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Drug therapy
Leading article
Estimation of body weight in children in the absence of scales: a necessary measurement to insure accurate drug dosing
  1. Susan M Abdel-Rahman1,2,
  2. Anna Ridge3,
  3. Gregory L Kearns1,2
  1. 1Department of Pediatrics, The University of Missouri—Kansas City School of Medicine, Kansas City, Missouri, USA
  2. 2The Division of Pediatric Pharmacology and Therapeutic Innovation, The Children's Mercy Hospital, Kansas City, Missouri, USA
  3. 3Raigmore Hospital, Inverness-shire, UK
  1. Correspondence to Dr Gregory L Kearns, The Children's Mercy Hospital, 2420 Pershing, Third Floor, Kansas City, MI 64108, USA; gkearns{at}cmh.edu

https://doi.org/10.1136/archdischild-2013-305211

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    Body weight (BW) is one of most important measurements in paediatric medicine. In addition to being one of the first parameters announced at the birth of a child in the developed world, BW is used to determine intravenous fluid requirements, shock voltage administered during cardio-respiratory arrest, endotracheal tube size and to assess nutritional status. In prepubertal children, height, age and BW represent co-migrating anthropometric surrogates which are predictive of organ function including the liver and kidney1 (figure 1) and by inference, the function of physiologic processes which collectively determine drug disposition.2 It has been previously stated3 that the BW-based dosing approach has its origins in the Kleiber principle4 which makes the following basic assumptions: (1) that total BW correlates with organ size and hence function and (2) that basal metabolism is proportional to the BW raised to the 0.75 power (BW0.75). Old, previously applied standard approaches for paediatric drug dosing such as Clark's rule (eg, Infant dose=(BWinfant /BWadult) Adult dose) have been largely abandoned in that a simple proportionality of BW between a child and an adult does not accurately reflect the nonlinearity in the relationship between BW and the age-dependent changes in drug disposition.2

    Figure 1

    Relationship between renal total cortical volume and weight (A) and height (B) in children and adolescents. Adapted from Tan et al1 as deposited in the NIH Public Access database (http://www.nih.gov; doi: 10.1097/TP.0b013e318237053ef).

    The safe administration of medicines to children relies on an ability to correctly calculate the drug dose5 and accurately measure and administer a given drug formulation. Given that the majority of paediatric drug doses are calculated on a milligram or microgram per kilogram bodyweight basis, it is essential that the prescriber and/or healthcare provider have an accurate determination of the child's …

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    Footnotes

    • Contributors SMA-R performed all analyses required in comparison with different methods for prediction of body weight and contributed these sections of the manuscript. She also contributed sections of the manuscript, created the illustrations and performed final copy editing of the manuscript prior to submission. AR contributed to the literature review and the creation of the summaries concerning the various weight estimation methods reviewed in the manuscript. She participated in the drafting of the manuscript and reviewed (and approved) the final draft prior to submission. GLK conducted the review of the literature regarding the use of weight as a physiological surrogate. He contributed to the drafting of the background and conclusions sections of the paper and took responsibility for preparing the final draft of the manuscript for submission.

    • Funding Supported in part by resources received from the WHO (contracts 200326848, 200376118, and 200474476), the Eunice Kennedy Shriver National Institute of Child Health and Human Development (Pediatric Trial Network contracts: HHSN2752010000031 (HHSN27500008) and HHSN275200900012C), the USA Food and Drug Administration (grant 1 U01 FD004249-01) and the Children's Mercy Hospital. The Mercy Tape represents intellectual property solely owned by the Children's Mercy Hospital (US patent number 8 590 168).

    • Competing interests None.

    • Provenance and peer review Commissioned; externally peer reviewed.