Reference Range Values For Pediatric Care-2nd PDF

Tw
Reference
Range Values
for Pediatric Care
2ND EDITION
Editor
Lamia Soghier, MD, MEd, FAAP
Contributing Editors
Karen Fratantoni, MD, MPH, FAAP
Christine Reyes, MD, FCAP
Assistant Editor
Kristin Mullins, PhD
American Academy of Pediatrics Publishing Staff
Mary Lou White, Chief Product and Services Officer/SVP, Membership, Marketing, Publishing
Mark Grimes, Vice President, Publishing
Carrie Peters, Editor, Professional/Clinical Publishing
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Linda Smessaert, MSIMC, Senior Marketing Manager, Professional Resources
Mary Louise Carr, MBA, Marketing Manager, Clinical Publications
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safety, and well-being of infants, children, adolescents, and young adults.
The recommendations in this publication do not indicate an exclusive course of treatment
or serve as a standard of medical care. Variations, taking into account individual
circumstances, may be appropriate.
Every effort has been made to ensure that the drug selection and dosage set forth in this text
are in accordance with the current recommendations and practice at the time of publication.
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iii
EDITOR
Lamia M. Soghier, MD, MEd, FAAP
Assistant Professor of Pediatrics
The George Washington University School of Medicine and
Health Sciences
Medical Director, Neonatal Intensive Care Unit
Children’s National Health System
Washington, DC
CONTRIBUTING EDITORS
Assistant Professor of Pediatrics
Health Sciences
Medical Director, Complex Care Program
Washington, DC

Associate Chief, Pathology and Laboratory Medicine Division
Director of Chemistry, Point of Care Testing and Clinical Laboratory
Support Services
Assistant Professor of Pediatrics and Pathology
Health Sciences
Washington, DC
ASSISTANT EDITOR
Kristin Mullins, PhD
Associate Director of Chemistry, Point of Care Testing, and Clinical
Laboratory Support Services
Washington, DC
iv Reference Range Values for Pediatric Care
CONTRIBUTORS
Sarah Goff, RD, LD, CNSC
Pediatric Clinical Dietitian
Washington, DC
Laura Leathers, PharmD, BCPPS

Clinical Pharmacy Specialist, CICU
Washington, DC
Sara Rooney, PharmD, BCPS, BCPPS

PICU Clinical Pharmacy Specialist
Washington, DC
Victoria C. Snelgrove, RD, LD, CNSC, CLC

Neonatal Intensive Care Unit Dietitian
Washington, DC
v
CONTENTS
Introduction...............................................................................................xiii
1. Conversions....................................................................................1
Conversion Formulas.............................................................................. 1
Temperature Conversion........................................................................ 1
Fahrenheit to Celsius Conversion...................................................... 2
Weight Conversion.................................................................................. 3
Newborn Weight Conversion Chart................................................. 3
Infant and Toddler Weight Conversion Chart.................................. 4
2. Scales and Scoring.........................................................................7

APGAR Score........................................................................................... 7
New Ballard Score................................................................................... 8
Pain Scales.............................................................................................. 10
Wong-Baker FACES Pain Rating Scale.......................................... 10
FLACC Pain Scale.............................................................................. 10
Neonatal Pain, Agitation, and Sedation Scale (NPASS) ............... 11
Pediatric Early Warning Score (PEWS).......................................... 16
Glasgow Coma Scale............................................................................. 17
Glasgow Coma Scale for Children.................................................. 17
Croup Score ........................................................................................... 18
3. Growth..........................................................................................19
Determining Body Surface Area.......................................................... 19
Growth Charts....................................................................................... 20
Average Growth Velocity by Age-group........................................ 20
Fenton Preterm Growth Chart—Boys............................................. 21
Fenton Preterm Growth Chart—Girls............................................. 22
WHO Birth to 24 Months: Boys—Head Circumference-
for-age and Weight-for-length Percentiles................................ 23
WHO Birth to 24 Months: Boys—Length-for-age and
Weight-for-age Percentiles.......................................................... 24
WHO Birth to 24 Months: Girls—Head Circumference-
for-age and Weight-for-length Percentiles................................ 25
WHO Birth to 24 Months: Girls—Length-for-age and
vi Reference Range Values for Pediatric Care
CDC 2 to 20 Years: Boys—Stature-for-age and

CDC 2 to 20 Years: Boys—Body Mass Index-for-age
Percentiles..................................................................................... 28
CDC 2 to 20 Years: Girls—Stature-for-age and
CDC 2 to 20 Years: Girls—Body Mass Index-for-age
Percentiles..................................................................................... 30
Growth Charts for Children With Special Health Care Needs......... 31
Online Growth Charts....................................................................... 31
Growth Charts for Special Populations.......................................... 31
Growth Charts for Children With Down Syndrome,
Birth to 36 Months: Boys—Weight-for-age Percentiles........... 32
Birth to 36 Months: Boys—Length-for-age Percentiles........... 33
Birth to 36 Months: Boys—Head Circumference-
for-age Percentiles........................................................................ 34
Birth to 36 Months: Boys—Weight-for-length Percentiles...... 35
Birth to 36 Months: Girls—Weight-for-age Percentiles .......... 36
Birth to 36 Months: Girls—Length-for-age Percentiles........... 37
Birth to 36 Months: Girls—Head Circumference-for-
age Percentiles.............................................................................. 38
Birth to 36 Months: Girls—Weight-for-length Percentiles...... 39
Height and Weight for Children With Cerebral Palsy....................... 40
Mid-upper Arm Circumference........................................................... 41
MUAC for Age, Boys 2 to 24 Months.............................................. 42
MUAC for Age, Boys 2 to 18 Years................................................. 43
MUAC for Age, Girls 2 to 24 Months.............................................. 44
MUAC for Age, Girls 2 to 18 Years.................................................. 45
Contents vii
Pediatric Malnutrition Indicators......................................................... 46

Malnutrition Criteria When a Single Data Point Is Available....... 46
Malnutrition Criteria When 2 or More Data Points
Are Available................................................................................. 46
Growth Measures for Extremities and for Ear Above
Eyeline Levels................................................................................ 47
Upper Arm (Shoulder to Elbow) Length......................................... 48
Forearm Length................................................................................. 49
Long-Bone Length—Upper Limb.................................................... 50
Long-Bone Length—Lower Limb.................................................... 51
Lower Leg (Knee to Ankle) Length.................................................. 52
Ear Above Eyeline Level (Gestational Age).................................... 53
Ear Above Eyeline Level (Birth Weight)......................................... 54
Mean Stretched Penile Length............................................................. 55
For Neonates...................................................................................... 55
For Children....................................................................................... 56
Primary Teeth Eruption Chart.............................................................. 57
4. Blood Pressure.............................................................................59
Blood Pressure Nomograms................................................................. 59
Healthy Term Newborns During the First 12 Hours
After Birth..................................................................................... 59
Preterm and Full-term Newborns During the First Day
After Birth (According to Birth Weight).................................... 60
Preterm and Full-term Newborns During the First Day
After Birth (According to Gestational Age).............................. 61
Preterm and Full-term Newborns According to Post
Conceptional Age......................................................................... 62
Children Younger Than 1 Year......................................................... 63
Blood Pressure Levels for Boys by Age and
Height Percentile.......................................................................... 64
Blood Pressure Levels for Girls by Age and
Height Percentile.......................................................................... 66
viii Reference Range Values for Pediatric Care
5. Laboratory Reference Range Values..........................................69

Cerebrospinal Fluid............................................................................... 70
Clinical Chemistry................................................................................. 73
For Infants, Children, Teens, and Young Adults............................ 73
For Newborns.................................................................................... 84
Thyroid Function Tests.......................................................................... 86
TSH, Total T3, Total T4, and Free T4 Values of Children.................. 86
Mean Thyroid-stimulating Hormone and Thyroxine
Values of Preterm and Term Newborns 0 to 28 Days............... 87
Growth Hormones................................................................................. 87
Hematology and Coagulation............................................................... 92
Hematology Values............................................................................ 92
For Infants and Toddlers............................................................. 92
For Children, Teens, and Young Adults..................................... 94
Age-Specific Leukocyte Differential................................................ 96
For Infants and Toddlers............................................................. 96
For Children and Teens............................................................... 98
Lymphocyte Subset Counts in Peripheral Blood............................ 99
Coagulation Values.............................................................................. 102
Age-Specific Coagulation Values—Healthy Preterm Infants
(30–36 Weeks)............................................................................. 102
Age-Specific Coagulation Values—Healthy, Full-term
Infants ......................................................................................... 105
Age-Specific Coagulation Values—Childhood Compared
With Adults................................................................................. 107
6. Hyperbilirubinemia Management............................................109
Risk Nomogram................................................................................... 109
Phototherapy Nomogram................................................................... 110
Exchange Transfusion Nomogram.................................................... 111
7. Rate and Gap Calculations........................................................113

Glucose Infusion Rate......................................................................... 113
Calculated Serum Osmolality ............................................................ 113
Anion Gap ........................................................................................... 113
Contents ix
8. Nutrition and Formula Information.........................................115

Preparation of Infant Formula for Standard and
Soy Formulas.............................................................................. 115
Common Modular Supplements........................................................ 116
Enteral Formulas, Including Their Main Nutrient
Components................................................................................ 117
Composition of Fluids Frequently Used in Oral Rehydration........ 125
Fluid Needs by Weight (Holliday-Segar Method)............................ 125
Common Electrolyte Additives.......................................................... 125
Dietary Reference Intakes (DRIs)....................................................... 126
DRIs for Age: Energy and Protein................................................. 126
Infants and Toddlers.................................................................. 126
Children and Adolescents......................................................... 126
Daily Requirements DRIs for Age: Macronutrients
and Micronutrients.................................................................... 127
Fluoride Sources and Supplementation............................................ 130
Topical Fluoride Sources................................................................. 130
Dietary Fluoride Supplementation Schedule................................ 130
9. Umbilical Vein and Artery Catheterization Measurements....131

Using Birth Weight to Measure Catheter Length............................ 131
Estimate of Insertional Length of Umbilical Catheters
Based on Birth Weight With 95% Confidence Intervals........ 132
Using Shoulder-Umbilical Length to Measure Umbilical
Artery Catheter Length.............................................................. 133
Umbilical Artery Catheter Length................................................. 133
Using Shoulder-Umbilical Length to Measure Umbilical
Vein Catheter Length................................................................. 134
Umbilical Vein Catheter Length..................................................... 134
x Reference Range Values for Pediatric Care
10. Endotracheal Tube Size and Depth of Insertion...................135

Neonatal ............................................................................................ 135
Neonatal Endotracheal Tube Size According to
Gestational Age and Weight................................................. 135
Neonatal Endotracheal Tube Depth of Insertion
According to Gestational Age and Weight.......................... 135
Pediatric............................................................................................. 136
Tube Size...................................................................................... 136
Depth of Insertion...................................................................... 136
11. Doses and Levels of C ommon Medications

Requiring Therapeutic Drug Monitoring..............................137
Antibiotics......................................................................................... 138
Amikacin..................................................................................... 138
Gentamicin.................................................................................. 140
Tobramycin................................................................................. 142
Vancomycin................................................................................. 144
Anticonvulsants................................................................................ 146
Fosphenytoin.............................................................................. 146
Levetiracetam (Keppra)............................................................. 148
Phenobarbital.............................................................................. 150
Valproic Acid and Derivatives.................................................. 152
Miscellaneous.................................................................................... 153
Digoxin........................................................................................ 153
Enoxaparin.................................................................................. 155
Warfarin...................................................................................... 156
12. Appendixes..............................................................................157
Acetaminophen Toxicity Nomogram............................................. 158
Rabies Guidelines............................................................................. 159
Rabies Postexposure Prophylaxis Schedule—
United States, 2010................................................................. 159
Immunization Schedules.................................................................. 160
Recommended Immunization Schedule for
Children and Adolescents Aged 18 Years
or Younger—United States, 2018.......................................... 160
Contents xi
Catch-up Immunization Schedule for Persons

Aged 4 Months–18 Years Who Start Late or
Who Are More Than 1 Month Behind—
United States, 2018................................................................. 162
Vaccines That Might Be Indicated for Children
and Adolescents Aged 18 Years or Younger
Based on Medical Indications............................................... 163
Bright Futures/American Academy of Pediatrics
Recommendations for Preventive Pediatric
Health Care (Periodicity Schedule)..............................See insert.
French Catheter Scale..........................................................See insert.
xiii
INTRODUCTION
Reference Range Values for Pediatric Care was created in response
to an overwhelming need from pediatricians, pediatric residents,
nurse practitioners, pediatric nurses, and other pediatric providers
who acknowledged the utility of the Reference Range Values section
in the first edition of Quick Reference Guide to Pediatric Care, part of
the American Academy of Pediatrics (AAP) point-of-care offerings,
which also include the American Academy of Pediatrics Textbook of
Pediatric Care and Pediatric Care Online.
This handbook was designed with the busy practitioner in mind.
Compact and clear-cut, it provides the most commonly used ref-
erence range values, charts, and formulas at your fingertips. The
values span the gamut of age-groups, from newborn to adolescence,
with a particular emphasis on the values needed for the treatment
of preterm newborns younger than 37 weeks’ gestation. This focus
is complemented by sections that address common newborn scores
(eg, APGAR Score, New Ballard Score) as well as the AAP new-
born hyperbilirubinemia management charts. In this new (second)
edition, sections on antibiotics and anticonvulsant medications have
been expanded and now also include other commonly used drugs
with recommended serum drug target levels; preterm and neonatal
populations continue to be highlighted to assist any pediatrician
responsible for the complex dosing for this age-group. Two experi-
enced pediatric pharmacists, Laura Leathers, PharmD, BCPPS, and
Sara Rooney, PharmD, BCPS, BCPPS, have reviewed and revised this
section. In addition, 2 pediatric/neonatal dietitians, Sarah Goff, RD,
LD, CNSC, and Victoria C. Snelgrove, RD, LD, CNSC, CLC, provide
current reference ranges for nutritional requirements for growing
infants, toddlers, children, and adolescents. The handbook continues
to feature pain scales, growth measures for extremities, and the AAP
immunization and periodicity schedules.
In writing the second edition of Reference Range Values for
Pediatric Care, we would like to thank Carrie Peters, Mark Grimes,
and the AAP editorial team. We would also like to give a spe-
cial thanks to Andrea Estrada, MD (pediatric endocrinology), at
Children’s National Health System for her contribution to the text.
xiv Reference Range Values for Pediatric Care
As we strive to improve the health of all children, we hope this

book is another little step to that end.
Lamia M. Soghier, MD, MEd, FAAP

1. Conversions
CONVERSION FORMULAS
Height (Length)
1 mm = 0.04 in 1 in = 2.54 cm
1 cm = 0.4 in 1 m = 39.37 in
Weight
28.35 g = 1 oz 1 L = 1.06 qt
453.6 g = 1 lb 1 fl oz = 29.57 mL
1,000 g = 1 kg 1 tbsp = 15 mL
1 kg = 2.2046 lb 1 tsp = 5 mL
Milligram and Milliequivalent Conversions
mEq/L = [(mg/L) × valence]/atomic weight mg/L = [(mEq/L) × atomic
Equivalent weight = atomic weight/valence weight]/valence
Milligram and Millimole Conversions
mmol/L = (mg/L)/molecular weight
Milliosmoles
The milliequivalent (mEq) is roughly equivalent to the milliosmole (mOsm), that is,
the unit of measure of osmotic pressure or tonicity. One osmole (Osm) is the amount
of a substance that dissociates in solution to form one mole (mol) of osmotically
active particles.
TEMPERATURE CONVERSION
Celsius: °C = (5/9) × (°F − 32)
Fahrenheit: °F = (9/5) × (°C + 32)
2 Reference Range Values for Pediatric Care
Fahrenheit to Celsius Conversion

