What is the recommended dose of diazepam (benzodiazepine) for a child?

Recommended Diazepam Dosing for Children

For children requiring diazepam, the recommended IV dose is 0.1-0.3 mg/kg every 5-10 minutes (maximum: 10 mg per dose) for status epilepticus, and for rectal administration 0.5 mg/kg up to 20 mg for seizure management when IV access is unavailable. 1

Intravenous (IV) Administration

Status Epilepticus

• IV: 0.1-0.3 mg/kg every 5-10 minutes (maximum: 10 mg per dose) 1
• Administer over approximately 2 minutes to avoid pain at IV site 1
• Diazepam should be followed immediately by a long-acting anticonvulsant due to its rapid redistribution and potential for seizure recurrence within 15-20 minutes 1

Sedation/Anxiolysis

• IV: 0.05-0.10 mg/kg given over 2-3 minutes (maximum single dose: 5 mg) 1
• Peak effect occurs at 3-5 minutes 1
• Dose, observe, and redose every 3-5 minutes to avoid oversedation 1

Rectal Administration

Seizure Management (when IV access unavailable)

• Rectal: 0.5 mg/kg up to 20 mg 1
• Effective in approximately 80% of cases with persistent convulsions 2
• Absorption may be erratic compared to IV administration 1

Acute Repetitive Seizures

• Dosage varies from 0.2 to 0.5 mg/kg based on age 3
• Children may receive one dose at onset and a second dose four hours later 3

Oral Administration

Sedation/Anxiolysis

• PO: 0.25-0.50 mg/kg (maximum: 20 mg) 1
• Children under 6 years old may require up to 1 mg/kg 1

Important Safety Considerations

• There is an increased risk of apnea when diazepam is given rapidly IV or when used in combination with other sedative agents 1
• Monitor oxygen saturation and respiratory effort closely 1
• Be prepared to support ventilation if respiratory depression occurs 1
• Paradoxical agitation may occur, especially in younger children 1
• For pediatric use, administer slowly over a three-minute period at a dosage not exceeding 0.25 mg/kg to reduce the risk of adverse effects such as apnea or prolonged somnolence 4
• After an interval of 15-30 minutes, the initial dosage can be safely repeated if needed 4
• If relief is not obtained after a third administration, consider adjunctive therapy appropriate to the condition being treated 4

Special Populations

• Efficacy and safety of parenteral diazepam has not been established in neonates (30 days or less of age) 4
• Prolonged central nervous system depression has been observed in neonates, apparently due to inability to biotransform diazepam into inactive metabolites 4
• Benzodiazepine withdrawal symptoms may occur after discontinuation 4

Drug Interactions

• When diazepam is used with opioid analgesics, reduce the opioid dosage by at least one-third and administer in small increments to avoid respiratory depression 4
• Flumazenil may be administered to reverse life-threatening respiratory depression caused by diazepam, but it also counteracts the anticonvulsant effects and may precipitate seizures 1

Remember that diazepam dosing in children should be calculated based on weight, and careful monitoring is essential due to the potential for respiratory depression and other adverse effects.