What is the recommended dose of albuterol (bronchodilator) for a 1-year-old via a nebulizer?

Albuterol Dosing for a 1-Year-Old via Nebulizer

For a 1-year-old child, administer albuterol nebulizer solution 0.63 mg (diluted in 3 mL of saline) for routine bronchodilator therapy, or use weight-based dosing of 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses during acute exacerbations, then every 1-4 hours as needed. 1, 2, 3

Routine Maintenance Dosing

• For children under 5 years of age, the standard dose is 0.63 mg/3 mL via nebulizer 1
• This lower dose is specifically FDA-approved for young children and represents the safest starting point for routine bronchodilator therapy 1
• The solution should be diluted to a minimum of 3 mL total volume for optimal nebulization 2, 3
• Use a gas flow rate of 6-8 L/min during nebulization 2, 3

Acute Exacerbation Dosing

For acute asthma exacerbations or severe wheezing, weight-based dosing is preferred:

• Administer 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for the first 3 doses 2, 3, 4
• For a typical 1-year-old weighing approximately 10 kg, this calculates to 1.5 mg, but the minimum dose of 2.5 mg should be used since the calculated dose falls below the established minimum 3, 4
• After the initial 3 doses, continue with 2.5 mg every 1-4 hours as needed based on clinical response 2, 3

Severe Exacerbations

• For continuous nebulization in life-threatening cases, use 0.5 mg/kg/hour 3, 4
• For a 10 kg child, this equals 5 mg/hour of continuous albuterol 4
• Add ipratropium bromide 0.25 mg to the first 3 albuterol doses for moderate-to-severe exacerbations 2, 3

Administration Technique

• Always use a properly fitted face mask that covers both nose and mouth snugly 1
• Avoid nebulizing medication into the eyes 1
• Dilute the albuterol dose to at least 3 mL with normal saline for optimal aerosol delivery 2, 3, 4
• Use oxygen as the driving gas when available, particularly in hypoxic patients 3
• Only use jet nebulizers; ultrasonic nebulizers are ineffective for albuterol solutions 1

Alternative: MDI with Spacer

• For mild-to-moderate exacerbations, an MDI with valved holding chamber (spacer) and face mask can be equally effective as nebulized therapy 2, 3, 4
• Administer 4-8 puffs (90 mcg/puff = 360-720 mcg total) every 20 minutes for 3 doses 2
• This requires proper technique and coaching but may be more practical in some settings 3, 4

Monitoring and Safety

Monitor closely for adverse effects, especially with frequent dosing:

• Tachycardia (most common) 2, 3
• Tremor 2, 3
• Hypokalemia (particularly with high or continuous dosing) 2, 3
• Hyperglycemia 1

Important clinical caveat: The safety and efficacy of inhaled corticosteroids in children under 1 year has not been fully established, but albuterol itself has been studied and used safely in this age group 1. Response to treatment is a better predictor of need for hospitalization than initial severity, so reassess after each treatment cycle 2.

Levalbuterol Alternative

• Levalbuterol (R-albuterol) 0.31 mg/3 mL can be used as an alternative 1
• Levalbuterol is administered at half the milligram dose of racemic albuterol with comparable efficacy 2, 3
• It may have fewer cardiovascular side effects, though this is not definitively established in infants 3
• Note that levalbuterol does not have FDA-approved labeling for children under 6 years, though it is used clinically 1