What is the recommended atropine dose for symptomatic bradycardia in pediatric patients?

• A. 0.04 mg/kg IV/IO
• B. 0.02 mg/kg IV/IO, minimum 0.1 mg; maximum per dose 0.5 mg
• C. 0.1 mg/kg IV/IO
• D. 0.5 mg/kg IV/IO

Answer: (B)

In pediatric symptomatic bradycardia, atropine is dosed by weight and given IV or IO to quickly counteract excessive vagal tone on the heart. The standard approach is 0.02 mg/kg per dose, with a minimum of 0.1 mg and a maximum of 0.5 mg per dose. This keeps the dose effective across different child sizes while limiting the risk of anticholinergic toxicity. The 0.02 mg/kg amount is the amount most likely to raise the heart rate when bradycardia is due to vagal stimulation, which is a common reversible cause in children. The minimum ensures even very small patients receive a measurable dose, while the maximum prevents too much atropine, which can cause overheating, delirium, tachyarrhythmias, or paradoxical bradycardia at high levels. If atropine doesn’t improve the rhythm, other interventions such as pacing or an epinephrine infusion are considered.