°F °C °F °C °F °C °F °C °F °C
125 51.6 92 33.3 59 15.0 26 −3.3 −7 −21.6
124 51.1 91 32.7 58 14.4 25 −3.9 −8 −22.2
123 50.5 90 32.2 57 13.9 24 −4.4 −9 −22.8
122 50.0 89 31.6 56 13.3 23 −5.0 −10 −23.3
121 49.4 88 31.1 55 12.8 22 −5.6 −11 −23.9
120 48.8 87 30.5 54 12.2 21 −6.1 −12 −24.4
119 48.3 86 30.0 53 11.7 20 −6.7 −13 −25.0
118 47.7 85 29.4 52 11.1 19 −7.2 −14 −25.5
117 47.2 84 28.9 51 10.5 18 −7.8 −15 −26.1
116 46.6 83 28.3 50 10.0 17 −8.3 −16 −26.6
115 46.1 82 27.8 49 9.4 16 −8.9 −17 −27.2
114 45.5 81 27.2 48 8.9 15 −9.4 −18 −27.8
113 45.0 80 26.6 47 8.3 14 −10.0 −19 −28.3
112 44.4 79 26.1 46 7.8 13 −10.5 −20 −28.9
111 43.8 78 25.5 45 7.2 12 −11.1 −21 −29.4
110 43.3 77 25.0 44 6.7 11 −11.7 −22 −30.0
109 42.7 76 24.4 43 6.1 10 −12.2 −23 −30.5
108 42.2 75 23.9 42 5.6 9 −12.8 −24 −31.1
107 41.6 74 23.3 41 5.0 8 −13.3 −25 −31.6
106 41.1 73 22.8 40 4.4 7 −13.9 −26 −32.2
105 40.5 72 22.2 39 3.9 6 −14.4 −27 −32.7
104 40.0 71 21.6 38 3.3 5 −15.0 −28 −33.3
103 39.4 70 21.1 37 2.8 4 −15.5 −29 −33.9
102 38.9 69 20.5 36 2.2 3 −16.1 −30 −34.4
101 38.3 68 20.0 35 1.7 2 −16.7 −31 −35.0
100 37.7 67 19.4 34 1.1 1 −17.2 −32 −35.5
99 37.2 66 18.9 33 0.6 0 −17.8 −33 −36.1
98 36.6 65 18.3 32 0.0 −1 −18.3 −34 −36.6
97 36.1 64 17.8 31 −0.6 −2 −18.9 −35 −37.2
96 35.5 63 17.2 30 −1.1 −3 −19.4 −36 −37.7
95 35.0 62 16.7 29 −1.7 −4 −20.0 −37 −38.3
94 34.4 61 16.1 28 −2.2 −5 −20.5 −38 −38.9
93 33.9 60 15.5 27 −2.8 −6 −21.1 −39 −39.4
−40 −40.0
Newborn Weight Conversion Chart
WEIGHT CONVERSION
Pounds 0 1 2 3 4 5 6 7 8 9 10
Ounces Grams
0 0 454 907 1,361 1,814 2,266 2,722 3,175 3,629 4,082 4,536
1 28 482 936 1,399 1,843 2,268 2,750 3,203 3,657 4,111 4,564
2 57 510 964 1,417 1,871 2,325 2,778 3,232 3,695 4,139 4,593
3 85 539 992 1,446 1,899 2,353 2,807 3,260 3,714 4,167 4,621
4 113 567 1,021 1,474 1,928 2,381 2,835 3,289 3,742 4,196 4,649
5 142 595 1,049 1,503 1,956 2,410 2,863 3,317 3,770 4,224 4,678
6 170 624 1,077 1,531 1,984 2,438 2,892 3,345 3,799 4,252 4,706
7 198 652 1,106 1,559 2,013 2,466 2,920 3,374 3,827 4,281 4,734
8 227 680 1,134 1,568 2,041 2,495 2,498 3,402 3,856 4,309 4,763
9 255 709 1,162 1,616 2,070 2,523 2,977 3,430 3,884 4,337 4,791
10 283 737 1,191 1,644 2,098 2,551 3,005 3,459 3,912 4,366 4,819
11 312 765 1,219 1,673 2,126 2,580 3,033 3,487 3,941 4,394 4,848
12 340 794 1,247 1,701 2,155 2,608 3,062 3,515 3,969 4,423 4,876
13 369 822 1,276 1,729 2,183 2,637 3,090 3,544 3,997 4,451 4,904
14 397 850 1,304 1,758 2,211 2,665 3,118 3,572 4,026 4,479 4,983
Conversions
15 425 879 1,332 1,786 2,240 2,693 3,147 3,600 4,054 4,508 4,961
3
4
Infant and Toddler Weight Conversion Chart
Reference Range Values for Pediatric Care

Kilograms Pounds Kilograms Pounds Kilograms Pounds Kilograms Pounds
3.0 6 lb 10 oz 7.0 15 lb 7 oz 11.0 24 lb 4 oz 15.0 33 lb 1 oz
Kilograms Pounds Kilograms Pounds Kilograms Pounds Kilograms Pounds
Infant/toddler weight conversion chart. Oregon Patient Safety Commission Web site. https://oregonpatientsafety.org/docs/newsletters/Inf_Tod_
Weight_Conversion_Poster.pdf. Accessed February 6, 2019. Content developed by the Oregon Patient Safety Commission (OPSC). Learn more
Conversions
about OPSC at https://oregonpatientsafety.org. Used with permission.
5
2. Scales and Scoring
APGAR Score
Points
0 Points 1 Point 2 Points Totaled
Activity
Limp Some flexion Active motion
(muscle tone)
Pulse Absent <100 beats/min >100 beats/min
Grimace
Cry or active
(reflex No response Grimace
withdrawal
irritability)
Appearance Acrocyanotic
Completely
(skin color/ Pale or blue (body pink,
pink
complexion) extremities blue)
Respiration,
Weak cry; hypo Good;
including Absent
ventilation crying
breathing
Severely depressed 0–3
Moderately depressed 4–6
Excellent condition 7–10

CHAPTER 83 Physical Examination of the Newborn 759
8
MATURATIONAL ASSESSMENT OF GESTATIONAL AGE (New Ballard Score)
NAME SEX
HOSPITAL NO. BIRTH WEIGHT
RACE LENGTH
DATE/TIME OF BIRTH HEAD CIRCUMFERENCE
DATE/TIME OF EXAM EXAMINER
New Ballard Score
AGE WHEN EXAMINED

APGAR SCORE: 1 MINUTE 5 MINUTES 10 MINUTES
NEUROMUSCULAR MATURITY
SCORE
NEUROMUSCULAR SCORE RECORD
SCORE Neuromuscular
MATURITY SIGN
1 0 1 2 3 4 5 HERE Physical
Total
POSTURE
MATURITY RATING
SQUARE WINDOW SCORE WEEKS
(Wrist)
90º 90º 60º 45º 30º 0º
10 20
ARM RECOIL 5 22
180º 140-180º 110-140º 90-110º 90º
0 24
POPLITEAL ANGLE 5 26
180º 160º 140º 120º 100º 90º 90º
10 28
SCARF SIGN 15 30
20 32
HEEL TO EAR 25 34
30 36
TOTAL NEUROMUSCULAR
35 38
MATURITY SCORE
PHYSICAL MATURITY 40 40
SCORE RECORD 45 42
PHYSICAL
SCORE
MATURITY SIGN
1 0 1 2 3 4 5 HERE 50 44
sticky gelatinous superficial cracking parchment leathery
smooth pink peeling
SKIN friable red pale areas deep cracking cracked
visible veins and/or rash,
transparent translucent few veins rare veins no vessels wrinkled
GESTATIONAL AGE
(weeks)
HOSPITAL NO. BIRTH WEIGHT
SCARF SIGN
RACE LENGTH 15 30
DATE/TIME OF BIRTH HEAD CIRCUMFERENCE 20 32
DATE/TIME
HEEL TO EAR OF EXAM EXAMINER
25 34
AGE WHEN EXAMINED
30 36
APGAR SCORE: 1 MINUTE 5 MINUTES 10 MINUTES
TOTAL NEUROMUSCULAR
35 38
MATURITY SCORE
NEUROMUSCULAR
PHYSICAL
PHYSICAL MATURITYMATURITY
MATURITY 40 40
SCORE
NEUROMUSCULAR SCORE
SCORE RECORD
RECORD 45 42
PHYSICAL SCORE Neuromuscular
SIGN SCORE
MATURITY
MATURITYSIGN
1 HERE Physical
1 00 11 22 33 44 55 HERE 50 44
Total
POSTURE smooth pink peeling
SKIN friable red pale areas deep cracking cracked
visible veins and/or rash,
GESTATIONAL AGE
MATURITY RATING
SQUARE WINDOW (weeks)
LANUGO none sparse abundant thinning bald areas mostly bald SCORE WEEKS
(Wrist) By dates
90º 90º 60º 45º 30º 0º
10
By ultrasound 20
heel-toe anterior
PLANTAR 50 mm faint creases creases over By exam
ARM RECOIL 40-50 mm: 1 transverse 5 22
SURFACE no crease red marks ant. 2/3 entire sole
40 mm: 2 180º 140-180º crease only
110-140º 90-110º 90º
0 24
stippled
barely flat areola raised areola full areola
POPLITEAL
BREAST areola 5 26
ANGLE imperceptible perceptible no bud 3-4 mm bud 5-10 mm bud
1-2 mm bud
180º 160º 140º 120º 100º 90º 90º
10 28
lids fused lids open sl. curved well-curved formed
and firm thick cartilage
EYE/EAR
SCARF SIGN loosely: 1 pinna flat pinna; soft; pinna; soft but 15 30
ear stiff
tightly: 2 stays folded slow recoil ready recoil instant recoil
20 32
GENITALS testes in testes testes
scrotum flat, scrotum empty testes down
HEEL TO EAR upper canal descending pendulous
(Male) smooth faint rugae good rugae 25 34
rare rugae few rugae deep rugae
prominent prominent 30 36
GENITALS clitoris majora and majora
clitoris and majora large
TOTAL NEUROMUSCULAR
prominent clitoris and small minora equally cover clitoris
(Female) enlarging minora small 35 38
and labia flat labia minora prominent and minora
MATURITY SCORE
minora
PHYSICAL MATURITY 40 40
Abbreviations: ant., anterior; exam, examination; sl., slightly.
TOTAL PHYSICAL RECORD
Reproduced
PHYSICAL al. New
with permission from Ballard JL, Khoury JC, Wedig K, et SCORE 45 42
Ballard score, expanded to include extremely premature infants. J Pediatr. MATURITY SCORE SCORE
MATURITY SIGN
1991;119(3):417–423. 1 0 1 2 3 4 5 HERE 50 44
smooth pink peeling
SKIN friable
Figure 83-1 red Maturational and/or rash,
pale
of areas deep cracking
gestational age cracked
(new Ballard score).
visible veins assessment
GESTATIONAL AGE
(weeks)
LANUGO none sparse abundant thinning bald areas mostly bald
By dates
By ultrasound
heel-toe anterior
PLANTAR 50 mm faint creases creases over By exam
Scales and Scoring
40-50 mm: 1 transverse

SURFACE no crease red marks ant. 2/3 entire sole
40 mm: 2 crease only
9
stippled
barely flat areola raised areola full areola
BREAST imperceptible areola
perceptible no bud 3-4 mm bud 5-10 mm bud
1-2 mm bud
lids fused lids open sl. curved well-curved formed

and firm thick cartilage
EYE/EAR loosely: 1 pinna flat pinna; soft; pinna; soft but
ear stiff
tightly: 2 stays folded slow recoil ready recoil instant recoil
GENITALS testes in testes testes

PAIN SCALES
© 1983 Wong-Baker FACES Foundation. www.WongBakerFACES.org. Used with permission.

Originally published in Whaley & Wong's Nursing Care of Infants and Children. © Elsevier Inc.
FLACC Pain Scale

Each of the 5 categories is scored from 0 to 2: (F) Face; (L) Legs; (A) Activity; (C) Cry; (C)
Consolability. The total score will be between 0 and 10.
For pediatric/preverbal children (validated 2 months to 7 years)
Not valid for children with developmental delay
Category Scoring
0 1 2
Face No particular Occasional grimace or Frequent to constant
expression or frown, withdrawn, disin quivering chin,
smile terested clenched jaw
Legs Normal position Uneasy, restless, tense Kicking, or legs
or relaxed drawn up
Activity Lying quietly, Squirming, shifting back Arched, rigid, or
normal position, and forth, tense jerking
moves easily
Cry No cry (awake Moans or whimpers, Crying steadily,
or asleep) occasional complaint screams or sobs,
frequent complaints
Consolability Content, Reassured by occasional Difficult to console or
relaxed touching, hugging, or be comfort
ing talked to; distractible
Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring post
operative pain in young children. Pediatr Nurs. 1997;23(3):293–297. © The Regents of the University
of Michigan.
Neonatal Pain, Agitation, and Sedation Scale (NPASS)
Sedation/
Sedation Pain Pain/Agitation
Assessment
Criteria −2 −1 0/0 1 2
Crying/ No cry with Moans or cries No sedation/ Irritable or crying at High-pitched or
irritability painful stimuli minimally with no pain intervals silent-continuous cry
painful stimuli signs Consolable Inconsolable
Behavior/ No arousal to Arouses minimally No sedation/ Restless, squirming Arching, kicking
state any stimuli to stimuli no pain Awakens frequently Constantly awake or arouses
No spontaneous Little spontaneous signs minimally/no movement
movement movement (not sedated)
Facial Mouth lax Minimal expres No sedation/ Any pain expression Any pain expression
expression No expression sion with stimuli no pain intermittent continual
signs
Extremities/ No grasp reflex Weak grasp reflex No sedation/ Intermittent clenched Continual clenched toes,
tone Flaccid tone ↓ muscle tone no pain toes, clenched fists, or clenched fists, or finger
signs finger splay splay
Body not tense Body tense
Vital signs No variability <10% variability No sedation/ ↑ 10%–20% from ↑ >20% from baseline
HR, RR, with stimuli from baseline no pain baseline Sao2 ≤75% with stimulation—
BP, Sao2 Hypoventilation with stimuli signs Sao2 76%–85% with slow ↑
or apnea stimulation—quick ↑ Out of sync/fighting ventilator
Scales and Scoring

Abbreviations: BP, blood pressure; HR, heart rate; RR, respiratory rate;
Sao2, arterial oxygen saturation. Premature Pain +1 if <30 weeks’ gestation/
Assessment corrected age
© Loyola University Health System, Loyola University Chicago, 2009
(Rev 2/10/09) Pat Hummel, MA, APN, NNP, PNP
All rights reserved. No part of this document may be reproduced in any form or by any means, electronic or mechanical, without written permission
of the author. The author cannot accept responsibility for errors or omission or for any consequences resulting from the application or interpretation
of this material.
11
Neonatal Pain, Agitation, and Sedation Scale (NPASS) (continued)
ASSESSMENT OF SEDATION
• Sedation is scored in addition to pain for each behavioral and
physiological criterion to assess the infant’s response to stimuli.
• Sedation does not need to be assessed/scored with every pain
assessment/score.
• Sedation is scored from 0 → −2 for each behavioral and
physiological criterion, then summed and noted as a negative
score (0 → −10).
—— A score of 0 is given if the infant has no signs of sedation, does
not underreact.
• Desired levels of sedation vary according to the situation.
—— “Deep sedation” → goal score of −10 to −5.
—— “Light sedation” → goal score of −5 to −2.
—— Deep sedation is not recommended unless an infant is receiving
ventilatory support, related to the high potential for hypoventi-
lation and apnea.
• A negative score without the administration of opioids/sedatives
may indicate
—— The premature infant’s response to prolonged or persistent
pain/stress
—— Neurological depression, sepsis, or another pathology
ASSESSMENT OF PAIN/AGITATION
• Pain assessment is the fifth vital sign—assessment for pain should
be included in every vital sign assessment.
• Pain is scored from 0 → +2 for each behavioral and physiological
criterion, then summed.
—— Points are added to the premature infant’s pain score and based
on the gestational age to compensate for the limited ability to
behaviorally communicate pain.
—— Total pain score is documented as a positive number (0 → +11).
• Treatment/interventions are suggested for scores >3.
—— Interventions for known pain/painful stimuli are indicated
before the score reaches 3.
• The goal of pain treatment/intervention is a score ≤3.
Scales and Scoring 13
• More frequent pain assessment indications are

—— Indwelling tubes or lines, which may cause pain, especially with
movement (eg, chest tubes) → at least every 2–4 h
—— Receiving analgesics and/or sedatives → at least every 2–4 h
—— 30–60 min after an analgesic is given for pain behaviors to
assess response to medication
—— Postoperative → at least every 2 h for 24–48 h, then every 4 h
until off medications
PARALYSIS/NEUROMUSCULAR BLOCKADE
• It is impossible to behaviorally evaluate a paralyzed infant for pain.
• Increases in HR and BP at rest or with stimulation may be the only
indicator of a need for more analgesia.
• Analgesics should be administered continuously by drip or
around-the-clock dosing.
—— Higher, more frequent doses may be required if the infant is
postoperative, has a chest tube, or has another pathology (such
as necrotizing enterocolitis) that would normally cause pain.
—— Opioid doses should be increased by 10% every 3–5 d, as toler-
ance will occur without symptoms of inadequate analgesia.
SCORING CRITERIA
CRYING/IRRITABILITY
−2 → No response to painful stimuli
—— No cry with needle sticks
—— No reaction to endotracheal tube or nares suctioning
—— No response to caregiving
−1 → Moans, sighs, or cries (audible or silent) minimally to painful
stimuli (eg, needle sticks, endotracheal tube or nares suctioning,
caregiving)
0 → No sedation signs or no pain/agitation signs
+1 → Infant irritable/crying at intervals—but can be consoled
—— If intubated, intermittent silent cry
+2 → Any of the following signs:
—— Cry is high-pitched.
—— Infant cries inconsolably.
—— If intubated, silent-continuous cry.
Neonatal Pain, Agitation, and Sedation Scale (NPASS) (continued)
BEHAVIOR/STATE
−2 → Does not arouse or react to any stimuli:
—— Eyes continually shut or open
—— No spontaneous movement
−1 → Little spontaneous movement, arouses briefly and/or minimally
to any stimuli
—— Opens eyes briefly
—— Reacts to suctioning
—— Withdraws to pain
—— Restless, squirming
—— Awakens frequently/easily with minimal or no stimuli
—— Kicking
—— Arching
—— Constantly awake
—— No movement or minimal arousal with stimulation
(not sedated, inappropriate for gestational age or
clinical situation)
FACIAL EXPRESSION
−2 → Any of the following signs:
—— Mouth lax
—— Drooling
—— No facial expression at
rest or with stimuli
−1 → Minimal facial expression
with stimuli
0→ N o sedation signs or no pain/
agitation signs
+1 → Any pain facial expression
observed intermittently
+2 → Any pain facial expression continual
EXTREMITIES/TONE
—— No palmar or planter grasp can be elicited.
—— Flaccid tone.
—— Weak palmar or planter grasp can be elicited.
—— Decreased tone.
+1 → Intermittent (<30 seconds’ duration) observation of toes and/or
hands as clenched, or fingers splayed
—— Body is not tense.
—— Frequent (≥30 seconds’ duration) observation of toes and/or
hands as clenched, or fingers splayed.
—— Body is tense/stiff.
VITAL SIGNS: HR, BP, RR, Sao2
—— No variability in vital signs with stimuli
—— Hypoventilation
—— Apnea
—— Ventilated infant—no spontaneous respiratory effort
−1 → Vital signs that show little variability with stimuli—<10% from
baseline
—— HR, RR, and/or BP are 10%–20% above baseline.
—— With care/stimuli, infant de-saturates minimally to
moderately (Sao2 76%–85%) and recovers quickly
(within 2 min).
—— HR, RR, and/or BP are >20% above baseline.
—— With care/stimuli, infant de-saturates severely (Sao2 <75%)
and recovers slowly (>2 min).
—— Out of sync/fighting ventilator.
Pediatric Early Warning Score (PEWS)

0 1 2 3 Score
Behavior Playing/ Sleeping Irritable Lethargic/
appropriate confused
OR
Reduced re
sponse to pain
Cardiovascular Pink Pale or Grey or Grey or
OR dusky cyanotic cyanotic, and
Capillary OR OR mottled
refill 1–2 s Capillary Capillary OR
refill refill 4 s Capillary refill
3s OR ≥5 s OR
Tachycardia Tachycardia of
of 20 beats/ 30 beats/min
min above above normal
normal rate rate
OR
Bradycardia
Respiratory Within >10 breaths/ >20 breaths/ ≥5 breaths/min
normal min above min above below normal
parameters, normal normal parameters,
no parameters parameters with retractions
retractions OR OR or grunting
Using Retractions OR
accessory OR ≥50% Fio2 or ≥8
muscles ≥40% Fio2 or L/min
OR ≥6 L/min
≥30% Fio2 or
≥3 L/min
• Score by starting with the most severe parameters first.
• Score 2 extra for every 15-min neb (includes continuous nebs) or persistent post
operative vomiting.
• Use liters per minute to score if regular nasal cannula is used.
• Use Fio2 to score if a high-flow nasal cannula is used.
Pediatric Early Warning Score (PEWS) (continued)

Heart Rate at Rest Respiratory Rate at Rest
(beats/min) (breaths/min)
Birth–1 mo 100–180 40–60
1–12 mo 100–180 35–40
1–3 y 70–110 25–30
4–6 y 70–110 21–23
7–12 y 70–110 19–21
13–19 y 55–90 16–18
Abbreviations: Fio2, fraction of inspired oxygen; neb, nebulization.

