Diazepam Dosing Guidelines for Children

Intravenous (IV) Administration

The American Academy of Pediatrics recommends IV diazepam dosing of 0.1-0.3 mg/kg every 5-10 minutes (maximum: 10 mg per dose) for status epilepticus in children, and it should be administered over approximately 2 minutes to avoid pain at the IV site 1
For sedation/anxiolysis, the recommended IV dose is 0.05-0.10 mg/kg given over 2-3 minutes (maximum single dose: 5 mg), with peak effect occurring at 3-5 minutes 2
Diazepam should be followed immediately by a long-acting anticonvulsant due to its rapid redistribution and potential for seizure recurrence within 15-20 minutes 1

For seizure management when IV access is unavailable, the recommended rectal dose is 0.5 mg/kg up to 20 mg, with absorption potentially being erratic compared to IV administration 1

For sedation/anxiolysis, the recommended oral dose is 0.25-0.50 mg/kg (maximum: 20 mg), with children under 6 years old potentially requiring up to 1 mg/kg 2

There is an increased risk of apnea when diazepam is given rapidly IV or when used in combination with other sedative agents, and monitoring of oxygen saturation and respiratory effort is crucial 1
Flumazenil may be administered to reverse life-threatening respiratory depression caused by diazepam, but it also counteracts the anticonvulsant effects and may precipitate seizures 1
Paradoxical agitation may occur, especially in younger children, when using diazepam for sedation/anxiolysis 2