Atropine Dosing for Bradycardia in Children

Dosing Algorithm

The American Academy of Pediatrics recommends a dose of 0.02 mg/kg IV/IO for symptomatic bradycardia in children, with a minimum single dose of 0.1 mg and maximum single dose of 0.5 mg for children and 1.0 mg for adolescents, which can be repeated every 5 minutes to a maximum total dose of 1 mg for children and 2 mg for adolescents 1
For symptomatic vagally mediated bradycardia or AV block, the recommended dose is 0.02 mg/kg IV/IO 1
The maximum single dose is 0.5 mg for a child and 1.0 mg for an adolescent 1
Atropine may be administered via endotracheal tube if IV/IO access is unavailable, with a dose of 0.01-0.03 mg/kg for neonates and 0.03-0.06 mg/kg for children and adolescents 1

The American Heart Association recommends oxygenation and ventilation as essential first maneuvers in treating symptomatic bradycardia 1
Epinephrine is the drug of choice if oxygen and adequate ventilation are not effective in treating hypoxia-induced bradycardia 1
For bradycardia associated with rapid sequence intubation (RSI), a dose of 0.01-0.02 mg/kg IV/IO is recommended before administration of sedative/anesthetic and paralytic agents 1, 2
For anticholinesterase poisoning, a dose of 0.05 mg/kg IV is recommended, repeated as needed for clinical effect 1, 3

The 2015 American Heart Association guidelines state that a dose of 0.02 mg/kg with no minimum dose may be considered when atropine is used as premedication for emergency intubation 2, 4
Atropine sulfate comes in different concentrations, and dosage should be calculated carefully 1
For IV/IO administration, atropine should be administered by slow push for cardiac arrest 1
When administered via endotracheal tube, atropine should be followed by or diluted in saline flush (1-5 mL) based on patient size 1

Atropine may cause tachycardia, which could worsen ischemia in patients with acute coronary syndrome 5

La dosis recomendada de atropina para neonatos es 0.01-0.03 mg/kg IV/IO, sin dosis mínima requerida según las guías más recientes de la American Heart Association 6
Las guías de 2015 eliminaron el requisito de dosis mínima de 0.1 mg que existía previamente, después de evidencia que demostró eficacia con 0.02 mg/kg sin dosis mínima, según la American Heart Association 6
No se recomienda el uso rutinario de atropina para preintubación en neonatos críticamente enfermos, pero puede ser razonable en situaciones de alto riesgo de bradicardia (Clase IIb), según la American Heart Association 6

No usar dosis mínima de 0.1 mg en neonatos: Esta recomendación antigua se basó en reportes de bradicardia paradójica con dosis muy bajas, pero evidencia reciente demuestra que 0.02 mg/kg sin dosis mínima es efectiva y segura, según la American Heart Association 6