What is the recommended dose of albuterol (bronchodilator) for an 11-month-old child?

Albuterol Dosing for an 11-Month-Old

For an 11-month-old infant with bronchospasm, administer 0.63 mg/3 mL of albuterol nebulizer solution every 4-6 hours as needed, or alternatively 1-2 puffs (90 mcg per puff) via metered-dose inhaler with spacer and face mask every 4-6 hours. 1

Standard Maintenance Dosing

Nebulizer Solution (Preferred for This Age)

• Dose: 0.63 mg/3 mL administered every 4-6 hours as needed for bronchospasm 1
• This is the American Academy of Pediatrics-recommended dose for all children under 5 years of age 1
• Use oxygen as the preferred gas source for nebulization at 6-8 L/min flow rate 1
• The treatment should be delivered over approximately 5-15 minutes 2

Metered-Dose Inhaler Alternative

• Dose: 1-2 puffs (90 mcg per puff) every 4-6 hours as needed 1
• Critical requirement: Must use a spacer/valved holding chamber with face mask for children under 4 years, as drug delivery is dramatically reduced without it 1
• Puffs can be taken in 10-15 second intervals 1

Acute Exacerbation Dosing

For Moderate to Severe Bronchospasm

• Initial treatment: 0.63 mg every 20 minutes for 3 doses, then every 1-4 hours as needed 1
• Weight-based calculation (0.075 mg/kg) at 11 months may yield doses below the minimum effective threshold 1
• Always use the minimum dose of 1.25 mg if weight-based calculation yields a lower number for acute exacerbations 1
• However, for routine maintenance in infants under 15 kg, the 0.63 mg dose is appropriate 1, 2

MDI for Acute Symptoms

• 4-8 puffs every 20 minutes for 3 doses, then every 1-4 hours as needed 1
• Again, spacer with face mask is mandatory 1

Important Clinical Considerations

Severe Status Asthmaticus

• For life-threatening exacerbations requiring continuous nebulization: 0.5 mg/kg per hour up to 10-15 mg/hour 1
• Must be diluted in 25-30 mL saline for 1 hour of nebulization 1

Adjunctive Therapy for Severe Cases

• Consider adding ipratropium bromide 0.25 mg to albuterol nebulization every 20 minutes for the first 3 doses in severe exacerbations 1
• For very young children, half doses (approximately 100-125 mcg) of ipratropium can be used 3
• The combination can be mixed in the same nebulizer solution 1

Safety Monitoring

Watch for Adverse Effects

• Monitor for tachycardia, skeletal muscle tremor, hypokalemia, hyperglycemia, and headache 1
• Repeat administration and adjust dose until desired clinical effect is achieved, unless symptomatic tachycardia develops 1

Warning Signs

• Increasing use or lack of expected effect indicates diminishing control and requires immediate medical reassessment 1
• This is often a sign of seriously worsening respiratory disease requiring therapy escalation 2

Critical Pitfalls to Avoid

1. Never use oral albuterol formulations in acute settings—they have slower onset, reduced effectiveness, and increased systemic side effects 4

2. Failure to use spacer with face mask in infants dramatically reduces drug delivery—this is non-negotiable for MDI administration 1

3. Do not underdose in acute exacerbations—while 0.63 mg is appropriate for maintenance, acute situations may require 1.25 mg minimum 1

4. Supplemental oxygen may be needed when using compressed air-driven nebulizers 1