A pediatric code changes the math the moment the team walks in. Every drug, every joule, and every fluid bolus has to be calculated against a number that adult resuscitation never asks for: the patient's weight. There is no fixed "one amp of epinephrine" shortcut like the one many providers lean on during adult arrests. In pediatrics, the dose is a function of kilograms, and getting that number fast, and getting the math right under pressure, is arguably as important as recognizing the rhythm on the monitor.
This guide pulls together the core weight-based dosing reference points for PALS drug dosages that come up most often in a pediatric arrest or peri-arrest event: epinephrine, amiodarone, atropine, adenosine, and isotonic fluids. It also covers length-based tape context for when a scale is not available, and walks through the dosing errors that show up again and again in pediatric emergency care so your team can build habits that catch them before they reach the patient. If you already know the adult side of this well, the ACLS medications cheat sheet is the companion reference for fixed adult dosing, and it is worth comparing side by side with what follows here so the differences stay clear in your head.
The reason PALS builds its entire medication framework around weight rather than fixed doses comes down to physiology. A 4 kg infant and a 60 kg adolescent can both be "pediatric" patients, and a fixed dose that is safe for one could be dangerously inadequate or dangerously excessive for the other. Adult ACLS can rely on standardized doses because the range of adult body weight, while variable, does not swing across an order of magnitude the way it does across infancy, childhood, and adolescence. PALS closes that gap by anchoring every core drug to milligrams (or micrograms) per kilogram, which is also why pediatric bradycardia management diverges from the adult approach in ways worth understanding on their own; the comparison between pediatric and adult bradycardia algorithms is a useful companion read if you want the full picture of how PALS diverges from ACLS beyond just dosing.
Current American Heart Association and American Academy of Pediatrics pediatric advanced life support guidance treats drug administration and weight-based dosing during cardiopulmonary resuscitation as a central focus of pediatric resuscitation science, precisely because dosing accuracy has such a direct line to outcomes. That is the framework this entire quick reference is built on, and it is the same framework tested in every PALS megacode station.
In the ideal world, every pediatric patient arrives with a current, accurate weight in kilograms already documented. In the real world of a code, that information is sometimes missing, outdated, or reported in pounds by a frightened caregiver doing quick mental math. This is where length-based resuscitation tapes, most commonly recognized under the Broselow brand, earn their place on the code cart. The tape measures a child's length and cross-references it to a color-coded zone that carries precalculated drug doses, equipment sizes, and defibrillation energy levels for that zone, so the team is not doing multiplication under pressure.
Research on length-based tapes shows they are a validated, practical way to rapidly estimate pediatric weight when a scale is not available or not practical in the moment, with the tape's precalculated dosing having been used and studied since it was first described as a rapid method for estimating weight and resuscitation drug dosages from length. Accuracy is strongest across the low-to-mid pediatric weight range and tends to fall off in children who are significantly underweight or overweight for their length, which is exactly why current AHA guidance frames the tape as a tool for when weight is unknown, not a replacement for an actual measured weight whenever one can be obtained. If your code cart still uses a Broselow-style tape, it is worth confirming during every shift check that the tape is the current version and that the color zones match the precalculated dosing sheet stocked with your pediatric drugs.
The following are the weight-based dosing anchors for the medications most likely to come up in a pediatric arrest or peri-arrest event. These reflect current AHA and American Academy of Pediatrics pediatric advanced life support guidance. Always confirm dosing against your institution's current protocol and the most recent published guideline, since medication concentrations, formulations, and reconstitution instructions can vary by pharmacy and by region.
Epinephrine remains the primary vasopressor for pediatric cardiac arrest regardless of the presenting rhythm, and early administration is consistently associated with better outcomes in both shockable and nonshockable arrests.
The tenfold difference between the two epinephrine concentrations used for IV/IO versus endotracheal dosing is one of the single most dangerous points of confusion in pediatric code drug administration, which is exactly why so many institutions keep the two concentrations physically separated on the code cart. This connects directly to the Pediatric Cardiac Arrest Algorithm, where epinephrine timing and rhythm checks are sequenced together.
Amiodarone is the antiarrhythmic of choice for pediatric shock-refractory ventricular fibrillation or pulseless ventricular tachycardia, given after the second shock in the arrest sequence.
Because the bolus dose and the infusion dose look similar on paper but are administered very differently, this is a common source of hesitation mid-code. Reviewing the arrest-specific dosing alongside the Pediatric Tachycardia with a Pulse Algorithm ahead of time helps separate the two scenarios in your mind before you are standing at the bedside.
Atropine has a narrower role in pediatric resuscitation than many providers expect. It is indicated for bradycardia caused by increased vagal tone or high-grade AV block, but it is not the first-line agent for bradycardia caused by hypoxia, which is the more common pediatric cause and should be treated with oxygenation and ventilation plus epinephrine if the bradycardia persists.
