Considerations

• For continuous nebulization in severe cases:

  • Can administer at 0.5 mg/kg/hour 1
  • This approach may provide more rapid clinical improvement than intermittent nebulization in severe cases 3

• For bronchiolitis (which is common in this age group):

  • Response to bronchodilators is variable and often limited
  • Consider trial of nebulized 3% hypertonic saline with salbutamol for mild to moderate bronchiolitis 4

Remember that proper technique and appropriate dosing are critical for effective treatment in young children. Always ensure the child is monitored closely during and after nebulization therapy.