Adapted from Monaghan A. Detecting and managing deterioration in children. Paediatr Nurs.
2005;17(1):32–35.
GLASGOW COMA SCALE

Glasgow Coma Scale for Children
Glasgow Coma Scale for Glasgow Coma Scale Modified
Sign Children >5 y for Children <5 ya Score
Eye Spontaneous Spontaneous 4
opening To command To sound 3
To pain To pain 2
None None 1
Verbal Oriented Alert, babbles, coos, words or 5
response sentences normal for age
Confused Less than usual ability, irritable cry 4
Inappropriate words Cries to pain 3
Incomprehensible sounds Moans to pain 2
None None 1
Glasgow Coma Scale for Children (continued)

Glasgow Coma Scale for Glasgow Coma Scale Modified
Sign Children >5 y for Children <5 ya Score
Motor Obey commands Normal spontaneous movements 6
response Localizes pain Localizes pain 5
Withdraws Withdraws 4
Abnormal flexion to pain Abnormal flexion to pain 3
Abnormal extension to pain Abnormal extension to pain 2
None None 1
a
For children >5 y, the responses are similar to the adult Glasgow Coma Scale.
Modified with permission from Kirkham FJ, Newton CR, Whitehouse W. Pediatric coma scales.
Dev Med Child Neurol. 2008;50(4):267–274.
CROUP SCORE
Croup is a respiratory illness that usually occurs in infants and
young children and may manifest with barking cough, stridor with
inspiration, and hoarseness. Severity scores, such as the Westley
Croup Score, can help the clinician distinguish between mild symp-
toms and severe symptoms and can be used to monitor response to
treatment. An online calculator may be found at www.mdcalc.com/
westley-croup-score.
3. Growth
DETERMINING BODY SURFACE AREA
Based on the nomogram, a straight line joining the patient’s height
and weight will intersect the center column at the calculated body
surface area (BSA). For children of normal height for weight, use the
child’s weight in pounds, and then read across to the corresponding
BSA in meters squared. Alternatively, you can use Mosteller’s formula.
Nomogram
Height For children of SA Weight
cm in normal height m2 lb kg
and weight 180 80
90 160 70
1.30
2.0 140
80 1.20 1.9 130 60
240 70 1.10 1.8 120
1.7 110 50
220 85 1.00 1.6 100
60 1.5
80 90 40
200 .90 1.4
190 75 50 80
1.3
180 70 .80 1.2 70
30
Surface area in meters squared
170 40 1.1 60
65 .70
160 1.0 25
60 50
150 0.9
30 .60 45 20
140 55
.55 40
0.8
Weight in pounds
130 50 .50 35
0.7 15
120 30
20 .45
45
110 0.6 25
.40
100 40 10
15 .35 0.5 20 9.0
90 18 8.0
35
16 7.0
.30 0.4
80 14
6.0
30 10
12
28 9 .25 5.0
70
8 10
26 0.3 9 4.0
24 7 8
60
6 .20 7
22 3.0
6
20 5 2.5
50 0.2
19 5
18 4 .15 2.0
17 4
40 16
3 1.5
15
3
14
13
.10 1.0
30 12 2 0.1
Alternative (Mosteller’s formula)

Surface area (m2) = Height (cm) x Weight (kg)
3600
Nomogram and equation to determine body surface area.

Abbreviation: SA, surface area.
From Arcara KM, Tschudy MM, eds. The Harriet Lane Handbook. 19th ed. St Louis, MO:
Mosby; 2012. Reproduced with permission. Copyright © 2012 Elsevier.
GROWTH CHARTS
Average Growth Velocity by Age-group
Head Circumference
Age Weight Height (cm/wk)
Preterm infant 15–20 g/kg/d 0.8–1.1 cm/wk 0.8–1
<2 kg
Preterm infant 20–30 g/d 0.8–1.1 cm/wk 0.8–1
>2 kg
0–4 mo 23–34 g/d 0.8–0.93 cm/wk 0.38–0.48
4–8 mo 10–16 g/d 0.37–0.47 cm/wk 0.16–0.2
8–12 mo 6–11 g/d 0.28–0.37 cm/wk 0.08–0.11
12–16 mo 5–9 g/d 0.24–0.33 cm/wk 0.04–0.08
16–20 mo 4–9 g/d 0.21–0.29 cm/wk 0.03–0.06
20–24 mo 4–9 g/d 0.19–0.26 cm/wk 0.02–0.04
2–6 y 5–8 g/d 5–8 cm/y NA
6–10 y NA
Abbreviation: NA, not applicable.

Reproduced with permission from Texas Children’s Hospital Pediatric Nutrition Reference Guide.
11th ed. Houston, TX: Texas Children’s Hospital; 2016:13.
1312 Appendix A
Appendix A - 4 Growth 21
Fig. A-4.1
Fenton Preterm Growth Chart—Boys
Abbreviation: WHO, World Health Organization.

Reproduced with permission from Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart
Reproduced with permission from Fenton TR, Kim JH. A systematic review and meta-analysis to
for preterm infants. BMC Pediatr. 2013;13:59.
revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59. © 2013 Fenton and Kim;
doi:10.1186/1471-2431-13-59
licensee BioMed Central Ltd.
Pediatric Nutrition, 7th Edition

Growth Charts 1313

Fig. A-4.2
Fenton Preterm Growth Chart—Girls
APP
Abbreviation: WHO, World Health Organization.

Reproduced with permission from Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart
Reproduced with permission from Fenton TR, Kim JH. A systematic review and meta-analysis to
for preterm infants. BMC Pediatr. 2013;13:59.
revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59. © 2013 Fenton and Kim;
doi:10.1186/1471-2431-13-59
licensee BioMed Central Ltd.
Appendix A 1313
Growth 23
WHO Birth to 24 Months: Boys

Head Circumference-for-age and Weight-for-length Percentiles
Abbreviations: circ., circumference; WHO, World Health Organization.
From National Center for Health Statistics. WHO growth standards are recommended for use in the U.S. for
infants and children 0 to 2 years of age. Centers for Disease Control and Prevention Web site. https://www.cdc.
gov/growthcharts/who_charts.htm. Updated September 9, 2010. Accessed February 6, 2019.
WHO Birth to 24 Months: Boys

Length-for-age and Weight-for-age Percentiles
infants and children 0 to 2 years of age. Centers for Disease Control and Prevention Web site. https://www.cdc.
gov/growthcharts/who_charts.htm. Updated September 9, 2010. Accessed February 6, 2019.
Growth 25
WHO Birth to 24 Months: Girls

Head Circumference-for-age and Weight-for-length Percentiles
From National Center for Health Statistics. WHO growth standards are recommended for use in the
U.S. for infants and children 0 to 2 years of age. Centers for Disease Control and Prevention Web
site. https://www.cdc.gov/growthcharts/who_charts.htm. Updated September 9, 2010. Accessed
February 6, 2019.
WHO Birth to 24 Months: Girls

Length-for-age and Weight-for-age Percentiles
infants and children 0 to 2 years of age. Centers for Disease Control and Prevention Web site. https://www.
cdc.gov/growthcharts/who_charts.htm. Updated September 9, 2010. Accessed February 6, 2019.
Growth 27
CDC 2 to 20 Years: Boys

Stature-for-age and Weight-for-age Percentiles
2 to 20 years: Boys NAME
Stature-for-age and Weight-for-age percentiles RECORD #
12 13 14 15 16 17 18 19 20
Mother’s Stature Father’s Stature cm in
Date Age Weight Stature BMI*
AGE (YEARS) 76
95
190
74
90
185 S
75
72
180 T
50 70 A
175 T
25 68 U
170 R
10 66
165 E
in cm 3 4 5 6 7 8 9 10 11 5
64
160 160
62 62
155 155
S 60 60
T 150 150
A 58
T 145
U 56
140 105 230
R
54
E 135 100 220
52
130 95 95 210
50
125 90 200
90
48 190
120 85
46 180
115 80
75
44 170
110 75
42 160
105 50 70
150 W
40
100 65 140 E
25
38 I
95 60 130 G
10
36 90 5 H
55 120
T
34 85 50 110
32 80 45 100
30
40 90
80 35 35 80
W 70 70
30 30
E 60 60
I 25 25
G 50 50
H 20 20
40 40
T
15 15
30 30
10 10
lb kg AGE (YEARS) kg lb
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Abbreviations: BMI,
Published May 30, body
2000 mass index;
(modified CDC, Centers for Disease Control and Prevention.
11/21/00).
SOURCE: Developed by the National Center for Health Statistics in collaboration with
From National CenterCenter
the National for Health Statistics.
for Chronic Clinical
Disease growthand
Prevention charts.
HealthCenters for Disease
Promotion (2000). Control
and Prevention Web site. https://www.cdc.gov/growthcharts/clinical_charts.htm. Updated
http://www.cdc.gov/growthcharts
June 16, 2017. Accessed February 6, 2019.
CDC 2 to 20 Years: Boys

Body Mass Index-for-age Percentiles
2 to 20 years: Boys NAME
Body mass index-for-age percentiles RECORD #
Date Age Weight Stature BMI* Comments

BMI
35
34
33
32
31
30
95
29
BMI 28
90
27 27
26 85 26
25 25
75
24 24
23 23
50
22 22
21 21
25
20 20
10
19 19
5
18 18
17 17
16 16
15 15
14 14
13 13
12 12
2 2
kg/m AGE (YEARS) kg/m
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Abbreviations: BMI,
2000 mass index;
10/16/00).
From National Center Center
Disease growthand
Prevention charts. Centers
Health for Disease
Promotion (2000). Control
and Prevention Web site. https://www.cdc.gov/growthcharts/clinical_charts.htm. Updated
http://www.cdc.gov/growthcharts
June 16, 2017. Accessed February 6, 2019.
Growth 29
CDC 2 to 20 Years: Girls

Stature-for-age and Weight-for-age Percentiles
2 to 20 years: Girls NAME
Stature-for-age and Weight-for-age percentiles RECORD #
12 13 14 15 16 17 18 19 20
Mother’s Stature Father’s Stature cm in
Date Age Weight Stature BMI*
AGE (YEARS) 76
190
74
185 S
72
180 T
70 A
95
175 T
90
68 U
170 R
75 66
165 E
in cm 3 4 5 6 7 8 9 10 11 50
64
160 25 160
62 62
155 10 155
60 5 60
150 150
58
145
56
140 105 230
54
S 135 100 220
T 52
A 130 95 210
50
T 125 90 200
U
48 190
R 120 85
E 95 180
46
115 80
44 170
110 90 75
42 160
105 70
150 W
40 75
100 65 140 E
38 I
95 60 130 G
50
36 90 H
55 120
25 T
34 85 50 110
10
32 80
5
45 100
30
40 90
80 35 35 80
W 70 70
30 30
E 60 60
I 25 25
G 50 50
H 20 20
40 40
T
15 15
30 30
10 10
lb kg AGE (YEARS) kg lb
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Abbreviations: BMI,
2000 mass index;
11/21/00).
From National CenterCenter
Disease growthand
Prevention charts. Centers
Health for Disease
Promotion (2000). Control and
Preventionhttp://www.cdc.gov/growthcharts
Web site. https://www.cdc.gov/growthcharts/clinical_charts.htm. Updated June 16, 2017.
Accessed February 6, 2019.
CDC 2 to 20 Years: Girls

Body Mass Index-for-age Percentiles
Abbreviations: BMI, body mass index; CDC, Centers for Disease Control and Prevention.
From National Center for Health Statistics. Clinical growth charts. Centers for Disease Control and
Prevention Web site. https://www.cdc.gov/growthcharts/clinical_charts.htm. Updated June 16, 2017.
Growth 31
GROWTH CHARTS FOR CHILDREN WITH SPECIAL HEALTH

CARE NEEDS
Online Growth Charts
PediTools (https://peditools.org): Clinical resource for a variety
of pediatric growth charts, including to report z scores. Mobile
compatible.
Growth Charts for Special Populations
Listed herein are growth charts developed for children with genetic
conditions that can alter growth. Currently, the Centers for Disease
Control and Prevention (CDC) recommends that clinicians use the
regular CDC growth charts for assessment of these children. The
inherent limitations of studies performed with each of these specific
populations may not afford the clinician an accurate assessment of
growth in these children.
• Trisomy 21 syndrome (Down syndrome) (Zemel, 2015)
• Prader-Willi syndrome (Holm, 1995)
• Williams syndrome (Morris, 1988)
• Cornelia de Lange syndrome (Kline, 1993)
• Turner syndrome (Ranke, 1983; Lyon, 1985)
• Rubinstein-Taybi syndrome (Stevens, 1990)
• Marfan syndrome (Pyeritz, 1983; Pyeritz, 1985)
• Achondroplasia (Horton, 1978)
Growth Charts for Children With Down Syndrome, Birth to 36 Months: Boys
Weight-for-age Percentiles
Abbreviation: circ., circumference.

Published October 2015.
From Zemel BS, Pipan M, Stallings VA, et al. Growth charts for children with Down syndrome in the United States. Pediatrics. 2015;136(5):e1204–e1211.
Growth 33
Length-for-age Percentiles

Head Circumference-for-age Percentiles

Growth 35
Weight-for-length Percentiles

Growth Charts for Children With Down Syndrome, Birth to 36 Months: Girls
Weight-for-age Percentiles

Growth 37
Length-for-age Percentiles

Head Circumference-for-age Percentiles

Growth 39
Weight-for-length Percentiles

Height and Weight for Children With Cerebral Palsy

Growth charts for cerebral palsy have been developed (Brooks, 2011)
using sex and the Gross Motor Function Classification System.
Available at the Life Expectancy Project Web site (www.
lifeexpectancy.org/articles/newgrowthcharts.shtml).
BIBLIOGRAPHY
Brooks J, Day S, Shavelle R, Strauss D. Low weight, morbidity, and mortality in
children with cerebral palsy: new clinical growth charts. Pediatrics. 2011;128(2):
e299–e307
Butler M, Lee P, Whitman B, eds. Management of Prader-Willi Syndrome. 3rd
ed. New York, NY: Springer-Verlag; 2006
Health Resources and Services Administration. The CDC Growth Charts for
Children with Special Health Care Needs Web site. http://depts.washington.
edu/growth/cshcn/text/page2b.htm. Accessed February 6, 2019
Horton WA, Rotter JI, Rimoin DL, Scott CI, Hall JG. Standard growth curves for
achondroplasia. J Pediatr. 1978;93(3):435–438
Kline AD, Barr M, Jackson LG. Growth manifestations in the Brachmann-de
Lange syndrome. Am J Med Genet. 1993;47(7):1042–1049
Lyon AJ, Preece MA, Grant DB. Growth curves for girls with Turner syndrome.
Arch Dis Child. 1985;60(10):932–935
Morris CA, Demsey SA, Leonard CO, Dilts C, Blackburn BL. Natural history of
Williams syndrome: physical characteristics. J Pediatr. 1988;113(2):318–326
Pyeritz RE. Growth and anthropometrics in the Marfan syndrome. In:
Papadatos CJ, Bartsocas CS, eds. Endocrine Genetics and Genetics of Growth.
New York, NY: Alan R. Liss Inc; 1985
Pyeritz RE. Marfan syndrome and related disorders. In: Rimoin DL, Pyeritz RE,
Korf B, eds. Emery and Rimoin’s Principles and Practice of Medical Genetics. 5th
ed. New York, NY: Churchill Livingstone; 2006
Ranke MB, Pflüger H, Rosendahl W, et al. Turner syndrome: spontaneous
growth in 150 cases and review of the literature. Eur J Pediatr. 1983;141(2):81–88
Stevens CA, Hennekam RC, Blackburn BL. Growth in the Rubinstein-Taybi
syndrome. Am J Med Genet Suppl. 1990;6:51–55
Zemel BS, Pipan M, Stallings VA, et al. Growth charts for children with Down
syndrome in the United States. Pediatrics. 2015;135(5):e1204–e1211
Growth 41
MID-UPPER ARM CIRCUMFERENCE

