What atropine dosing is suggested for pediatric symptomatic bradycardia with poor perfusion?

• A. 0.01 mg/kg IV, max 0.1 mg
• B. 0.04 mg/kg IV, max 2 mg
• C. 0.02 mg/kg IV/IO, min 0.1 mg, max per dose 0.5 mg
• D. No atropine recommended

Answer: (C)

In pediatric symptomatic bradycardia with poor perfusion, atropine is used to counteract excessive vagal (parasympathetic) influence on the heart, helping the heart rate rise quickly to improve perfusion. The recommended approach is a dose of 0.02 mg/kg given IV or IO, with a minimum dose of 0.1 mg to ensure a detectable amount in smaller children and a maximum of 0.5 mg per dose to prevent excessive anticholinergic effects. If perfusion remains compromised and the rhythm persists, repeating the same dose every 3–5 minutes is acceptable, up to the per-dose maximum. This dosing targets rapid vagal relief and is specific to pediatric bradycardia where atropine is indicated; smaller or larger per-dose amounts are not aligned with the guideline, and there are scenarios where atropine may not be effective, requiring other interventions.