Dexamethasone Injection Dosing for a 2-Year-Old
For a 2-year-old child, the recommended dose of Decadron (dexamethasone) injection is 0.6 mg/kg (maximum 16 mg) as a single dose for croup, or 0.15 mg/kg every 6 hours for bacterial meningitis, depending on the clinical indication. 1, 2
Dosing by Clinical Indication
Croup (Most Common Indication)
- Administer 0.6 mg/kg as a single dose (maximum 16 mg) 2
- Can be given intravenously, intramuscularly, or orally—all routes are equally effective 2
- For a typical 2-year-old weighing 12 kg, this equals approximately 7.2 mg 2
- Onset of action occurs within 30 minutes, with clinical effects lasting 24-72 hours 2
- No tapering is required after a single dose, and this does not cause adrenal suppression 2
Bacterial Meningitis
- Administer 0.15 mg/kg IV every 6 hours for 2-4 days 1
- Critical timing: Must be given 10-20 minutes before or at least concomitant with the first antibiotic dose—dexamethasone is ineffective if started after antimicrobials 1
- For a 12 kg child, this equals 1.8 mg per dose 1
Cerebral Edema
- Initial dose: 10 mg IV, followed by 4 mg every 6 hours IM until symptoms subside 3
- Response typically occurs within 12-24 hours 3
- This is an adult dosing regimen from the FDA label; pediatric-specific dosing would be weight-based at approximately 0.15 mg/kg every 6 hours 1
Acute Adrenal Insufficiency (Emergency)
- 2-3 mg/kg IV/IO (maximum 100 mg) over 3-5 minutes, followed by 1-5 mg/kg every 6 hours 4
- For a 12 kg child, initial dose would be 24-36 mg 4
Critical Safety Considerations
Avoid high-dose regimens (≥0.5 mg/kg/day) in young children due to risks of:
- Gastrointestinal perforation 1
- Hypertension and hyperglycemia 1
- Neurodevelopmental impairment 1
- Impaired growth 1
Common Pitfalls to Avoid
- Do not use dexamethasone for streptococcal pharyngitis—use acetaminophen or NSAIDs instead 1
- Do not delay antibiotics to give dexamethasone first in meningitis—they must be given together or dexamethasone slightly before 1
- Do not use simple weight-based scaling from adult doses—children have different pharmacokinetics than adults, and neonates/infants have immature elimination pathways 5, 6
- Preservative-free solutions must be used in neonates and premature infants when mixing for IV infusion 3
Practical Administration Notes
- When mixing with infusion solutions, use within 24 hours as these lack preservatives 3
- Intramuscular administration has a slower absorption rate than IV—recognize this when choosing route 3
- For croup, oral administration is preferred when the child can tolerate it, as it avoids injection pain and is equally effective 2