What dose of domperidone should be given to a 13.6kg, 2-year-old child for abdominal pain?

Domperidone Dosing for a 13.6 kg, 2-Year-Old Child

For a 13.6 kg, 2-year-old child with abdominal pain, administer domperidone at 0.25 mg/kg per dose (3.4 mg), which equals approximately 0.7 mL of the 5 mg/mL drops, given three times daily 15-30 minutes before meals.

Dosing Calculation and Rationale

The standard pediatric dose of domperidone is 0.25 mg/kg per dose, administered 3 times daily before meals 1. For this 13.6 kg child:

• Dose per administration: 0.25 mg/kg × 13.6 kg = 3.4 mg
• Volume per dose: 3.4 mg ÷ 5 mg/mL = 0.68 mL (round to 0.7 mL)
• Frequency: Three times daily, 15-30 minutes before meals
• Total daily dose: 10.2 mg/day (well within safe limits)

Evidence Supporting Use in Pediatric Abdominal Pain

Domperidone has demonstrated efficacy specifically for functional abdominal pain in children aged 5-12 years, with significant improvement in abdominal pain severity (54.1% reduction vs 24.7% placebo, P = 0.008) and patient-reported general improvement (74% vs 50% placebo, P = 0.013) at 8 weeks 1.

• At 6-month follow-up, 60% of children treated with domperidone achieved cure compared to 38% with placebo (P = 0.028) 1
• The medication acts as a prokinetic agent through dopamine-2 receptor antagonism, improving gastric motility without crossing the blood-brain barrier significantly 2
• No intervention-related adverse effects were reported in the pediatric trial 1

Administration Guidelines

Timing is critical for optimal efficacy:

• Administer 15-30 minutes before each of the three main meals 1
• This pre-meal timing allows the prokinetic effect to enhance gastric emptying when food is consumed
• The medication improves symptoms through effects on the chemoreceptor trigger zone and motor function of the stomach and small intestine 2

Safety Profile and Monitoring

Domperidone has an excellent safety profile in children due to minimal blood-brain barrier penetration, unlike metoclopramide which causes neurological side effects 2. In the largest pediatric study:

• No adverse effects were reported in children with functional abdominal pain 1
• In adult studies, side effects occurred in approximately 12% of patients, most commonly headache, tachycardia/palpitations, and diarrhea 3
• Only 12% of adults discontinued treatment due to side effects 3

Monitor for:

• Symptom improvement within 3 days of starting treatment (when improvement typically begins) 4
• Rare cardiac effects (palpitations), though uncommon in pediatric populations
• Headache or gastrointestinal symptoms

Clinical Pitfalls to Avoid

Common dosing errors:

• Do not confuse the concentration: 5 mg/mL means each mL contains 5 mg, not 5 mg per 5 mL
• Do not use "every 8 hours" dosing—domperidone for gastroparesis/abdominal pain is dosed TID (three times daily) before meals, not on a strict 8-hour schedule 1, 3
• Ensure pre-meal administration timing; giving with or after meals reduces efficacy

Age consideration: While the primary pediatric study enrolled children 5-12 years old 1, domperidone is used in younger children at weight-based dosing of 0.25 mg/kg per dose. At 2 years old, this child falls within the acceptable age range for off-label use with appropriate monitoring.

Expected Outcomes

Symptom improvement timeline 4:

• Initial improvement typically occurs by day 3 of treatment
• Significant reduction in abdominal pain severity by week 8
• Sustained benefit through 6 months of follow-up in pediatric studies 1

Primary symptoms that improve include postprandial fullness, nausea, upper abdominal pain, and overall gastroparesis symptoms 4, 1, 3.