Pediatric Drug Dosing Guidelines

Dose Rounding Strategies

The American Academy of Pediatrics recommends medications be assigned to specific rounding tolerance categories based on therapeutic index and toxicity risk, with narrow therapeutic index drugs rounded only to the nearest 0.1 mL or not rounded at all 1
The American Academy of Pediatrics suggests dose-dependent toxicity drugs be rounded down to easily administered doses while respecting maximum dose guidelines, and standard medications can tolerate wider rounding percentages after expert consensus 1
Expert consensus achieved a 10% rounding tolerance for metoclopramide despite tardive dyskinesia risk, reflecting real-world practice patterns, and automated dose-rounding systems in e-prescribing can reduce errors when properly calibrated to medication-specific tolerances 1

The American Academy of Pediatrics recommends oseltamivir dosing for infants 0-8 months (term) at 3 mg/kg/dose twice daily for 5 days, for infants 9-11 months at 3.5 mg/kg/dose twice daily for 5 days, and for children ≥12 months using weight-tiered dosing 2
The American Academy of Allergy, Asthma, and Immunology recommends epinephrine dosing for anaphylaxis at 0.01 mg/kg (0.01 mL/kg of 1:1000 solution) intramuscularly, with a maximum of 0.3 mg per dose, and repeat every 5 minutes as needed, and 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) intravenously for cardiac arrest or profound hypotension after failed IM doses 3