Mid-upper arm circumference is correlated with body mass index in
children, teens, and adults and is useful to assess in patients whose
weight is affected by fluid status. These charts are available in print
(Abdel-Rahman, 2017) and on PediTools (https://peditools.org).
MUAC for Age, Boys 2 to 24 Months

cm cm
19 19
2 to 24 months: Boys
mid-upper arm circumference-for-age percentiles 97
95
18 18
90
17 17
75
16 50 16
M 25 M
U U
15 15
A A
C 10 C
3
14 14
13 13
12 12
AGE (MONTHS)
11 11
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Figure S1. MUAC growth charts based on the LMS data described herein for boys aged 2 months through 2 years.
Abbreviation: MUAC, mid-upper arm circumference.
© 2016, American Society for Parenteral and Enteral Nutrition. All rights reserved.
From Abdel-Rahman SM, Bi C, Thaete K. Construction of lambda, mu, sigma values for
determining mid-upper arm circumference z scores in U.S. children aged 2 months through
18 years. Nutr Clin Pract. 2017;32(1):68–76, with permission.
Growth 43
MUAC for Age, Boys 2 to 18 Years

cm cm
42 42
97
41 2 to 18 years: Boys 41
mid-upper arm circumference-for-age percentiles
40 95 40
39 39
38 38
90
37 37
36 36
35 35
75
34 34
33 33
32 32
50
21 21
M 30 30 M
U U
29 29
A 25 A
C 28 28 C
27 10
27
26 26
5
25 3 25
24 24
23 23
22 22
21 21
20 20
19 19
18 18
17 17
16 16
15 15
AGE (YEARS)
14 14
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Figure S2. MUAC growth charts based on the LMS data described herein for boys aged 2 years through 18 years.
Abbreviation: MUAC, mid-upper
© 2016, Americanarm circumference.
Society for Parenteral and Enteral Nutrition. All rights reserved.
MUAC for Age, Girls 2 to 24 Months
cm cm
19 19
2 to 24 months: Girls 97
95
18 18
90
17 17
75
16 50 16
M M
U 25 U
15 15
A A
C C
10
5
14 14
3
13 13
12 12
AGE (MONTHS)
11 11
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Figure S3. MUAC growth charts based on the LMS data described herein for girls aged 2 months through 2 years.
Abbreviation: MUAC, mid-upper arm
© 2016, American circumference.
Society for Parenteral and Enteral Nutrition. All rights reserved.
Growth 45
MUAC for Age, Girls 2 to 18 Years

cm cm
41 41
97
40 2 to 18 years: Girls 40
39 39
95
38 38
37 37
36 36
90
35 35
34 34
33 33
32 75
32
21 21
30 30
29 29
50
28 28
M
U 27 27 M
A 26 U
25 26
C A
25 25 C
24 10 24
23 5 23
3
22 22
21 21
20 20
19 19
18 18
17 17
16 16
15 15
14 14
AGE (YEARS)
13 13
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Figure S4. MUAC growth charts based on the LMS data described herein for boys aged 2 years through 18 years.
© 2016, American Society for Parenteral and Enteral Nutrition. All rights reserved.
Abbreviation: MUAC, mid-upper arm circumference.
PEDIATRIC MALNUTRITION INDICATORS

Malnutrition Criteria When a Single Data Point Is Available
Mild Moderate Severe
Primary Indicatorsa Malnutrition Malnutrition Malnutrition
Weight for height z score −1 to −1.9 z score −2 to −2.9 z score −3 or greater
z score
BMI for age z score −1 to −1.9 z score −2 to −2.9 z score −3 or greater
z score
Length/height z score No data No data −3 z score
Mid-upper arm Greater than or Greater than or Greater than or
circumference equal to −1 to equal to −2 to equal to −3 z
−1.9 z score −2.9 z score score
Abbreviation: BMI; body mass index.
a
Primary indicators when only a single data point is available for use as a criterion for identification
and diagnosis of malnutrition related to undernutrition.
Reproduced with permission from Becker P, Carney LN, Corkins MR, et al. Consensus statement
of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition:
indicators r ecommended for the identification and documentation of pediatric malnutrition
(undernutrition). Nutr Clin Pract. 2014;30(1):147–161.
Malnutrition Criteria When 2 or More Data Points Are Available

Mild Moderate Severe
Primary Indicatorsa Malnutrition Malnutrition Malnutrition
Weight gain velocity <75%b of the <50%b of the <25%b of the
(<2 years of age) normc for expected normc for expected normc for expected
weight gain weight gain weight gain
Weight loss 5% usual body 7.5% usual body 10% usual body
(2–20 years of age) weight weight weight
Deceleration in Decline of 1 z Decline of 2 z score Decline of 3 z score
weight for length/ score
height z score
Inadequate nutrient 51%–75% 26%–50% <25% estimated
intake estimated energy/ estimated energy/ energy/protein
protein need protein need need
a
Primary indicators when ≥2 data points are available for use as criteria for identification and diag
nosis of malnutrition related to undernutrition, per Academy of Nutrition and Dietetics/American
Society of Parenteral and Enteral Nutrition 2014 pediatric malnutrition consensus statement.
b
Guo S, Roche AF, Fomon SJ, et al. Reference data on gains in weight and length during the first
two years of life. J Pediatr. 1991;119(3):355–362.
c
World Health Organization (WHO). Child growth standards: weight velocity. WHO Web site.
http://www.who.int/childgrowth/standards/w_velocity/en/index.html. Accessed February 6, 2019.
Reproduced with permission from Becker P, Carney LN, Corkins MR, et al. Consensus statement
of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition:
indicators recommended for the identification and documentation of pediatric malnutrition
(undernutrition). Nutr Clin Pract. 2014;30(1):147–161.
Growth 47
GROWTH MEASURES FOR EXTREMITIES AND FOR EAR

ABOVE EYELINE LEVELS
The following measures show the reference ranges for length of
upper and lower extremities, and level of ears, for newborns. They
can be used to determine abnormalities (eg, newborns with sus-
pected genetic anomalies or with contractures for which full limb
length may not be feasible). The illustrations show the optimal
method to measure. The graph can be used to plot measurements
and determine percentiles.
Upper Arm (Shoulder to Elbow) Length
From Rollins JD, Tribble LM, Collins JS, et al, eds. Growth References. 3rd ed. Greenwood, SC:
Greenwood Genetic Center; 2011, with permission.
Growth 49
Forearm Length
Long-Bone Length—Upper Limb
Growth 51
Long-Bone Length—Lower Limb
Lower Leg (Knee to Ankle) Length
Growth 53
Ear Above Eyeline Level (Gestational Age)
Ear Above Eyeline Level (Birth Weight)
Growth 55
MEAN STRETCHED PENILE LENGTH

For Neonates
50
Penis
40
30
Length (mm)
20
10
0
28 30 32 34 36 38 40
Conceptual age (weeks)
Stretched phallic length of 63 normal premature and full-term male infants (closed circle), showing
lines of mean ± 2 SD. Correlation coefficient is 0.80. Superimposed are data for 2 small-for-gestational
age infants (open triangle), 7 large-for-gestation infants (closed triangle), and 4 twins (closed square),
all of which are in the normal range.
Reproduced with permission from Feldman KW, Smith DW. Fetal phallic growth and penile standards
for newborn male infants. J Pediatr. 1975;86(3):395–398.
MEAN STRETCHED PENILE LENGTH (continued)

For Children
Penile lengths in each age group with mean, 1 SD, 2 SD, 2.5 SD values
7.5
2.5 SD
7.0 2 SD
6.5 1 SD
6.0 Mean
Penile length, cm
5.5 1 SD
5.0 2 SD
2.5 SD
4.5
4.0
3.5
3.0
2.5
0.0–1.0 1.1–3.0 3.1–6.0 6.1–12.0 12.1–24.0 24.1–36.0 36.1–48.0 48.1–60.0
Age groups, months
Age-related changes of stretched penile length in normal male subjects

(n = 1040)
Penile Length
Rate of Mean
Age Group Subjects Mean ± Range Increase −2.5 SD Mean
(months) (n) SD (cm) (cm) (mm/mo) (cm) +2.5 SD
Term newborn 165 3.65 ± 0.27 3.1–4.3 - 2.96 4.33
1–3 112 3.95 ± 0.35 3.2–4.7 1 3.05 4.85
3.1–6 130 4.26 ± 0.40 3.4–5.2 1 3.24 5.27
6.1–12 148 4.65 ± 0.47 3.6–5.5 0.6 3.48 5.83
12.1–24 135 4.82 ± 0.44 3.8–5.8 0.1 3.82 5.83
24.1–36 120 5.15 ± 0.46 4.2–6.0 0.2 3.98 6.33
36.1–48 117 5.58 ± 0.47 4.6–6.4 0.3 4.39 6.77
48.1–60 113 6.02 ± 0.50 4.7–6.6 0.3 4.80 7.23
Reproduced with permission from Camurdan AD, Oz MO, Ilhan MN, Camurdan OM, Sahin F, Beyazo
va U. Current stretched penile length: cross-sectional study of 1040 healthy Turkish children aged 0
to 5 years. Urology. 2007;70(3):572–575.
development Growth 57
PRIMARY
Primary TEETH
Teeth eruption ChartERUPTION CHART
Primary Teeth
Upper Teeth Erupt Shed

Central incisor 8-12 months 6-7 years
Lateral incisor 9-13 months 7-8 years
Canine (cuspid) 16-22 months 10-12 years
First molar 13-19 months 9-11 years
Second molar 23-33 months 10-12 years
Lower Teeth Erupt Shed

Second molar 23-31 months 10-12 years
First molar 14-18 months 9-11 years
Canine (cuspid) 17-23 months 9-12 years

Lateral incisor 10-16 months 7-8 years
Central incisor 6-10 months 6-7 years
From: American Dental Association. Tooth eruption: the primary teeth. J Am Dent Assoc. 2005;136(11):1619.
Copyright © American Dental Association. Used with permission.
4. Blood Pressure
BLOOD PRESSURE NOMOGRAMS
Healthy Term Newborns During the First 12 Hours After Birth
A B
80 80
Systolic Systolic
Mean
(torr) 60 (torr) 60
40 40
20 20
0 1 2 3 4 5 0 1 2 3 4 5
80 80
Diastolic Pulse
(torr) 60 (torr) 60
40 40
20 20
0 1 2 3 4 5 0 1 2 3 4 5
Birth Weight (kg) Birth Weight (kg)
A, Linear regressions (broken lines) and 95% confidence limits (solid lines) of systolic (top) and
diastolic (bottom) aortic blood pressures on birth weight in 61 healthy term newborns during the
first 12 hours after birth. For systolic pressure, y = 7.13x + 40.45; r = 0.79. For diastolic pressure,
y = 4.81x + 22.18; r = 0.71. For both, n = 413 and p < .001. B, Linear regressions (broken lines) and
95% confidence limits (solid lines) of mean pressure (top) and pulse pressure (systolic-diastolic
pressure amplitude) (bottom) on birth weight in 61 healthy term newborns during the first 12 hours
after birth. For mean pressure, y = 5.16x + 29.80; n = 443; r = 0.80. For pulse pressure, y = 2.31x +
18.27; n = 413; r = 0.45. For both, p < .001.
From Versmold HT, Kitterman JA, Phibbs RH, Gregory GA, Tooley WH. Aortic blood pressure
during the first 12 hours of life in infants with birth weight 610 to 4,220 grams. Pediatrics.
1981;67(5):607–613.
BLOOD PRESSURE NOMOGRAMS (continued)

Preterm and Full-term Newborns During the First Day After Birth
(According to Birth Weight)
Upper 95% C.L.
90
Systolic Blood Pressure (mm Hg)
80
70
60
50
Lower 95% C.L.
40
30
20
10
0
.750 1.000 1.250 1.500 1.750 2.000 2.250 2.500 2.750 3.000 3.250 3.500 3.750 4.000
Birth Weight (kg)

Diastolic Blood Pressure (mm Hg)
70
Upper 95% C.L.
60
50
40
30
20 Lower 95% C.L.
10
0
.750 1.000 1.250 1.500 1.750 2.000 2.250 2.500 2.750 3.000 3.250 3.500 3.750 4.000
Birth Weight (kg)
Linear regression of mean systolic and diastolic blood pressures by birth weight on day 1 after birth,
with 95% confidence limits (C.L.s) (upper and lower dashed lines).
From Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted
to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood
Pressure Study Group. J Perinatol. 1995;15(6):470–479. Reproduced with permission. Copyright ©
1995 Nature Publishing Group.
Blood Pressure 61
Preterm and Full-term Newborns During the First Day After Birth
(According to Gestational Age)
90 Upper 95% C.L.
80
70
60
50
40
Lower 95% C.L.
30
20
10
0
22 24 26 28 30 32 34 36 38 40 42
Gestational Age (weeks)
70
60
Upper 95% C.L.
50
40
30
Lower 95% C.L.
20
10
0
22 24 26 28 30 32 34 36 38 40 42
Gestational Age (weeks)
Linear regression of mean systolic and diastolic blood pressures by gestational age on day 1 after
birth, with 95% confidence limits (C.L.s) (upper and lower dashed lines).
From Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted
to neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood
Pressure Study Group. J Perinatol. 1995;15(6):470–479. Reproduced with permission. Copyright ©
1995 Nature Publishing Group.
BLOOD PRESSURE NOMOGRAMS (continued)

Preterm and Full-term Newborns (According to Post Conceptional Age)
Upper 95% C.L.
110
100
90
80
70
60
Lower 95% C.L.
50
40
30
20
10
0
24 26 28 30 32 34 36 38 40 42 44 46
Post Conceptional Age (weeks)
100
90
80
Upper 95% C.L.
70
60
50
40
30
Lower 95% C.L.
20
10
0
24 26 28 30 32 34 36 38 40 42 44 46
Post Conceptional Age (weeks)
Linear regression of mean systolic and diastolic blood pressures by post conceptual age in weeks,
with 95% confidence limits (C.L.s) (upper and lower dashed lines).
From Zubrow AB, Hulman S, Kushner H, et al. Determinants of blood pressure in infants admitted to
neonatal intensive care units: a prospective multicenter study. Philadelphia Neonatal Blood Pressure
Study Group. J Perinatol. 1995;15(6):470–479. Reproduced with permission. Copyright © 1995
Nature Publishing Group.
Blood Pressure 63
Children Younger Than 1 Year
115 115
110 95th 110 95th
90th 105 90th
105
100 100
SYSTOLIC BP
75th
SYSTOLIC BP
75th
95 95
50th 90 50th
90
85 85
80 80
75 75
70 70
65 65
0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12
MONTHS MONTHS
75 75
95th
95th
70 90th 70
90th
65 65
DIASTOLIC BP (K4)
DIASTOLIC BP (K4)
75th
75th
60 60
50th
55 55 50th
50 50
45 45
0 1 2 3 4 5 6 7 8 9 10 11 12 0 1 2 3 4 5 6 7 8 9 10 11 12
MONTHS MONTHS
90th Percentile
Systolic BP 87 101 106 106 106 105 105 106 105 105 105 105 105 76 98 101 104 105 106 106 106 106 106 108 105 105
Diastolic BP 68 65 63 63 63 65 66 67 68 68 69 69 69 68 65 64 64 65 66 66 66 66 67 67 67 67
Height CM 51 59 63 66 68 70 72 73 74 75 77 78 80 54 55 56 58 51 63 66 68 70 72 74 75 77
Weight KG 4 4 5 5 6 7 8 9 9 10 10 11 11 4 4 4 5 5 6 7 8 9 9 10 10 11
Left, Age-specific percentiles of blood pressure (BP) measurements in boys—birth to 12 months of

age; Korotkoff phase IV (K4) used for diastolic BP. Right, Age-specific percentiles of blood pressure
(BP) measurements in girls—birth to 12 months of age; Korotkoff phase IV (K4) used for diastolic BP.
From Task Force on Blood Pressure Control in Children. Report of the Second Task Force on Blood
Pressure Control in Children—1987. Pediatrics. 1987;79(1):1–25.
BLOOD PRESSURE LEVELS FOR BOYS BY AGE AND

HEIGHT PERCENTILE
Systolic BP (mm Hg) Diastolic BP (mm Hg)
← Percentile of Height → ← Percentile of Height →
Age BP
(y) Percentile 5th 10th 25th 50th 75th 90th 95th 5th 10th 25th 50th 75th 90th 95th
1 50th 80 81 83 85 87 88 89 34 35 36 37 38 39 39
90th 94 95 97 99 100 102 103 49 50 51 52 53 53 54
95th 98 99 101 103 104 106 106 54 54 55 56 57 58 58
99th 105 106 108 110 112 113 114 61 62 63 64 65 66 66
2 50th 84 85 87 88 90 92 92 39 40 41 42 43 44 44
90th 97 99 100 102 104 105 106 54 55 56 57 58 58 59
95th 101 102 104 106 108 109 110 59 59 60 61 62 63 63
99th 109 110 111 113 115 117 117 66 67 68 69 70 71 71
3 50th 86 87 89 91 93 94 95 44 44 45 46 47 48 48
90th 100 101 103 105 107 108 109 59 59 60 61 62 63 63
95th 104 105 107 109 110 112 113 63 63 64 65 66 67 67
99th 111 112 114 116 118 119 120 71 71 72 73 74 75 75
4 50th 88 89 91 93 95 96 97 47 48 49 50 51 51 52
90th 102 103 105 107 109 110 111 62 63 64 65 66 66 67
95th 106 107 109 111 112 114 115 66 67 68 69 70 71 71
99th 113 114 116 118 120 121 122 74 75 76 77 78 78 79
5 50th 90 91 93 95 96 98 98 50 51 52 53 54 55 55
90th 104 105 106 108 110 111 112 65 66 67 68 69 69 70
95th 108 109 110 112 114 115 116 69 70 71 72 73 74 74
99th 115 116 118 120 121 123 123 77 78 79 80 81 81 82
6 50th 91 92 94 96 98 99 100 53 53 54 55 56 57 57
90th 105 106 108 110 111 113 113 68 68 69 70 71 72 72
95th 109 110 112 114 115 117 117 72 72 73 74 75 76 76
99th 116 117 119 121 123 124 125 80 80 81 82 83 84 84
7 50th 92 94 95 97 99 100 101 55 55 56 57 58 59 59
90th 106 107 109 111 113 114 115 70 70 71 72 73 74 74
95th 110 111 113 115 117 118 119 74 74 75 76 77 78 78
99th 117 118 120 122 124 125 126 82 82 83 84 85 86 86
8 50th 94 95 97 99 100 102 102 56 57 58 59 60 60 61
90th 107 109 110 112 114 115 116 71 72 72 73 74 75 76
95th 111 112 114 116 118 119 120 75 76 77 78 79 79 80
99th 119 120 122 123 125 127 127 83 84 85 86 87 87 88
9 50th 95 96 98 100 102 103 104 57 58 59 60 61 61 62
90th 109 110 112 114 115 117 118 72 73 74 75 76 76 77
95th 113 114 116 118 119 121 121 76 77 78 79 80 81 81
99th 120 121 123 125 127 128 129 84 85 86 87 88 88 89
Blood Pressure 65

