Midazolam Dosing for Procedural Sedation in Children

Weight-Based Dosing Algorithm

For children 6 months to 5 years of age, the American College of Emergency Physicians recommends an initial IV dose of 0.05-0.1 mg/kg midazolam, with a practical calculation starting at 0.5 mg IV, waiting 3-5 minutes, then giving additional 0.25 mg increments as needed, with a maximum total dose of 0.6 mg/kg if needed to achieve adequate sedation 1

The American College of Emergency Physicians warns that respiratory depression is the primary risk, particularly when midazolam is combined with opioids or other sedatives, and recommends continuous oxygen saturation monitoring throughout the procedure and recovery, with bag-valve-mask ventilation equipment immediately available 1
The American College of Emergency Physicians recommends having flumazenil readily accessible to reverse life-threatening respiratory depression, and notes that the combination of midazolam with fentanyl or other narcotics significantly increases respiratory depression risk 1

The American College of Emergency Physicians states that the recovery time from midazolam sedation is typically 30-60 minutes, though this varies with total dose administered 1