Ventolin Inhaler Dosing for 18-Month-Old Children
For an 18-month-old child, administer 1-2 puffs (90 mcg per puff) of Ventolin (albuterol) MDI every 4-6 hours as needed for bronchospasm, using a spacer with face mask, which is mandatory at this age. 1
Standard Maintenance Dosing
- The recommended dose for children under 5 years is 1-2 puffs every 4-6 hours as needed for symptom relief 1
- Each puff delivers 90 mcg of albuterol 2
- A spacer/holding chamber with face mask must be used for all children under 4 years of age - failure to use this dramatically reduces drug delivery and therapeutic effect 1
- Puffs should be administered 10-15 seconds apart; longer intervals provide no additional benefit 1
Acute Exacerbation Dosing
If your child is experiencing an acute asthma exacerbation with increased work of breathing, the dosing changes substantially:
- Administer 4-8 puffs every 20 minutes for 3 doses initially 2, 1
- After the first 3 doses, continue with 4-8 puffs every 1-4 hours as needed based on symptom severity 2
- For severe exacerbations, consider doubling the usual dose 1
- Always use the spacer with face mask during acute episodes 1
Critical Safety Considerations
- Increasing use or lack of expected effect indicates worsening asthma control and requires immediate medical evaluation 1
- At 18 months of age, if using nebulizer solution instead of MDI, the minimum effective dose is 1.25 mg even if weight-based calculations yield a lower number 1
- Monitor for adverse effects including tachycardia, tremor, and irritability, though these are less common with inhaled versus systemic administration 1
When to Add Ipratropium
For moderate to severe exacerbations not responding to albuterol alone after 15-30 minutes:
- Add ipratropium bromide (half dose of approximately 100-125 mcg for very young children like 18-month-olds) via nebulizer 3
- Administer every 20 minutes for 3 doses, then every 6 hours until improvement begins 3
- This combination is particularly important if the child has respiratory rate concerns, significant work of breathing, or life-threatening features 3
Administration Technique Pitfalls
The most common error at this age is attempting to use the MDI without a spacer and face mask, which results in minimal drug delivery to the lungs and treatment failure 1. Ensure proper seal of the face mask and that the child takes 5-6 breaths through the spacer after each puff actuation.