Age BP
(y) Percentile 5th 10th 25th 50th 75th 90th 95th 5th 10th 25th 50th 75th 90th 95th
10 50th 97 98 100 102 103 105 106 58 59 60 61 61 62 63

90th 111 112 114 115 117 119 119 73 73 74 75 76 77 78
95th 115 116 117 119 121 122 123 77 78 79 80 81 81 82
99th 122 123 125 127 128 130 130 85 86 86 88 88 89 90
11 50th 99 100 102 104 105 107 107 59 59 60 61 62 63 63
90th 113 114 115 117 119 120 121 74 74 75 76 77 78 78
95th 117 118 119 121 123 124 125 78 78 79 80 81 82 82
99th 124 125 127 129 130 132 132 86 86 87 88 89 90 90
12 50th 101 102 104 106 108 109 110 59 60 61 62 63 63 64
90th 115 116 118 120 121 123 123 74 75 75 76 77 78 79
95th 119 120 122 123 125 127 127 78 79 80 81 82 82 83
99th 126 127 129 131 133 134 135 86 87 88 89 90 90 91
13 50th 104 105 106 108 110 111 112 60 60 61 62 63 64 64
90th 117 118 120 122 124 125 126 75 75 76 77 78 79 79
95th 121 122 124 126 128 129 130 79 79 80 81 82 83 83
99th 128 130 131 133 135 136 137 87 87 88 89 90 91 91
14 50th 106 107 109 111 113 114 115 60 61 62 63 64 65 65
90th 120 121 123 125 126 128 128 75 76 77 78 79 79 80
95th 124 125 127 128 130 132 132 80 80 81 82 83 84 84
99th 131 132 134 136 138 139 140 87 88 89 90 91 92 92
15 50th 109 110 112 113 115 117 117 61 62 63 64 65 66 66
90th 122 124 125 127 129 130 131 76 77 78 79 80 80 81
95th 126 127 129 131 133 134 135 81 81 82 83 84 85 85
99th 134 135 136 138 140 142 142 88 89 90 91 92 93 93
16 50th 111 112 114 116 118 119 120 63 63 64 65 66 67 67
90th 125 126 128 130 131 133 134 78 78 79 80 81 82 82
95th 129 130 132 134 135 137 137 82 83 83 84 85 86 87
99th 136 137 139 141 143 144 145 90 90 91 92 93 94 94
Abbreviation: BP, blood pressure.

Note: The 90th percentile is 1.28 SD, the 95th percentile is 1.645 SD, and the 99th percentile is
2.326 SD over the mean.
From National Heart, Lung, and Blood Institute (NHLBI). Blood pressure for boys by age and height
percentile. NHLBI Web site. https://www.nhlbi.nih.gov/files/docs/guidelines/child_tbl.pdf.
BLOOD PRESSURE LEVELS FOR GIRLS BY AGE AND

HEIGHT PERCENTILE
BP
Age (y) Percentile 5th 10th 25th 50th 75th 90th 95th 10th 25th 50th 75th 90th 95th 95th
1 50th 83 84 85 86 88 89 90 38 39 39 40 41 41 42
90th 97 97 98 100 101 102 103 52 53 53 54 55 55 56
95th 100 101 102 104 105 106 107 56 57 57 58 59 59 60
99th 108 108 109 111 112 113 114 64 64 65 65 66 67 67
2 50th 85 85 87 88 89 91 91 43 44 44 45 46 46 47
90th 98 99 100 101 103 104 105 57 58 58 59 60 61 61
95th 102 103 104 105 107 108 109 61 62 62 63 64 65 65
99th 109 110 111 112 114 115 116 69 69 70 70 71 72 72
3 50th 86 87 88 89 91 92 93 47 48 48 49 50 50 51
90th 100 100 102 103 104 106 106 61 62 62 63 64 64 65
95th 104 104 105 107 108 109 110 65 66 66 67 68 68 69
99th 111 111 113 114 115 116 117 73 73 74 74 75 76 76
4 50th 88 88 90 91 92 94 94 50 50 51 52 52 53 54
90th 101 102 103 104 106 107 108 64 64 65 66 67 67 68
95th 105 106 107 108 110 111 112 68 68 69 70 71 71 72
99th 112 113 114 115 117 118 119 76 76 76 77 78 79 79
5 50th 89 90 91 93 94 95 96 52 53 53 54 55 55 56
90th 103 103 105 106 107 109 109 66 67 67 68 69 69 70
95th 107 107 108 110 111 112 113 70 71 71 72 73 73 74
99th 114 114 116 117 118 120 120 78 78 79 79 80 81 81
6 50th 91 92 93 94 96 97 98 54 54 55 56 56 57 58
90th 104 105 106 108 109 110 111 68 68 69 70 70 71 72
95th 108 109 110 111 113 114 115 72 72 73 74 74 75 76
99th 115 116 117 119 120 121 122 80 80 80 81 82 83 83
7 50th 93 93 95 96 97 99 99 55 56 56 57 58 58 59
90th 106 107 108 109 111 112 113 69 70 70 71 72 72 73
95th 110 111 112 113 115 116 116 73 74 74 75 76 76 77
99th 117 118 119 120 122 123 124 81 81 82 82 83 84 84
8 50th 95 95 96 98 99 100 101 57 57 57 58 59 60 60
90th 108 109 110 111 113 114 114 71 71 71 72 73 74 74
95th 112 112 114 115 116 118 118 75 75 75 76 77 78 78
99th 119 120 121 122 123 125 125 82 82 83 83 84 85 86
Blood Pressure 67

BP
9 50th 96 97 98 100 101 102 103 58 58 58 59 60 61 61

90th 110 110 112 113 114 116 116 72 72 72 73 74 75 75
95th 114 114 115 117 118 119 120 76 76 76 77 78 79 79
99th 121 121 123 124 125 127 127 83 83 84 84 85 86 87
10 50th 98 99 100 102 103 104 105 59 59 59 60 61 62 62
90th 112 112 114 115 116 118 118 73 73 73 74 75 76 76
95th 116 116 117 119 120 121 122 77 77 77 78 79 80 80
99th 123 123 125 126 127 129 129 84 84 85 86 86 87 88
11 50th 100 101 102 103 105 106 107 60 60 60 61 62 63 63
90th 114 114 116 117 118 119 120 74 74 74 75 76 77 77
95th 118 118 119 121 122 123 124 78 78 78 79 80 81 81
99th 125 125 126 128 129 130 131 85 85 86 87 87 88 89
12 50th 102 103 104 105 107 108 109 61 61 61 62 63 64 64
90th 116 116 117 119 120 121 122 75 75 75 76 77 78 78
95th 119 120 121 123 124 125 126 79 79 79 80 81 82 82
99th 127 127 128 130 131 132 133 86 86 87 88 88 89 90
13 50th 104 105 106 107 109 110 110 62 62 62 63 64 65 65
90th 117 118 119 121 122 123 124 76 76 76 77 78 79 79
95th 121 122 123 124 126 127 128 80 80 80 81 82 83 83
99th 128 129 130 132 133 134 135 87 87 88 89 89 90 91
14 50th 106 106 107 109 110 111 112 63 63 63 64 65 66 66
90th 119 120 121 122 124 125 125 77 77 77 78 79 80 80
95th 123 123 125 126 127 129 129 81 81 81 82 83 84 84
99th 130 131 132 133 135 136 136 88 88 89 90 90 91 92
15 50th 107 108 109 110 111 113 113 64 64 64 65 66 67 67
90th 120 121 122 123 125 126 127 78 78 78 79 80 81 81
95th 124 125 126 127 129 130 131 82 82 82 83 84 85 85
99th 131 132 133 134 136 137 138 89 89 90 91 91 92 93
16 50th 108 108 110 111 112 114 114 64 64 65 66 66 67 68
90th 121 122 123 124 126 127 128 78 78 79 80 81 81 82
95th 125 126 127 128 130 131 132 82 82 83 84 85 85 86
99th 132 133 134 135 137 138 139 90 90 90 91 92 93 93
BLOOD PRESSURE LEVELS FOR GIRLS BY AGE AND HEIGHT

PERCENTILE (continued)
BP
17 50th 108 109 110 111 113 114 115 64 65 65 66 67 67 68

90th 122 122 123 125 126 127 128 78 79 79 80 81 81 82
95th 125 126 127 129 130 131 132 82 83 83 84 85 85 86
99th 133 133 134 136 137 138 139 90 90 91 91 92 93 93
Abbreviation: BP, blood pressure.

Note: The 90th percentile is 1.28 SD, the 95th percentile is 1.645 SD, and the 99th percentile is
2.326 SD over the mean.
From National Heart, Lung, and Blood Institute (NHLBI). Blood pressure for boys by age and height
percentile. NHLBI Web site. https://www.nhlbi.nih.gov/files/docs/guidelines/child_tbl.pdf.
5. Laboratory Reference Range Values
Laboratories use different analyzers, reagents, and test methods.
Results obtained may therefore differ between laboratories. Always
refer to the reference ranges provided by the laboratory that
performed the testing when making clinical decisions. The values
provided in this section are for general guidance purposes only.
Reminder: Only order tests that are necessary according
to the clinical picture. A reference range encompasses 95% of
results from normal, healthy individuals. Generally, 1 result
for every 20 tests ordered will be slightly outside the reference
range even though the patient may not be ill. Thus, it is always
best to order only tests that are necessary according to the clini-
cal picture to prevent unnecessary additional laboratory testing,
physician visits, and patient worry.
Infant, Child, or
Preterm Full-term Full-term Infant 1 to 3 Teen 4 Months
Component Newborn 1 to 7 Days 8 to 30 Days Months to 16 Years Adult
Color Clear or Clear or Clear or Clear Clear Clear
xanthochromic xanthochromic xanthochromic
RBCs (/mcL) — 3–23 — — — —
WBCs (/mcL) 21–28 <30 <12 <6 <1 <5
Polymorphonuclear 19%–60% 37%–60% <10% None None None
CEREBROSPINAL FLUIDa
cells (/mcL)
Lymphocytes (/mcL) — 0–20 (if <24 h) ≤11 ≤5 ≤5 60%–70%

0–4 (if 7 d)
Monocytes (/mcL) — <4 (50%–99%) ≤4 (50%–99%) <4 (33%–67%) <4 (44%–90%) 30%–50%
Protein (mg/dL) 65–150 79 (23) (132) 68 (20) (100) 58 (17) (89) up 5–45 5–45
(mean [SD]) to 42 d; 53 (17)
(95th percentile) (83) up to 56
d; 5–45 after
56 d
Glucose (mg/dL) 24–63 (1.3–3.5 >50 (>2.8 ≥38 (2.1 ≥45 (≥2.5 45–72 (2.5–4.0 2.2–4.7
mmol/L) mmol/L) mmol/L), >50% mmol/L) mmol/L), 60% in mmol/L
in serum serum
CSF glucose/blood 0.55–1.05 ≥0.6 ≥0.6 ≥0.6 ≥0.6 —
glucose
Infant, Child, or
Preterm Full-term Full-term Infant 1 to 3 Teen 4 Months
Component Newborn 1 to 7 Days 8 to 30 Days Months to 16 Years Adult
Lactate (mmol/L) 5–30 (approx <3.1 (if >2 d) <3.1 <3.1 <2.4 (if 1–12 y) —
imately 10%
serum value)
Opening pressure — 8–11 <28 <28 <28 50–180
(mm H2O) in lateral
recumbent position
CSF volume (mL) — — — — 60–100 100–160
Fluctuation with — 0.5–1.0 0.5–1.0 0.5–1.0 0.5–1.0 0.5–1.0
respiration
Abbreviations: CSF, cerebrospinal fluid; RBC, red blood cell; WBC, white blood cell.
Calculating the ratio of RBCs to WBCs in CSF
General rule: For every 500 RBCs in CSF, it is acceptable to have 1 WBC.
Normal ratio of RBCs to WBCs in peripheral blood is 1,000 RBCs:1–2 WBCs (106/L).
No. of WBCs introduced into the CSF per liter = [(WBC[peripheral] × RBC[CSF])/RBC(peripheral)] × 106/L.
Compare this number with the actual number of WBCs in the CSF.
1,000 × 106/L RBCs in CSF raises CSF protein concentration by approximately 0.015 g/L.
a
Correction factors should not be used to reassure that meningitis is unlikely.
Reference Range Values
71
BIBLIOGRAPHY
Ahmed A, Hickey SM, Ehrett S, et al. Cerebrospinal fluid values in the term
neonate. Pediatr Infect Dis J. 1996;15(4):298–303
Avery RA, Shah SS, Licht DJ, et al. Reference range for cerebrospinal fluid
opening pressure in children. N Engl J Med. 2010;363(9):891–893
Biou D, Benoist JF, Nguyen-Thi C, Huong X, Morel P, Marchand M.
Cerebrospinal fluid protein concentrations in children: age-related values
in patients without disorders of the central nervous system. Clin Chem.
2000;46(3):399–403
Griffith BP, Booss J. Neurologic infections of the fetus and newborn. Neurol
Clin. 1994;12(3):541–564
Kestenbaum LA, Ebberson J, Zorc JJ, Hodinka RL, Shah SS. Defining cere-
brospinal fluid white blood cell count reference values in neonates and young
infants. Pediatrics. 2010;125(2):257–264
Lipton JD, Schafermeyer RW. Evolving concepts in pediatric bacterial
meningitis—part I: pathophysiology and diagnosis. Ann Emerg Med.
1993;22(10):1602–1615
McMillan JA, Oski FA, Feigin RD, et al, eds. Oski’s Pediatrics: Principles and
Practice. 3rd ed. Philadelphia, PA: JB Lippincott; 1999
Naidoo BT. The cerebrospinal fluid in the healthy newborn infant. S Afr Med J.
1968;42(35):933–935
Nascimento-Carvalho CMC, Moreno-Carvalho OA. Normal cerebrospinal
fluid values in full-term gestation and premature neonates. Arq Neuropsiquiatr.
1998;56(3A):375–380
Shah SS, Ebberson J, Kestenbaum LA, Hodinka RL, Zorc JJ. Age-specific
reference values for cerebrospinal fluid protein concentration in neonates and
young infants. J Hosp Med. 2011;6(1):22–27
Soldin JS, Brugnara C, Gunter KC, et al, eds. Pediatric Reference Ranges. 2nd
ed. Washington, DC: AAAC Press; 1997
Srinivasan L, Shah SS, Padula MA, Abbasi S, McGowan KL, Harris MC.
Cerebrospinal fluid reference ranges in term and preterm infants in the neona-
tal intensive care unit. J Pediatr. 2012;161(4):729–734
Wong M, Schlaggar BL, Buller RS, Storch GA, Landt M. Cerebrospinal fluid
protein concentration in pediatric patients: defining clinically relevant reference
values. Arch Pediatr Adolesc Med. 2000;154(8):827–831
Reference Range Values 73
CLINICAL CHEMISTRY
For Infants, Children, Teens, and Young Adultsa
Alanine Aminotransferase (ALT) (U/L)
Tissues with high concentration: Liver and kidney. There is evidence suggesting
that these c
utoffs are not sensitive enough to detect chronic liver disease in pedi-
atric p
opulations. Note that infants tend to have a broader range of results com-
pared with older children, and girls of all ages tend to have lower levels than boys.
1–<13 y 9–25
13–<19 y Male: 9–24
Female: 8–22
Aldolase (U/L)
Tissues with high concentration: Liver, muscle, and brain.
10–24 mo 3.4–11.8
2–16 y 1.2–8.8
Adult (17–64 y) 1.7–4.9
Alkaline Phosphatase (ALP) (U/L)
Tissues with high concentration: Liver, bone, intestine, and placenta. A substantial
elevation may occur during accelerated bone growth in children and adolescents.
6 mo–1 y 104–455
2–8 y 111–277
9–14 y 76–479
15–18 y Male: 64–310
Female: 37–222
Ammonia (μmol/L)
It is critical that a free-flowing (no tourniquet) venous (or arterial) sample be col-
lected into a heparinized (and preferably chilled) tube, immediately placed onto
ice, and analyzed within 30 min to prevent artifactual elevation of the result.
All ages <51
Amylase (U/L)
0–14 d 3–10
15 d–<13 wk 2–22
13 wk–<1 y 3–50
1 y–<19 y 25–101
CLINICAL CHEMISTRY (continued)

