Table 2.

Pediatric symptom management (non-pain) at the end of life

Symptom	Medication	Common Pediatric Dosage (<60 kg)	Maximum Daily Dosagea
Agitation/Delirium	Nonpharmacologic	Familiar objects, low lighting, soothing tones/music
	Lorazepam	0.05 mg/kg/dose PO, SL (preferred for seizure), or PR every 4–6 h	2 mg per dose
	Chloral hydrate	25–50 mg/kg/day PO/PR divided every 6–8 h	1 g/day for infants, 2 g/ day for children
	Haloperidol	0.01–0.02 mg/kg per dose PO, SL, or PR every 8–12 h	0.15 mg/kg/ day
Dyspnea	Nonpharmacologic	Elevate head of bed, fluid restriction, suctioning, bedside fan, flowing air
	Morphine	0.15 mg/kg PO/SL every 2 h PRN (titrate to effect)
	Lorazepam*	0.05 mg/kg PO/SL every 4–6 h PRN (titrate to effect)	2 mg per dose
Nausea/Vomiting	Nonpharmacologic	Avoid irritating foods or smells, relaxation, biofeedback, acupuncture, aromatherapy
	Ondansetron	0.15 mg/kg/dose PO/IV every 8 h PRN	8 mg per dose
	Promethazine	>2 y: 0.25 mg/kg/dose PO/IV every 6–8 hr PRN	1 mg/kg/day
	Scopolamine	8–15 kg: half patch TD every 3 days, >15 kg: 1 patch TD every 3 days	1 patch every 3 days
	Metoclopramide	0.01–0.02 mg/kg/dose per dose IV every 4 hr
	Lorazepam	0.05 mg/kg PO/SL every 4–6 h PRN (titrate to effect)	2 mg per dose
Secretions	Nonpharmacologic	Fluid restriction, gentle suctioning
	Glycopyrrolate	0.04–0.1 mg/kg/d PO every 4–8 h	1–2 mg per dose or 8 mg/day
		0.01–0.02 mg/kg/d IV every 4–6 h

Abbreviations: IV, intravenous; PR, per rectum, SL, sub-lingual; TD, transdermal

^aCommon maximum dosage; however, dose escalation may be necessary at EOL

^*Lorazepam used for dyspnea associated with anxiety

Adapted from Johnson L-M, Snaman JM, Cupit MC, Baker JN. End-of-Life Care for Hospitalized Children. Pediatr Clin N Am. 2014;61:835–854.