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

Diazepam Dosing for Children

The recommended diazepam dosing for children varies by route of administration: IV dosing is 0.1-0.3 mg/kg every 5-10 minutes (maximum 10 mg per dose) for status epilepticus; rectal dosing is 0.5 mg/kg (maximum 20 mg); and oral dosing is 0.25-0.5 mg/kg (maximum 20 mg) for sedation/anxiolysis. 1

Intravenous (IV) Administration

• For status epilepticus: 0.1-0.3 mg/kg every 5-10 minutes with a maximum of 10 mg per dose 1
• For sedation/anxiolysis: 0.05-0.10 mg/kg administered over 2-3 minutes with a maximum single dose of 5 mg 1
• Administer slowly over at least one minute for each 5 mg (1 mL) to reduce the risk of venous thrombosis, phlebitis, and local irritation 2
• In pediatric patients, administer slowly over a three-minute period at a dosage not exceeding 0.25 mg/kg to minimize the risk of adverse effects such as apnea 2
• After an interval of 15-30 minutes, the initial dosage can be safely repeated if needed 2

Rectal Administration

• When IV access is unavailable for seizure management: 0.5 mg/kg up to a maximum of 20 mg 1
• Rectal diazepam has been shown to be effective in 80.83% of cases with persistent convulsions, compared to 90% efficacy with IV administration 3
• Dosage for acute repetitive seizures in children ranges from 0.2 to 0.5 mg/kg based on age 4

Oral Administration

• For sedation/anxiolysis: 0.25-0.50 mg/kg with a maximum of 20 mg 1
• Children under 6 years may require up to 1 mg/kg 1

Important Safety Considerations

• Monitor for respiratory depression, especially when:
  • Administering IV diazepam rapidly 1, 2
  • Using in combination with opioids or other CNS depressants 2
  • Treating very young children, particularly neonates (≤30 days) who may experience prolonged CNS depression due to inability to metabolize diazepam 2
• Have resuscitative equipment readily available to support respiration 2
• Diazepam should be followed by a long-acting anticonvulsant due to its rapid redistribution and potential for seizure recurrence within 15-20 minutes 1
• Flumazenil may be used to reverse life-threatening respiratory depression but may precipitate seizures 1
• Paradoxical agitation may occur, especially in younger children 1
• Avoid use during pregnancy, particularly in the first trimester 2

Special Populations

• Efficacy and safety have not been established in neonates (≤30 days of age) 2
• Benzyl alcohol in diazepam formulations has been associated with fatal gasping syndrome in premature infants 2

Clinical Pearls

• When IV access is difficult, rectal administration provides an effective alternative with minimal side effects 3
• For children who fail to respond to rectal diazepam (approximately 19% of cases), IV administration may still be effective 3
• Diazepam has a faster onset but shorter duration of action compared to other benzodiazepines like lorazepam 5