Aspartate Aminotransferase (AST) (U/L)
15 d–<1 y 20–67
1–<7 y 21–44
7–<12 y 18–36
12–<19 y Male: 14–35
Female: 13–26
Bicarbonate (mmol/L)
>6 y 19–26
Bilirubin (Total) (mg/dL)
0–24 h <5.1
1–2 d <7.2
3–5 d <10.3
1 mo–adult <0.8
Bilirubin (Conjugated) (mg/dL)
Neonates <0.4
Non-neonates <0.2
Blood Gases, Arterial
Paco2 (mm HCO3–
Age pH Pao2 (mm Hg) Hg) (mEq/L)
Cord blood 7.18–7.38 5.85–30.15 32.74–65.66 14–22
Birth 7.11–7.36 8–24 27–40 13–22
5–10 min 7.09–7.30 33–75 27–40 13–22
Newborn 30 min 7.21–7.38 31–85 27–40 13–22
60 min 7.26–7.49 55–80 27–40 13–22
1d 7.29–7.45 54–95 27–40 13–22
Child or adult 7.35–7.45 83–108 32–48 20–28
Calcium (Total) (mg/dL)
0–<1 y 8.5–11.0
1–<19 y 9.2–10.5
Calcium (Ionized) (mg/dL)

0–31 d 3.9–6.0
1–6 mo 3.7–5.9
Male: 1–19 y 4.9–5.5
Female: 1–17 y
Man: 20 y–adult 4.8–5.3
Woman: 18 y–adult
Carbon Monoxide (Carboxyhemoglobin) (%)
Nonsmoker 0.5–1.5
Smoker ≤10
Neurological impairment 20–60
Lethal >50%
Chloride (mmol/L)
1–<18 y 102–112
18 y–adult 100–108
C-reactive Protein (mg/L)
Newborn 0.01–0.44
Adult 0.09–10.41
Creatine Kinase (U/L)
Age Male Female
0–90 d 28–300 42–470
3–12 mo 24–170 26–240
13–24 mo 27–160 24–175
2–10 y 30–150 24–175
11–14 y 30–150 30–170
15–18 y 33–145 24–140

Creatinine (Enzymatic) (mg/dL)
0–14 d 0.33–0.93
15 d–<2 y 0.10–0.36
2–<5 y 0.20–0.43
5–<12 y 0.31–0.61
12–<15 y 0.45–0.81
15–<19 y Male: 0.62–1.09
Female: 0.49–0.84
Erythrocyte Sedimentation Rate (ESR) (mm/h)

Measures the rate of fall of red blood cells in anticoagulated blood and reflects
level of rouleaux formation caused by acute phase reactants. Level of rouleaux
formation can be falsely lowered in people who have afibrinogenemia, anemia, or
sickle cell disease. Levels may vary depending on age, ethnicity, sex, or freshness
of blood sample. For these reasons, C-reactive protein measurement is a more
sensitive and accurate indicator of an inflammatory process than ESR.
Child 0–10
Man: <50 y 0–15
Woman: <50 y 0–20
Ferritin (ng/mL)
4–<15 d 99.6–717.0
15 d–<6 mo 14.0–647.2
6 mo–<1 y 8.4–181.9
1–<5 y 5.3–99.9
5–<14 y 13.7–78.8
14–<16 y Male: 12.7–82.8
Female: 5.5–67.4
16–<19 y Male: 11.1–171.9
Folate (ng/mL)b
Newborn period 7.0–3.18
Childhood 1.8–8.8
Adulthood 4.4–27.8
Glucose (mg/dL)
0–<1 d Boy: 36–110
Girl: 36–89
1–7 d 47–110
>7 d 54–117
γ-Glutamyltransferase (GGT) (U/L)
Tissues with high concentration: Liver, kidney, pancreas, and prostate.
0–14 d 23–219
15–<1 y 8–127
1–<11 y 6–16
11–<19 y 7–21
Haptoglobin (mg/dL)
Neonates tend to have very low, even unmeasurable, haptoglobin levels.
Haptoglobin is an acute phase reactant.
0–14 d 0–10
15 d–<1 y 7–221
1–<12 y 7–163
12–<19 y 7–179
Hemoglobin A1c (%)
These values are target ranges as determined by the American Diabetes
Association.
Normal 4.5–5.6
At risk for diabetes 5.7–6.4
Diabetes mellitus ≥6.5
Hemoglobin F (% Total Hemoglobin)c
1d 62.7–91.3
5d 65.4–88.2
3 wk 55.7–84.2
6–9 wk 31.3–74.5
3–4 mo <54.6
6 mo <9.0
8–11 mo <3.6
>11 mo <2.0

Iron (mcg/dL)
0–<14 y 16–128
14–<19 y Male: 31–168
Female: 20–162
Lactate (Serum) (mmol/L)
0–2 mo 1.0–3.5
3 mo–1 y 1.0–3.3
2–18 y 1.0–2.4
Lactate Dehydrogenase (LDH) (U/L)
Tissues with high concentration: Liver, heart, muscle, red blood cells, and white
blood cells.
1–14 d 309–1,222
15 d–<1 y 163–452
1–<10 y 192–321
10–<15 y Boy: 170–283
Girl: 157–272
15–<19 y 130–250
Lead (mcg/dL)
The Centers for Disease Control and Prevention and the American Academy of
Pediatrics recommends lead screening for all children who are eligible or enrolled
in Medicare and any children who are believed to be at high risk for lead exposure.
Child <5
Lipase (U/L)
0–<19 y 4.0–39.0
Lipids (mg/dL)
These are target ranges recommended by the National Lipid Association,
the National Cholesterol Education Program, and the Expert Panel on
Integrated Guidelines for Cardiovascular Health and Risk Reduction in
Children and Adolescents.
Child or
Chemical Adolescent Adult
Cholesterol Optimal: <170 Optimal: <200
Borderline: Borderline: 200–239
170–199 High: ≥240
High: ≥200
Low-density lipoprotein (LDL) Optimal: <110 Optimal: <100
Borderline: Borderline: 130–159
110–129 High: ≥160
High: ≥130
High-density lipoprotein (HDL) >45 >40
Magnesium (mg/dL)
0–14 d 1.99–3.94
15 d–<1 y 1.97–3.09
1–<19 y 2.09–2.84
Methemoglobin (% of Hemoglobin)c
All 0.04–1.50
Osmolality (Serum or Plasma) (mOsm/kg)
Neonates 266–295
All 275–295
Phosphate (mg/dL)
0–14 d 5.6–10.5
15 d–<1 y 4.8–8.4
1–<5 y 4.3–6.8
5–<13 y 4.1–5.9
13–<16 y Boy: 3.5–6.2
Girl: 3.2–5.5
16–<19 y 2.9–5.0

Potassium (mEq/L)d
Artifactually elevated potassium levels are one of the most common errors in
laboratory testing. A common cause is hemolysis of the sample. If elevated
potassium levels do not fit the clinical picture, confirmation of results is suggested
before treatment.
0–<1 wk 3.2–5.7
1 wk–<1 mo 3.4–6.2
1–<6 mo 3.5–5.8
6 mo–1 y 3.5–6.3
>1 y 3.3–4.7
Prealbumin (mg/dL)
0–14 d 2–12
15 d–<1 y 5–24
1–<5 y 12–23
5–<13 y 14–26
13–<16 y 18–31
16–<19 y Male: 20–35
Female: 17–33
Protein Electrophoresis (g/dL)
Total
Age Protein Albumin α1-Globulin α2-Globulin β-Globulin γ-Globulin
Cord 4.8–8.0
blood
Preterm 3.6–6.0
newborn
Full-term 4.6–7.0
0–<15 d 4.4–7.6 3.0–3.9 0.1–0.3 0.3–0.6 0.4–0.6 0.7–1.4
15 d–<1 y 5.1–7.3 2.2–4.8 0.1–0.3 0.5–0.9 0.5–0.9 0.5–1.3
1–2 y 5.6–7.5 3.6–5.2 0.1–0.4 0.5–1.2 0.5–1.1 0.5–1.7
3–<16 y 6.0–8.0 3.6–5.2 0.1–0.4 0.5–1.2 0.5–1.1 0.5–1.7
≥16 y 6.4–8.3 3.9–5.1 0.2–0.4 0.4–0.8 0.5–1.0 0.6–1.2
Pyruvate (mg/dL)
All 0.30–0.70
Rheumatoid Factor (RF) (IU/mL)
RF is a heterogenous group of autoantibodies whose levels may be elevated
in response to a wide variety of rheumatic and non-rheumatic inflammatory
conditions.

0–14 d 9.0–17.1
15 d–<19 y 9.0–9.0
Sodium (mEq/L)d
0–<7 d 131–144
7–31 d 132–142
1–<6 mo 132–140
6 mo–1 y 131–140
>1 y 132–141
Total Iron-Binding Capacity (TIBC) (mcg/dL)
Infant 100–400
Adult 250–425
Transferrin (g/L)
9 wk–<1 y 107–324
1–<19 y 220–337
Triglycerides (mg/dL)
Age Male Female
0–7 d 19–174 26–159
8–30 d 37–279 33–270
31–90 d 42–279 34–340
1–3 y 25–119
4–6 y 30–110
7–9 y 26–123
10–11 y 22–131 37–124
12–13 y 22–138 35–124
14–15 y 32–158 36–129
16–<19 y 32–134 35–134

Troponin I (ng/L)
Values herein correspond to the 99th percentile. Sensitive indicator of early
myocardial damage in children. Level is elevated within hours of cardiac injury
and persists for 3–7 d.
5–<15 d <968
3 mo–<19 y <21
Urea Nitrogen (BUN) (mg/dL)
0–4 d 3–19
5 d–2 y 6–17
3–12 y 8–18
13–18 y 9–21
Uric Acid (mg/dL)
0–14 d 2.8–12.7
15 d–<1 y 1.6–6.3
1 y–<12 y 1.8–4.9
12–<19 y Male: 2.6–7.6
Female: 2.6–5.9
Vitamin A (Retinol) (mcg/dL)e
0–<1 y 8.0–53.6
1–<11 y 27.5–44.4
11–<16 y 24.9–55.0
16–<19 y 28.7–75.1
Vitamin B1 (Thiamine) (mcg/dL)
All 4.5–10.3
Vitamin B2 (Riboflavin) (mcg/dL)
All 4–24
Vitamin B12 (Cobalamin) (pg/mL)
Newborn 160–1,300
Child, adolescent, or adult 200–835
Vitamin C (Ascorbic Acid) (mg/dL)
All 0.4–2.0
Vitamin D (Total) (25-hydroxyvitamin D) (ng/mL)

This test is for assessment of vitamin D sufficiency. Be aware that there are 2 forms
of vitamin D, D2 and D3, that make up total vitamin D measurement. Not all tests
measure total vitamin D. Although optimum levels of vitamin D are still somewhat
controversial, levels >50 ng/mL have been associated with adverse events.
Sufficiency ≥20
Insufficiency 12–<20
Deficiency <12
Vitamin E (Tocopherol) (mg/L)e,f
0–<1 y 2–21
1–<19 y 6–14
Zinc (mcg/dL)
All 70–120
a
All en dashes (–) indicate through except, for example, if an age range stops at 24 mo and the next
age range starts at 2 y; the en dash in the former age range indicates up to 24 mo (2 y).
b
Nanomole per liter (nmol/L) values were multiplied by 430.71 (molecular weight of folate) and
divided by 1,000 to convert to nanogram per milliliter (ng/mL).
c
Source supplied values as mean and SD. The 95% reference interval was calculated as
mean ± 1.96 SD.
d
Millimole per liter (mmol/L) = milliequivalent (mEq/L).
e
Values in source were in International System of Units. Conversion to conventional units can be
found at https://caliper.research.sickkids.ca/#.
f
Milligram per deciliter (mg/dL) conventional units from caliper were multiplied by 10 to convert to
milligram per liter (mg/L).
For Newborns
2- to 4-Hour
Analyte Cord Blood Venous Blood
pH 7.25–7.45 7.28–7.44
Pco2 (mm Hg) 28–52 29–57
Hct (%) 38–58 47–67
Hgb (g/L) 1.33–1.97 1.46–2.34
Sodium (mmol/L) 132–144 131–143
Potassium (mmol/L) 2.7–7.9 4.2–6.2
Chloride (mmol/L) 99–115 101–121
Calcium (ionized) (mmol/L) 0.4–1.85 0.97–1.29

For Newborns
2- to 4-Hour
Analyte Cord Blood Venous Blood
Magnesium (ionized) (mmol/L) 0.12–0.4 0.2–0.4
Glucose (mmol/L) 2.05–6.27 2.16–4.82
Glucose (mg/dL) 37–113 39–87
Lactate (mmol/L) 0.8–8.4 0.9–6.9
Urea nitrogen (BUN) (mmol/L) 0.93–3.36 1.11–3.96
Urea nitrogen (BUN) (mg/dL) 2.6–9.4 3.1–11.1
Abbreviations: Hct, hematocrit; Hgb, hemoglobin.

Reproduced with permission from Dollberg S, Bauer R, Lubetzky R, Mimouni FB. A reappraisal
of neonatal blood chemistry reference ranges using the Nova M electrodes. Am J Perinatol.
2001;18(8):433–440.
BIBLIOGRAPHY
Adeli K, Higgins V, Nieuwesteeg M, et al. Biochemical marker reference values
across pediatric, adult, and geriatric ages: establishment of robust pediatric and
adult reference intervals on the basis of the Canadian Health Measures Survey.
Clin Chem. 2015;61(8):1049–1062
Bailey D, Colantonio D, Kyriakopoulou L, et al. Marked biological variance
in endocrine and biochemical markers in childhood: establishment of pediat-
ric reference intervals using healthy community children from the CALIPER
cohort. Clin Chem. 2013;59(9):1393–1405
Burritt MF, Slockbower JM, Forsman RW, et al. Pediatric reference intervals for
19 biologic variables in healthy children. Mayo Clinic Proc. 1990;65(3):329–336
Colantonio DA, Kyriakopoulou L, Chan MK, et al. Closing the gaps in pedi-
atric laboratory reference intervals: a CALIPER database of 40 biochemical
markers in a healthy and multiethnic population of children. Clin Chem.
2012;58(5):854–868
Gaujoux-Viala C. C-reactive protein versus erythrocyte sedimentation rate in
estimating the 28-joint Disease Activity Score. J Rheumatol. 2013;40(11):
1785–1787
Ghoshal AK, Soldin SJ. Evaluation of the Dade Behring Dimension RxL: inte-
grated chemistry system-pediatric reference ranges. Clin Chim Acta. 2003;
331(1–2):135–146
Hirsch R, Landt Y, Porter S, et al. Cardiac troponin I in pediatrics: normal values

and potential use in assessment of cardiac injury. J Pediatr. 1997;130(6):872–877
Marshall MD, Kales SN, Christiani DC, Goldman RH. Are reference intervals
for carboxyhemoglobin appropriate? A survey of Boston area laboratories.
Clin Chem. 1995;41(10):1434–1438
National Institutes of Health (NIH) Office of Dietary Supplements (ODS).
Vitamin D fact sheet for health professionals. NIH ODS Web site. https://ods.
od.nih.gov/factsheets/VitaminD-HealthProfessional. Updated November 8,
2018. Accessed February 6, 2019
Raizman JE, Cohen AH, Teodoro-Morrison T, et al. Pediatric reference value
distributions for vitamins A and E in the CALIPER cohort and establishment of
age-stratified reference intervals. Clin Biochem. 2014;47(9):812–815
Ridefelt P, Gustafson J, Aldrimer M, Hellberg D. Alkaline phosphatase in
healthy children: reference intervals and prevalence of elevated levels. Horm
Res Paediatr. 2014;82(6):399–404
Rödöö P, Ridefelt P, Aldrimer M, et al. Population-based pediatric reference
intervals for HbA1c, bilirubin, albumin, CRP, myoglobin and serum enzymes.
Scand J Clin Lab Invest. 2013;73(5):361–367
Schwimmer JB, Dunn W, Norman GJ, et al. SAFETY study: alanine amino
transferase cutoff values are set too high for reliable detection of pediatric
chronic liver disease. Gastroenterology. 2010;138(4):1357–1364
Soldin SJ, Murthy JN, Agarwalla PK, Ojeifo O, Chea J. Pediatric reference
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2012
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THYROID FUNCTION TESTS

TSH, Total T3, Total T4, and Free T4 Values of Children
Age Values
Thyroid-stimulating Hormone (TSH) (mIU/L)
4 d–<1 y 0.73–4.77
6 mo–<14 y 0.7–4.17
14–<19 y 0.47–3.41
Triiodothyronine (Total) (T3) (ng/dL)
4 d–<1 y 84.64–234.38
1–<12 y 113.28–189.45
12–<15 y 97.66–176.43
15–<17 y Boy: 93.75–156.25
Girl: 92.45–141.93
17–<19 y 89.84–167.97
Thyroxine (Total) (T4) (mcg/dL)
7 d–<1 y 5.87–13.67
1–<9 y 6.16–10.32
9–<12 y 5.48–9.31
12–<14 y Boy: 5.01–8.28
Girl: 5.08–8.34
14–<19 y Male: 4.68–8.62
Female: 5.46–12.99
Thyroxine (Free) (T4) (ng/dL)
5–<15 d 1.05–3.21
15–<30 d 0.68–2.53
30 d–<1 y 0.89–1.7
1–<19 y 0.89–1.37
Mean Thyroid-stimulating Hormone and Thyroxine Values of Preterm and

Term Newborns 0 to 28 Daysa
Gestation
Analyte (wk) Cord Blood Day 7 Day 14 Day 28
Total T4 23–27 5.44 (2.02) 4.04 (1.79) 4.74 (2.56) 6.14 (2.33)
(mcg/dL) 28–30 6.29 (2.02) 6.29 (2.10) 6.60 (2.25) 7.46 (2.33)
(mean [SD])
31–34 7.61 (2.25) 9.40 (3.42) 9.09 (3.57) 8.94 (2.95)
>37 9.17 (1.94) 12.67 (2.87) 10.72 (1.40) 9.71 (2.18)
Free T4 23–27 1.28 (0.41) 1.47 (0.56) 1.45 (0.51) 1.50 (0.43)
(ng/dL) 28–30 1.45 (0.43) 1.82 (0.66) 1.65 (0.44) 1.71 (0.43)
(mean [SD])
31–34 1.49 (0.33) 2.14 (0.57) 1.96 (0.43) 1.88 (0.46)
>37 1.41 (0.39) 2.70 (0.57) 2.03 (0.28) 1.65 (0.34)
TSH (mIU/L) 23–27 6.80 (2.90) 3.50 (2.60) 3.90 (2.70) 3.80 (4.70)
(mean [SD]) 28–30 7.00 (3.70) 3.60 (2.50) 4.90 (11.20) 3.60 (2.50)
31–34 7.90 (5.20) 3.60 (4.80) 3.80 (9.30) 3.50 (3.40)
>37 6.70 (4.80) 2.60 (1.80) 2.50 (2.00) 1.80 (0.90)
Abbreviations: T4, thyroxine; TSH, thyroid-stimulating hormone.

