Almost every paediatric drug error that reaches a child starts with a weight that was estimated, remembered, copied from a previous admission, or reported by a parent. Age-based formulae and tape-based estimates exist for the child who arrives unconscious in the back of an auto-rickshaw, not for the child sitting on the couch while you write a prescription.
The errors cluster in predictable places. A child who has been unwell for a week weighs less than at the last visit. A malnourished child weighs far less than any age formula predicts, and the same formula overestimates in obesity. A weight in the notes from three months ago is a different child.
So weigh, write the weight and the date at the top of the chart, and calculate from that. When a resuscitation makes weighing impossible, say aloud that the weight is estimated and by what method - it tells everyone downstream how much to trust the doses that follow, and it is the one piece of information that never gets recorded otherwise.
- Weigh the child at the visit rather than using a recorded or reported weight.
- Write the weight and the date of weighing at the top of the drug chart.
- Expect age-based formulae to overestimate in malnutrition and in acute illness.
- State aloud when a weight is estimated, and by which method.
- Re-weigh on a prolonged admission before recalculating maintenance doses.
Why it matters
Nearly every paediatric dosing error traces back to a weight nobody actually measured that day.
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