The minimum dose floor is a detail that trips up teams doing rapid mental math for very small infants, since 0.02 mg/kg on a tiny patient can calculate out to less than 0.1 mg. Rounding up to the minimum, rather than down to the calculated number, is the safer default here. For a full walkthrough of when atropine fits into the broader bradycardia sequence, see the Pediatric Bradycardia with a Pulse Algorithm.
Adenosine is the first-line pharmacologic agent for stable supraventricular tachycardia in children once vagal maneuvers have been attempted or bypassed due to instability, and its very short half-life means administration technique matters as much as the dose itself.
Clinical research on optimal adenosine dosing in children found that the effective dose response varies meaningfully by patient, which is part of why the second, higher dose exists as a standard step rather than an exception; see the dose-response findings in this study on optimal adenosine dosing for pediatric SVT. This pairs naturally with the Pediatric Tachycardia with a Pulse Algorithm, which sequences adenosine alongside synchronized cardioversion for the unstable patient.
Fluid resuscitation is a core PALS intervention for pediatric shock, including septic shock, and current guidance favors a more measured approach than the older reflexive large-volume bolus.
The shift toward smaller, reassessed boluses reflects the recognition that fluid overload carries its own morbidity risk in pediatric shock, so clinical judgment about bolus size and pace, rather than a single fixed number, is now built into the guidance itself.
Every drug above assumes IV or IO access, and PALS is explicit that IO access should be attempted quickly if IV access is not immediately available, rather than delaying drug administration while repeated peripheral IV attempts fail on a small or vasoconstricted vein. The endotracheal route exists for epinephrine specifically as a bridge option, using the higher concentration and higher dose described above, but it is not interchangeable with IV/IO dosing for any other core code drug and it is not considered a preferred route once IO access is achievable.
Because IO access is so central to timely pediatric drug delivery, it is worth reviewing landmark selection, needle sizing, and confirmation technique separately from drug dosing itself. The step-by-step guide to intraosseous access walks through the tibial and humeral approaches most commonly used in pediatric resuscitation, including how to confirm placement before pushing a code drug through the line.
Pediatric emergency care is widely recognized as a high-risk environment for medication errors, and the reasons are structural rather than a matter of individual carelessness. Weight-based dosing itself, verbal orders shouted mid-code, a lack of standardized pediatric formulations, and the sheer rarity of pediatric arrests compared to adult codes all combine to create conditions where errors are more likely, according to a review of pediatric medication safety in the emergency department published by the American Academy of Pediatrics.
The most dangerous and most studied category is the tenfold error, where a misplaced decimal point or an extra zero delivers ten times the intended dose. A review of emergency department medication safety reports identified pediatric weight errors and resultant medication dosing errors as a recurring pattern, with decimal point confusion and zero placement flagged as frequent contributing causes. A handful of specific failure points show up again and again:
The most consistent fix identified across pediatric safety research is removing the need for real-time calculation altogether. Precalculated dosing references, whether a length-based tape, a laminated weight-based chart taped to the code cart, or a smart pump with pediatric dosing limits built in, reduce the opportunities for a tenfold error to slip through. A second team member reading back every dose and route out loud before it is drawn up, a practice sometimes called closed-loop communication, adds a human check on top of the printed reference.
Weight-based dosing accuracy is not something you want to be reasoning through for the first time during a real pediatric arrest. It is a skill built through repetition: running mock codes with different weight zones, drilling the epinephrine concentration distinction until it is automatic, and pairing each drug with the algorithm it belongs to so the dose and the sequence come to mind together rather than as separate facts to recall under pressure.
This is exactly the kind of scenario-based recall that a PALS certification or recertification course is built to reinforce, since the megacode stations are designed to test dosing decisions in the context of a full pediatric arrest sequence rather than as isolated flashcard facts. If you want to work through the algorithms these drugs plug into, the PALS algorithms hub lays out the full sequence for arrest, bradycardia, tachycardia, and shock side by side, which makes it easier to see exactly where each drug in this reference fits.
Weight-based dosing is what makes pediatric resuscitation both harder and, in a meaningful sense, safer than the adult equivalent: harder because there is math involved at every step, safer because that math forces a deliberate pause to confirm weight, concentration, and route before a drug is pushed. Keep a current dosing reference on or near every pediatric code cart, confirm your length-based tape is current if your unit still uses one, and build the habit of saying the dose and route out loud before anyone draws it up.
None of this replaces hands-on practice. Running through epinephrine, amiodarone, atropine, adenosine, and fluid dosing in a simulated code, on a recurring basis rather than only at recertification time, is what keeps this reference from being just a page you read once and forget. If your PALS card is coming up for renewal, treat it as a chance to rehearse these numbers again under realistic pressure, not just to check a compliance box.
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