The use of oral midazolam in paediatric patients

NHS Tayside ED Guidance
NHS Tayside

Much can be done to reduce fear and anxiety in paediatric patients by good communication with the child and reducing pain by giving analgesia.

Once analgesia has been addressed and the child remains distressed, it may be useful to consider anxiolysis – decreasing fear and anxiety for the child.

Oral midazolam syrup can be helpful with this.

The common clinical situations in which it may be considered in the Emergency Department will include:-

  • suturing of wounds
  • wound cleansing and toilet
  • burns dressings

As noted above, midazolam should never be prescribed alone and a child being considered for oral midazolam must be considered for oral paracetamol first.

Midazolam must never be prescribed alongside opiate analgesics, as in combination a marked cardiovascular and respiratory depression may occur.

Dosage

The safe and effective dose of midazolam syrup is 0.5mg/kg

Dosage table

This dose would not produce clinically significant respiratory depression and therefore there is no routine monitoring for the patient to be managed in a resuscitation environment.

If in any doubts or concerns about the appropriateness of use of Midazolam then please consult senior medical staff for help.

Oral midazolam must never be prescribed alongside opiates.

Always ensure patient has had oral paracetamol first.

For further information see protocol on Staffnet.

Editorial Information

Last reviewed: 01/10/2016

Author(s): Barry Klassen, Jenna Headley.

Reviewer name(s): C Donald.