Ventolin (Albuterol) Dosing for a 3-Year-Old Child
For a 3-year-old child, the recommended dose of Ventolin (albuterol) via nebulizer solution is 0.63 mg/3 mL, which can be administered every 4-6 hours as needed for bronchospasm. 1
Nebulizer Solution Dosing
- For children under 5 years of age: 0.63 mg/3 mL of albuterol nebulizer solution 1
- Can be administered every 20 minutes for 3 doses in acute situations, then every 1-4 hours as needed 1
- May double the dose for severe exacerbations 1
- Can be mixed with other medications such as cromolyn solution, budesonide inhalant suspension, or ipratropium solution for nebulization 1
Metered-Dose Inhaler (MDI) Dosing
- For children under 5 years: 1-2 puffs (90 mcg per puff) every 4-6 hours as needed 1
- For acute exacerbations: 4-8 puffs every 15-20 minutes for 3 doses, then every 1-4 hours as needed 1
- Important: A spacer/holding chamber must be used when administering MDI treatments to young children 1
- Children under 4 years may not generate sufficient inspiratory flow to activate an autoinhaler 1
Continuous Nebulization (For Severe Cases)
- For severe status asthmaticus: 0.5 mg/kg per hour up to 10-15 mg/hour 1
- Must be diluted in a larger amount of saline (usually 25-30 mL for 1 hour of nebulization) 1
- Studies show continuous nebulization may result in more rapid clinical improvement than intermittent nebulization in severe cases 2
Administration Considerations
- Oxygen is the preferred gas source for nebulization 1
- Supplemental oxygen may be needed when compressed air-driven nebulizers are used 1
- For MDIs, periodically clean the actuator as drug may plug the orifice 1
- A valved holding chamber significantly improves drug delivery with MDIs for young children 3
Monitoring and Safety
- Monitor for potential adverse effects: tachycardia, skeletal muscle tremor, hypokalemia, hyperglycemia, and headache 1
- Administration can be repeated and dose adjusted until desired clinical effect is achieved, unless the patient develops symptomatic tachycardia 1
- The threshold dose for toxicity in children is approximately 1 mg/kg; most cases of unintentional overdose are benign and self-limiting 4
Alternative Formulations
- Levalbuterol (R-albuterol) may also be used at half the dose of racemic albuterol 1
- For children under 5 years: 0.31 mg/3 mL of levalbuterol nebulizer solution 1
Clinical Pearls
- Increasing use or lack of expected effect indicates diminishing asthma control 1
- Different albuterol MDI products (Ventolin HFA, Proventil HFA, ProAir HFA) deliver different fine particle doses and should not be considered interchangeable 3
- For severe exacerbations, consider adding ipratropium bromide to albuterol nebulization for the first 3 hours of treatment 1