Albuterol Dosing for a 1-Year-9-Month-Old Child
For a 21-month-old child with acute wheezing, use a metered-dose inhaler (MDI) with spacer and face mask as first-line therapy, delivering 2 puffs (180 mcg total) every 20 minutes for up to 3 doses, then every 1-4 hours as needed. 1
Preferred Delivery Method: MDI with Spacer
A metered-dose inhaler with spacer (and face mask for this age) is the preferred delivery system over nebulization for infants and young children, as it is cheaper, more convenient, and equally or more effective. 1
For children under 2 years with acute wheezing, MDI with spacer has been shown to reduce hospital admissions compared to nebulization (5% vs 20% admission rate), particularly in more severe exacerbations. 2
The spacer device is better tolerated by young children (94% of parents found it easier to use, 62% reported better acceptance). 3
Specific MDI Dosing Protocol
Acute Exacerbation Treatment:
- Initial dose: 2 puffs (90 mcg per puff = 180 mcg total) via MDI with spacer and face mask 4
- Repeat every 20 minutes for the first 3 doses 1
- Then continue every 1-4 hours as needed 1
- Each puff should be administered separately with 5-6 breaths through the spacer before the next puff 3
Weight-Based Dosing Alternative:
- If using weight-based dosing: 50 mcg/kg per treatment (approximately 2 puffs for a 10-13 kg child) 3
- This can be repeated up to 20 puffs total if needed in severe cases 1
Nebulizer Dosing (If MDI Cannot Be Used)
If the child cannot tolerate the spacer and face mask, use nebulization: 1
- Dose: 0.15 mg/kg (minimum 2.5 mg) via nebulizer 1
- For a 10-13 kg child, this equals approximately 1.5-2 mg, but round up to the standard 2.5 mg dose 5
- Dilute to a minimum of 3 mL total volume with normal saline 6
- Deliver via oxygen-driven nebulizer at 6-8 L/min flow rate 7, 6
- Repeat every 20 minutes for 3 doses, then every 1-4 hours as needed 7, 8
Important Clinical Considerations
Safety Profile:
- Cumulative dosing with albuterol 180-360 mcg via MDI-spacer in children under 2 years does not result in significant safety issues and improves symptoms by at least 48%. 4
- Monitor for tachycardia, tremor, and other beta-adrenergic side effects, though these are rare with inhaled therapy. 1, 7
Severe Exacerbations:
- For severe or life-threatening wheezing, consider adding ipratropium bromide 250 mcg to the nebulizer (if using nebulization) or 2-3 puffs via MDI every 20 minutes for 3 doses. 1, 7, 6
- More frequent administration (every 20 minutes) can be continued beyond 3 doses if needed in severe cases. 7
Common Pitfalls to Avoid:
- Do not use the 0.083% concentration for children under 15 kg—use the 0.5% concentration diluted appropriately instead. 5
- Ensure proper face mask fit for optimal drug delivery in this age group. 6
- If previously effective dosing fails to provide relief, this signals seriously worsening asthma requiring immediate reassessment. 5