Total T4 and free T4 have been converted from International System of Units to conventional units by
a
multiplying by 0.0777. This conversion factor was supplied by the source.

Based on Williams FL, Simpson J, Delahunty C, et al; Collaboration from the Scottish Preterm Thyroid
Group. Developmental trends in cord and postpartum serum thyroid hormones in preterm infants.
J Clin Endocrinol Metab. 2004;89(11):5314–5320.
GROWTH HORMONES
In children: Spontaneous growth hormone (GH) secretion is pulsatile
and unpredictable throughout the day, with more peaks overnight in
children who have an established diurnal rhythm. Therefore, random
GH values are generally not helpful.
Growth hormone stimulation tests (arginine, insulin-induced
hypoglycemia, levodopa, or clonidine) may be useful, but they are
difficult to perform. There are different stimulated values suggested,
depending somewhat on which assay is used, but commonly it is
thought that GH deficiency can be ruled out with a value of 10 ng/mL
or greater.
Therefore, a common approach to a diagnosis of GH deficiency

begins with a combination of clinical assessment, auxology (height
and growth evaluations), measurement of insulin-like growth factor 1
(IGF-1) and insulin-like growth factor binding protein 3 (IGFBP-3) and
bone age. Synthesis of IGF-1 and IGFBP-3 is controlled by GH levels,
but IGF-1 and IGFBP-3 have stable levels, rather than the fluctuation
of GH levels. Measuring both IGF-1 and IGFBP-3 has generally been
shown to have superior diagnostic sensitivity and specificity.
Results for these tests differ according to the method used by the
laboratory. Please refer to your local laboratory values when inter-
preting test results.
Insulin-like Growth Factor 1 (ng/mL)

0 27.0 –157.0 17.9–125.6
1 29.7–166.8 19.5–132.3
2 33.9–183.9 22.2–145.4
3 39.0–204.5 25.9–164.2
4 44.3–225.0 30.7–187.8
5 50.0–245.5 36.2–214.4
6 56.2–267.1 42.0–240.4
7 63.4–291.9 48.6–269.6
8 72.4–323.1 56.9–305.3
9 83.6–361.6 67.2–349.4
10 96.9–406.6 79.5–400.3
11 111.6–454.4 92.6–452.6
12 126.1–498.7 105.3–499.1
13 138.6–532.5 115.9–533.4
14 147.5–551.2 123.4–552.0
15 152.2–553.5 127.4–554.2
16 152.9–541.8 127.9–541.5
17 150.6–520.6 125.3–517.3
18 146.2–493.6 120.5–485.8
19 140.2–462.7 114.4–450.8
Insulin-like Growth Factor 1 (ng/mL) (continued)

Age Malea Femalea
20 133.1–430.0 107.8–416.0
21–25 115.2–354.8 92.9–342.0
26–30 97.9–281.6 78.4–270.0
31–35 88.3–246.0 73.1–243.0
36–40 83.4–232.7 69.0–227.0
41–45 74.9–216.4 61.5–204.4
46–50 66.9–205.1 56.8–194.5
51–55 60.6–200.3 53.0–189.6
56–60 54.3–194.2 45.6–172.4
61–65 48.8–187.7 42.2–169.0
66–70 46.5–191.9 38.3–162.5
71–75 40.9–179.2 36.6–164.7
76–80 37.1–172.0 34.7–164.8
81–85 33.8–165.4 34.4–172.4
86–90 32.2–166.1 33.6–177.8
All reference ranges are the 2.5–97.5 percentile.

a
Reproduced with permission from Bidlingmaier M, Friedrich N, Emeny RT, et al. Reference intervals
for insulin-like growth factor-1 (IGF-1) from birth to senescence: results from a multicenter study
using a new automated chemiluminescence IGF-1 immunoassay conforming to recent international
recommendations. J Clin Endocrinol Metab. 2014;99(5):1712–1721.
Insulin-like Growth Factor 1 (ng/mL)

Tanner Stage Age Valuesa
I 6.1–12.9 81.3–255.3
II 8.1–14.8 106.2–432.3
Male III 10.9–16.0 244.9–511.4
IV 12.4–17.1 222.6–577.7
V 13.5–20.0 227.4–517.8
I 5.8–12.1 85.9–323.0
II 9.3–14.1 117.5–451.3
Female III 9.3–15.1 258.3–528.5
IV 11.8–16.6 224.2–585.8
V 12.5–19.9 188.2–515.6
a
All reference ranges are the 2.5–97.5 percentile.
Reproduced with permission from Bidlingmaier M, Friedrich N, Emeny RT, et al. Reference intervals
for insulin-like growth factor-1 (IGF-1) from birth to senescence: results from a multicenter study
using a new automated chemiluminescence IGF-1 immunoassay conforming to recent international
recommendations. J Clin Endocrinol Metab. 2014;99(5):1712–1721.
Insulin-like Growth Factor Binding Protein 3 (mcg/mL)

Caution: Results are highly age and method dependent; refer to your
laboratory’s reference range.
Age Values
1–<3 y 1.3–3.5
3–<10 y Boy: 2.0–5.0
Girl: 2.9–5.3
10–<13 y Boy: 3.0–5.8
Girl: 3.2–6.0
13–<15 y Boy: 3.6–6.0
Girl: 3.3–6.3
15–18 y Male: 3.5–6.8
Female: 3.3-6.6
>18 y Male and female: 3.3–6.6
Reproduced with permission from Soldin OP, Dahlin JR, Gresham EG, King J, Soldin SJ. IMMULITE
2000 age and sex-specific reference intervals for alpha fetoprotein, homocysteine, insulin, insulin-like
growth factor-1, insulin-like growth factor binding protein-3, C-peptide, immunoglobulin E and intact
parathyroid hormone. Clin Biochem. 2008;41(12): 937–942.
17α-Hydroxyprogesterone (ng/dL)
Age Values
0–<6 mo 25–248
6 mo–<6 y Girl: 3–107
6–<10 y Girl: 6–62 Boy: 7–100
10–<18 y Girl: 15–137
Reproduced with permission from Soldin OP, Sharma H, Husted L, Soldin SJ. Pediatric reference
intervals for aldosterone, 17α-hydroxyprogesterone, dehydroepiandrosterone, testosterone and
25-hydroxy vitamin D3 using tandem mass spectrometry. Clinical Biochem. 2009;42(9):823–827.
Cortisol (mcg/dL)a
Ageb 5:00 to 11:00 am 5:00 to 11:00 pm
0–24 mo 1.0–34.0 1.0–30.0
2–10 y 1.0–33.0 1.0–24.0
11–18 y 1.0–28.0 1.0–22.0
a
Microgram per liter (mcg/L) units from the original source were divided by 10 to convert to
microgram per deciliter (mcg/dL) units used in this table.
b
All en dashes (–) indicate through except, for example, if an age range stops at 24 mo and the next
age range starts at 2 y; the en dash in the former age range indicates up to 24 mo (2 y).
Modified with permission from Soldin SJ, Murthy JN, Agarwalla PK, Oljeifo O, Chea J. P ediatric
reference ranges for creatine kinase, CKMB, Troponin I, iron, and cortisol. Clinical Biochem.
1999;32(1):77–80.
BIBLIOGRAPHY
Growth Hormone Research Society. Consensus guidelines for the diagnosis
and treatment of growth hormone (GH) deficiency in childhood and adoles-
cence: summary statement of the GH Research Society. J Clin Endocrinol Metab.
2000;85(11):3990–3993
For Infants and Toddlers
Hematology Values
HEMATOLOGY AND COAGULATION
Mean
Corpuscular White
Mean Hemoglobin Blood Red Blood
Hemoglobin Hematocrit Corpuscular Concentration Reticulocytes Cells (× Platelets (× Cells (×
Age (g) (%) Volume (fL) (g/dL per RBC) (%) 103/mcL) 10 /mcL)
3
1012/L)
22–25 12.2 (1.6) 38.59 (3.94) 125.10 3.73 247 (59) 3.09 (0.34)
weeks’ (7.84) (2.17)
gestationa
(mean [SD])
26–29 12.91 (1.38) 40.88 (4.40) 118.50 4.08 242 (69) 3.46 (0.41)
weeks’ (7.96) (0.84)
gestationa
(mean [SD])
>30 weeks’ 13.64 (2.21) 43.55 (7.20) 114.38 6.40 232 (87) 3.82 (0.64)
gestationa (9.34) (2.99)
(mean [SD])
1–3 db M: 12.5–16.6 M: 36.4–47.4 M: M: 32.8–36.4 M: 2.2–4.8 M: 7.69– M: M:
F: 12.7–16.4 F: 36.5–47.7 94.0–106.3 F: 31.7–36.3 F: 2.1–3.7 13.12 140–238 3.69–4.75
F: 89.7– F: 7.51– F: 133–255 F: 3.79–4.76
105.4 15.83
4–7 db M: 12.5–16.3 M: 35.9–46.6 M: 87.1–96.5 M: 30.9–33.4 M: 0.4–2.7 M: 6.54– M: M:
F: 12.6–15.3 F: 36.1–44.0 F: 86.5–93.8 F: 30.6–32.3 F: 0.4–2.0 12.32 129–271 3.98–5.08
F: 5.86– F: 95–230 F: 4.05–4.83
12.23
8–14 db M: M: M: M: 30.4–33.0 M: 0.4–2.7 M: 7.66– M: M:

11.9–15.7 34.4–45.4 87.1–94.8 F: 30.5–31.9 F: 0.4–2.0 14.05 120–297 3.75–4.93
F: F: F: F: 7.46– F: F:
12.7–14.9 36.6–43.2 87.4–92.2 14.55 106–294 4.01–4.73
Mean
Corpuscular White
Mean Hemoglobin Blood Red Blood
Hemoglobin Hematocrit Corpuscular Concentration Reticulocytes Cells (× Platelets (× Cells (×
Age (g) (%) Volume (fL) (g/dL per RBC) (%) 103/mcL) 103/mcL) 1012/L)
2 wk–<1 M: M: M: M: 30.6–32.6 M: 0.4–2.7 M: 8.90– M: M:
mob 11.6–14.2 33.6–41.0 88.0–95.2 F: 30.5–32.0 F: 0.4–2.0 16.69 157–406 3.61–4.46
F: F: F: F: 8.55– F: F:
11.6–14.3 34.1–41.8 88.4–93.3 15.72 114–364 3.70–4.59
1–<2 mob M: M: M: M: 30.0–32.0 M: 0.9–3.8 M: 8.36– M: M:
10.2–12.7 29.1–36.6 86.5–92.1 F: 29.8–31.7 F: 1.5–3.2 13.66 221–471 3.24–4.08
F: F: F: F: 7.34– F: F:
11.1–13.7 32.0–39.9 85.7–91.6 12.32 184–430 3.55–4.57
2–<6 mob M: M: M: M: 27.6–29.9 M: 0.9–3.1 M: 7.91– M: M:
10.5–13.0 30.5–37.7 79.6–86.3 F: 28.5–30.4 F: 1.1–2.9 13.41 215–448 3.67–4.61
F: F: F: F: 6.85– F: F:
10.7–13.4 30.5–38.6 82.0–87.0 12.84 147–423 3.63–4.61
6 mo–2 yb M: M: M: M: 26.0–29.0 M: 0.8–2.0 M: 7.73– M: M:
10.4–12.5 30.5–36.4 75.6–83.1 F: 26.5–29.3 F: 0.9–2.0 13.12 185–399 3.81–4.74
F: F: F: F: 7.05– F: F:
10.8–12.6 30.9–36.4 76.6–83.2 12.98 211–408 3.83–4.67

Abbreviations: F, female (girl); M, male (boy); RBC, red blood cell.
a
Forestier F, Daffos F, Catherine N, Renard M, Andreux JP. Developmental hematopoiesis in normal human fetal blood. Blood.
1991;77(11):2360–2363.
b
Soldin SJ, Wong EC, Brugnara C, Soldin OP, eds. Pediatric Reference Intervals. 7th ed. Washington, DC: AACC Press; 2011:58.
93
Hematology Values (continued)
For Children, Teens, and Young Adults
Analytea Age Range (y) Male Female

Hemoglobin (g/dL)
3–5 11.4–14.3 11.4–14.3
6–8 11.5–14.3 11.5–14.3
9–10 11.8–14.7 11.8–14.7
11–14 12.4–15.7 11.9–14.8
15–19 13.3–16.9 11.9-14.8
>19 13.6–16.9 11.9–14.8
Hematocrit (%)
3–5 34–42 34–42
6–7 34–42 34–42
8–11 35–43 35–43
12–15 38–47 35–43
>16 40–50 35–43
RBCs (× 10 /mcL)
6
3–5 4.0–5.1 4.0–5.1

6–10 4.1–5.2 4.1–5.2
11–14 4.2–5.3 4.1–5.1
>15 4.3–5.7 3.8–5.0
RDW (%)
3–5 11.3–13.4 11.3–13.4
>6 11.4–13.5 11.4–13.5
MCV (fL)
3–5 77.2–89.5 77.2–89.5
6–11 77.8–91.1 77.8–91.1
12–14 79.9–93.0 79.9–93.0
>15 82.5–98.0 82.5–98.0
MCH (pg/cell)
3–5 26.1–30.7 26.1–30.7
6–15 26.3–31.7 26.3–31.7
>16 27.6–33.3 27.6–33.3
MCHC (g/dL)
3–5 32.4–34.9 32.4–34.9
>6 32.5–35.2 32.5–35.2
Platelets (× 103/mcL)
3–5 187.4–444.6 187.4–444.6
6–9 186.7–400.4 186.7–400.4
10–13 176.9–381.3 176.9–381.3
14–26 138.7–319.6 158.1–361.6
27–79 151.8–324.0 153.2–361.3
MPV (fL)
3–5 6.4–9.5 6.4–9.5
6–11 6.6–9.8 6.6–9.8
>12 7.0–10.3 7.0–10.3
WBCs (× 103/mcL)
3–5 4.4–12.9 4.4–12.9
6–79 3.8–10.4 3.8–10.4
Abbreviations: MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin

concentration; MCV, mean corpuscular volume; MPV, mean platelet volume; RBC, red blood cell;
RDW, red cell distribution width; WBC, white blood cell.
Adeli K, Raizman JE, Chen Y, et al. Complex biological profile of hematologic markers across
a
pediatric, adult, and geriatric ages: establishment of robust pediatric and adult reference intervals
on the basis of the Canadian Health Measures Survey. Clin Chem. 2015;61(8):1075–1086.
For Infants and Toddlers
Age-Specific Leukocyte Differential

Neutrophils Lymphocytes Monocytes Eosinophils Basophils Normoblasts (nRBC)
(× 103/mcL) (× 103/mcL) (× 103/mcL) (× 103/mcL) (× 103/mcL) (× 103/mcL)
Absolute Absolute Absolute Absolute Absolute Absolute
Age Count % Count % Count % Count % Count % Count %
22–25 weeks’ — 6.5 (3.5) — 87 (6) — 3.0 (2.5) — 3 (3) — 0.5 (1.0) — 21 (23)
gestationa
(mean [SD])
26–29 weeks’ — 8.5 (4.0) — 8.5 (6.0) — 3.0 (2.5) — 4 (3) — 0.5 (1.0) — 21 (67)
gestationa
(mean [SD])
>30 weeks’ — 23 (15) — 68.5 — 3 (2) — 5 (3) — 0.5 (1.0) — 17 (40)

gestationa (15.0)
(mean [SD])
1–3 db M: M: M: M: 14–41 M: M: 4–13 M: M: 2–6 M: M and F: M and F: M and F:

4.33–9.11 24.1–47.1 1.84–3.58 F: 11–40 0.52–1.77 F: 5–11 0.07–0.39 F: 2–4 0.02–0.11 0–1 0.06–1.30 0.1–8.3
F: 4.43– F: F: F: F: F:
11.43 21.2–55.4 1.68–2.85 0.57–1.72 0.05–0.32 0.02–0.07
4–7 db M: M: M: M: 14–46 M: M: 7–17 M: M: 2–6 M: M and F: M and F: M and

3.33–6.58 24.1–47.1 1.53–4.09 F: 10–45 0.52–1.77 F: 6–14 0.09–0.42 F: 2–5 0.02–0.11 0–1 0.040– F: 0
F: F: F: F: F: F: 0.011
3.18–7.19 21.2–55.4 1.17–3.45 0.57–1.72 0.05–0.39 0.02–0.07
1–<2 wkb M: M: M: M: 9–47 M: M: 7–18 M: M: 2–5 M: M and F: M and F: M and

3.71–8.36 24.1–47.1 1.35–3.86 F: 8–46 0.52–1.77 F: 6–19 0.07–0.35 F: 2–5 0.02–0.11 0–1 0.040– F: 0
F: F: F: F: F: F: 0.011
3.91–8.26 21.2–55.4 1.46–3.78 0.57–1.72 0.05–0.29 0.02–0.07
2 wk–<1 mob M: M: M: M: 9–56 M: M: 6–18 M: M: 2–7 M: M and F: M and F: M and

