Pediatric Dosing Guidelines for Diazepam
The recommended dose of diazepam for pediatric patients varies by indication, with status epilepticus requiring 0.1-0.3 mg/kg IV (maximum 10 mg per dose), sedation/anxiolysis requiring 0.05-0.10 mg/kg IV or 0.25-0.50 mg/kg orally, and rectal administration requiring 0.5 mg/kg. 1
Intravenous (IV) Administration
- For status epilepticus, administer 0.1-0.3 mg/kg IV every 5-10 minutes with a maximum dose of 10 mg 1
- IV diazepam should be administered slowly over approximately 2 minutes to avoid pain at the injection site 1
- For pediatric patients, the FDA recommends administering IV diazepam slowly over a three-minute period in a dosage not exceeding 0.25 mg/kg to minimize risk of respiratory depression 2
- After an interval of 15-30 minutes, the initial dosage can be safely repeated if seizures continue 2
Rectal Administration
- When IV access is unavailable, rectal diazepam can be administered at 0.5 mg/kg (maximum 20 mg) 1
- Rectal administration has been shown to be as effective as IV diazepam in controlling seizures in children with intractable epilepsy 3
- Studies show 87.3% of seizures stopped within 10 minutes after rectal diazepam administration 3
Oral Administration
- For sedation/anxiolysis, the recommended oral dose is 0.25-0.50 mg/kg with a maximum of 20 mg 1
- Children under 6 years may require higher doses up to 1 mg/kg for effective anxiolysis 1
Safety Considerations and Monitoring
- Respiratory depression is a significant risk, particularly when diazepam is administered rapidly IV or combined with other sedative agents 1, 2
- Always monitor oxygen saturation and respiratory effort when administering diazepam to pediatric patients 1
- Resuscitative equipment should be readily available when administering diazepam to children 2
- The FDA specifically warns about prolonged central nervous system depression in neonates (30 days or less) due to their inability to biotransform diazepam into inactive metabolites 2
- Paradoxical agitation may occur, especially in younger children 1
Alternative Benzodiazepines
- Lorazepam is an alternative benzodiazepine for seizure management at 0.05-0.10 mg/kg IV/IM (maximum 4 mg per dose), which may be repeated every 10-15 minutes 4
- Midazolam can be used at 0.2 mg/kg IM for seizures when IV access is unavailable 4, 5
Clinical Pearls
- 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
- Do not mix or dilute diazepam with other solutions or drugs in the same syringe or infusion container 2
- Extreme care must be used when administering diazepam to very ill patients and those with limited pulmonary reserve 2
- If a second dose fails to control seizures, consider alternative anticonvulsants or seek emergency medical assistance 3