3.47–9.42 18.4–32.4 1.68–5.25 F: 8–57 0.28–1.38 F: 5–14 0.12–0.51 F: 2–4 0.01–0.07 0–1 0.040– F: 0
F: F: F: F: F: F: 0.011
3.77–9.43 17.0–40.9 1.65–5.04 0.42–1.21 0.03–0.37 0.01–0.06
Neutrophils Lymphocytes Monocytes Eosinophils Basophils Normoblasts (nRBC)
(× 103/mcL) (× 103/mcL) (× 103/mcL) (× 103/mcL) (× 103/mcL) (× 103/mcL)
Absolute Absolute Absolute Absolute Absolute Absolute
Age Count % Count % Count % Count % Count % Count %
1 –<2 mob M: M: M: M: 12–68 M: M: 6–17 M: M: 2–5 M: M and F: M and F: M and
2.20–6.45 14.6–40.9 2.22–5.63 F: 16–68 0.28–1.05 F: 5–14 0.10–0.42 F: 2–6 0.01–0.07 0–1 0.03–0.09 F: 0
F: F: F: F: F: F:
2.49–6.26 15.7–49.1 2.15–5.14 0.28–1.21 0.08–0.32 0.01–0.05
2–<6 mob M: M: M: M: 16–68 M: M: 4–11 M: M: 2–6 M: M and F: M and F: M and

2.57–7.54 17.0–55.5 2.34–5.45 F: 15–68 0.28–1.07 F: 4–12 0.05–0.36 F: 2–5 0.01–0.06 0–1 0.03–0.13 F: 0
F: F: F: F: F: F:
2.22–7.11 18.6–60.0 1.88–5.39 0.24–1.17 0.01–0.28 0.01–0.07
6 mo–2 yb M: M: M: M: 15–67 M: M: 4–10 M: M: 1–5 M: M and F: M and F: M and

2.47–6.41 22.7–69.2 2.32–5.49 F: 13–70 0.25–1.15 F: 4–9 0.03–0.29 F: 1–4 0.01–0.06 0–1 0.03–0.12 F: 0
F: F: F: F: F: F:
2.34–6.44 23.8–69.3 2.03–5.68 0.26–1.08 0.01–0.20 0.01–0.06
Abbreviations: F, female (girl); M, male (boy); nRBC, nucleated red blood cell.
a
Forestier F, Daffos F, Catherine N, Renard M, Andreux JP. Developmental hematopoiesis in normal human fetal blood. Blood.
1991;77(11):2360–2363.
b
Soldin SJ, Wong EC, Brugnara C, Soldin OP, eds. Pediatric Reference Intervals. 7th ed. Washington, DC: AACC Press; 2011:58.

97
Age-Specific Leukocyte Differential (continued)
For Children and Teens
Analytea Age Range (y) Male Female

Neutrophils (× 103/mcL)
3–5 1.6–7.8 1.6–7.8
6–16 1.4–6.1 1.5–6.5
>16 1.8–7.2 2.0–7.4
Lymphocytes (× 103/mcL)
3–5 1.6–5.3 1.6–5.3
6–11 1.4–3.9 1.4–3.9
>12 1.0–3.2 1.0–3.2
Monocytes (× 103/mcL)
3–5 0.3–0.9 0.3–0.9
>6 0.2–0.8 0.2–0.8
Eosinophils (× 103/mcL)
3–5 0.0–0.5 0.0–0.5
6–11 0.0–0.5 0.0–0.5
>12 0.1–0.2 0.1–0.2
Basophils (× 103/mcL)
3–5 0.0–0.1 0.0–0.1
>6 0.0–0.1 0.0–0.1
a
Adeli K, Raizman JE, Chen Y, et al. Complex biological profile of hematologic markers across
pediatric, adult, and geriatric ages: establishment of robust pediatric and adult reference intervals
on the bases of the Canadian Health Measures Survey. Clin Chem. 2015;61(8):1075–1086.
Lymphocyte Subset Countsa in Peripheral Blood
Subsetb N 0 to 3 Months 3 to 6 Months 6 to 12 Months 1 to 2 Years 2 to 6 Years 6 to 12 Years 12 to 18 Years
WBCs 800 10.60 9.20 9.10 8.80 7.10 6.50 6.00
(7.20–18.00) (6.70–14.00) (6.40–13.00) (6.40–12.00) (5.20–11.00) (4.40–9.50) (4.40–8.10)
Lymphocytes 800 5.40 6.30 5.90 5.50 3.60 2.70 2.20
(3.40–7.60) (3.90–9.00) (3.40–9.00) (3.60–8.90) (2.30–5.40) (1.90–3.70) (1.40–3.30)
CD3 699 3.68 3.93 3.93 3.55 2.39 1.82 1.48
(2.50–5.50) (2.50–5.60) (1.90–5.90) (2.10–6.20) (1.40–3.70) (1.20–2.60) (1.00–2.20)
CD19 699 0.73 1.55 1.52 1.31 0.75 0.48 0.30
(0.30–2.00) (0.43–3.00) (0.61–2.60) (0.72–2.60) (0.39–1.40) (0.27–0.86) (0.11–0.57)
CD16/CD56 770 0.42 0.42 0.40 0.36 0.30 0.23 0.19
(0.17–1.10) (0.17–0.83) (0.16–0.95) (0.18–0.92) (0.13–0.72) (0.10–0.48) (0.07–0.48)
CD4 699 2.61 2.85 2.67 2.16 1.38 0.98 0.84
(1.60–4.00) (1.80–4.00) (1.40–4.30) (1.30–3.40) (0.70–2.20) (0.65–1.50) (0.53–1.30)
CD8 699 0.98 1.05 1.04 1.04 0.84 0.68 0.53
(0.56–1.70) (0.59–1.60) (0.50–1.70) (0.62–2.00) (0.49–1.30) (0.37–1.10) (0.33–0.92)
CD4/CD45RA/ 694 2.25 2.23 2.10 1.64 0.96 0.56 0.39
CD62L (1.20–3.60) (1.30–3.60) (1.10–3.60) (0.95–2.80) (0.42–1.50) (0.31–1.00) (0.21–0.75)
CD8/CD45RA/ 696 0.73 0.74 0.70 0.76 0.54 0.41 0.30
CD62L (0.38–1.30) (0.45–1.20) (0.33–1.20) (0.40–1.40) (0.26–0.85) (0.20–0.65) (0.17–0.56)
CD4/CD45RA 694 2.27 2.32 2.21 1.65 0.98 0.57 0.40
(1.20–3.70) (1.30–3.70) (1.10–3.70) (1.00–2.90) (0.43–1.50) (0.32–1.00) (0.23–0.77)

CD8/CD45RA 696 0.87 0.91 0.87 0.94 0.67 0.54 0.40
(0.45–1.50) (0.55–1.40) (0.48–1.50) (0.49–1.70) (0.38–1.10) (0.31–0.90) (0.24–0.71)
CD4/HLA-DR/ 694 0.08 0.11 0.10 0.10 0.06 0.04 0.03
CD38 (0.03–0.18) (0.05–0.26) (0.04–0.22) (0.05–0.25) (0.03–0.14) (0.02–0.08) (0.01–0.06)
CD8/HLA-DR/ 697 0.05 0.07 0.09 0.15 0.11 0.06 0.04
CD38 (0.02–0.16) (0.03–0.17) (0.04–0.27) (0.05–0.54) (0.05–0.34) (0.03–0.18) (0.02–0.13)
99
Lymphocyte Subset Countsa in Peripheral Blood (continued)
CD4/HLA-DR 694 0.10 0.15 0.12 0.13 0.09 0.07 0.06
(0.04–0.18) (0.06–0.28) (0.05–0.26) (0.07–0.28) (0.05–0.18) (0.04–0.12) (0.03–0.10)
CD8/HLA-DR 697 0.05 0.08 0.09 0.18 0.14 0.09 0.07
(0.02–0.16) (0.03–0.17) (0.04–0.29) (0.06–0.60) (0.07–0.42) (0.04–0.27) (0.03–0.18)
CD4/CD38 694 2.54 2.77 2.55 2.02 1.21 0.75 0.57
(0.16–3.90) (1.60–4.00) (1.20–4.10) (1.20–3.30) (0.59–2.00) (0.48–1.20) (0.33–1.00)
CD8/CD38 697 0.93 0.94 0.93 0.95 0.67 0.48 0.31
(0.55–1.60) (0.53–1.50) (0.45–1.60) (0.57–1.90) (0.39–1.10) (0.24–0.74) (0.16–5.70)
CD4/CD28 695 2.56 2.65 2.58 2.12 1.33 0.94 0.79
(1.60–3.80) (1.60–4.00) (1.20–4.20) (1.30–3.40) (0.69–2.00) (0.63–1.50) (0.49–1.20)
CD8/CD28 696 0.71 0.73 0.67 0.72 0.50 0.40 0.29
(0.35–1.30) (0.35–1.20) (0.28–1.10) (0.40–1.30) (0.28–0.87) (0.21–0.70) (0.16–0.52)
CD4/CD95 695 0.29 0.41 0.51 0.50 0.42 0.36 0.40
(0.16–0.58) (0.23–0.62) (0.29–0.82) (0.27–0.91) (0.27–0.65) (0.25–0.62) (0.25–0.66)
CD8/CD95 696 0.12 0.16 0.22 0.34 0.30 0.25 0.21

(0.05–0.31) (0.06–0.39) (0.08–0.66) (0.10–0.85) (0.11–0.58) (0.08–0.53) (0.08–0.45)
CD3/CD4/ 644 0.32 0.33 0.34 0.40 0.36 0.35 0.38

CD45RO (0.06–0.90) (0.12–0.63) (0.16–0.80) (0.21–0.85) (0.22–0.66) (0.23–0.63) (0.24–0.70)
CD3/CD4−/ 644 0.10 0.12 0.12 0.23 0.19 0.21 0.16

CD45RO (0.03–0.33) (0.03–0.29) (0.04–0.33) (0.06–0.57) (0.09–0.44) (0.07–0.39) (0.06–0.31)
CD3/CD45RO 644 0.48 0.46 0.47 0.65 0.57 0.59 0.56

(0.09–1.20) (0.15–0.86) (0.22–1.10) (0.30–1.30) (0.33–1.00) (0.32–0.95) (0.34–0.97)
CD3−/CD19/ 655 0.60 1.20 1.29 1.04 0.56 0.28 0.03

CD38 (0.12–2.00) (0.00–2.80) (0.02–2.20) (0.00–2.20) (0.01–1.20) (0.00–0.67) (0.00–0.35)
CD3−/CD19 655 0.62 1.26 1.33 1.10 0.67 0.34 0.04

(0.12–2.10) (0.00–2.80) (0.02–2.30) (0.00–2.30) (0.02–1.40) (0.00–0.74) (0.00–0.39)
Abbreviation: WBC, white blood cell.

a
Values are presented as medians (10th and 90th percentiles).
b
Subset counts (numbers of cells per microliter × 10−3) were obtained by multiplying subset percentages times anchor marker percentages
(ie, CD3/CD4 or CD3/CD8) of total CD45 lymphocyte population times the absolute lymphocyte count (WBCs × lymphocyte percentage).
Reproduced with permission from Shearer WT, Rosenblatt HM, Gelman RS, et al; Pediatric AIDS Clinical Trials Group. Lymphocyte subsets in healthy
children from birth through 18 years of age: the Pediatric AIDS Clinical Trials Group P1009 study. J Allergy Clin Immunol. 2003;112(5):973–980.
101
COAGULATION VALUES
Age-Specific Coagulation Valuesa—Healthy Preterm Infants
(30–36 Weeks)
Common Day 1 Day 5 Day 30 Day 90 Day 180

Coagulation Tests After Birth After Birth After Birth After Birth After Birth
PT (s) 13.0 12.5 11.8 12.3 12.5
(10.6– (10.0– (10.0– (10.0– (10.0–
16.2) 15.3) 13.6) 14.6) 15.0)
aPTT (s) 53.6 50.5 44.7 39.5 37.5
(27.5– (26.9– (26.9– (28.3– (21.7–
79.4) 74.1) 62.5) 50.7) 53.3)
Thrombin time (s) 24.8 24.1 24.4 25.1 25.2
(19.2– (18.8– (18.8– (19.4– (18.9–
30.4) 29.4) 29.9) 30.8) 31.5)
Factor I (fibrinogen) 2.43 2.80 2.54 2.46 2.28
(g/L) (1.50– (1.60– (1.50– (1.50– (1.50–
3.73) 4.18) 4.14) 3.52) 3.60)
Factor II (prothrom 0.45 0.57 0.57 0.68 0.87
bin) (U/mL) (0.20– (0.29– (0.36– (0.30– (0.51–
0.77) 0.85) 0.95) 1.06) 1.23)
Factor V (U/mL) 0.88 1.00 1.02 0.99 1.02
(0.41– (0.46– (0.48– (0.59– (0.58–
1.44) 1.54) 1.56) 1.39) 1.46)
Factor VII (U/mL) 0.67 0.84 0.83 0.87 0.99
(0.21– (0.30– (0.21– (0.31– (0.47–
1.13) 1.38) 1.45) 1.43) 1.51)
Factor VIII (U/mL) 1.11 1.15 1.11 1.06 0.99
(0.50– (0.53– (0.50– (0.58– (0.50–
2.13) 2.05) 1.99) 1.88) 1.87)
vWF (U/mL) 1.36 1.33 1.36 1.12 0.98
(0.78– (0.72– (0.66– (0.75– (0.54–
2.10) 2.19) 2.16) 1.84) 1.58)
Factor IX (U/mL) 0.35 0.42 0.44 0.59 0.81

(0.19– (0.14– (0.13– (0.25– (0.50–
0.65) 0.74) 0.80) 0.93) 1.20)
Factor X (U/mL) 0.41 0.51 0.56 0.67 0.77
(0.11– (0.19– (0.20– (0.35– (0.35–
0.71) 0.83) 0.92) 0.99) 1.19)

Factor XI (U/mL) 0.30 0.41 0.43 0.59 0.78
(0.08– (0.13– (0.15– (0.25– (0.46–
0.52) 0.69) 0.71) 0.93) 1.10)
Factor XII (U/mL) 0.38 0.39 0.43 0.61 0.82
(0.10– (0.09– (0.11– (0.15– (0.22–
0.66) 0.69) 0.75) 1.07) 1.42)
PK (U/mL) 0.33 0.45 0.59 0.79 0.78
(0.09– (0.26– (0.31– (0.37– (0.40–
0.57) 0.75) 0.87) 1.21) 1.16)
HMWK (U/mL) 0.49 0.62 0.64 0.78 0.83
(0.09– (0.24– (0.16– (0.32– (0.41–
0.89) 1.00) 1.12) 1.24) 1.25)
Factor XIII A subunit 0.70 1.01 0.99 1.13 1.13
(U/mL) (0.32– (0.57– (0.51– (0.71– (0.65–
1.08) 1.45) 1.47) 1.55) 1.61)
Factor XIII B subunit 0.81 1.10 1.07 1.21 1.15
(U/mL) (0.35– (0.68– (0.57– (0.75– (0.67–
1.27) 1.58) 1.57) 1.67) 1.63)
Coagulation Inhibitor Tests

ATIII (U/mL) 0.38 0.56 0.59 0.83 0.90
(0.14– (0.30– (0.37– (0.45– (0.52–
0.62) 0.82) 0.81) 1.21) 1.28)
AMG (U/mL) 1.10 1.25 1.38 1.80 2.09
(0.56– (0.71– (0.72– (1.20– (1.10–
1.82) 1.77) 2.04) 2.66) 3.21)
α2PI (U/mL) 0.78 0.81 0.89 1.06 1.15
(0.40– (0.49– (0.55– (0.64– (0.77–
1.16) 1.13) 1.23) 1.48) 1.53)
C1 INH (U/mL) 0.65 0.83 0.74 1.14 1.40
(0.31– (0.45– (0.40– (0.60– (0.96–
0.99) 1.21) 1.24) 1.68) 2.04)
Age-Specific Coagulation Valuesa—Healthy Preterm Infants

(30–36 Weeks) (continued)

AAT (U/mL) 0.90 0.94 0.76 0.81 0.82
(0.36– (0.42– (0.38– (0.49– (0.48–
1.44) 1.46) 1.12) 1.13) 1.16)
Protein C (U/mL) 0.28 0.31 0.37 0.45 0.57
(0.12– (0.11– (0.15– (0.23– (0.31–
0.44) 0.51) 0.59) 0.67) 0.83)
Protein S 0.26 0.37 0.56 0.76 0.82
(U/mL) (0.14– (0.13– (0.22– (0.40– (0.44–
0.38) 0.61) 0.90) 1.12) 1.20)
Tests of Fibrinolysis
Plasminogen (U/mL) 1.70 1.91 1.81 2.38 2.75
(1.12– (1.21– (1.09– (1.58– (1.91–
2.48) 2.61) 2.53) 3.18) 3.59)
Abbreviations: α2PI, α2-antiplasmin; AAT, α1-antitrypsin; AMG, α2-macroglobulin; aPTT, activated

artial thromboplastin time; ATIII, antithrombin III; C1 INH, C1 inhibitor; HMWK, high-molecular-
p
weight kininogen; PK, prekallikrein; PT, prothrombin time; vWF, von Willebrand factor.
a
Values are given as a mean followed by lower and upper boundaries encompassing 95% of
the population.
Reproduced with permission from Andrew M, Paes B, Milner R, et al. Development of the human
coagulation system in the healthy premature infant. Blood. 1988;72(5):1651–1657.
Age-Specific Coagulation Valuesa—Healthy, Full-term Infants
Common
Coagulation Day 1 After Day 5 After Day 30 Day 90 Day 180
Tests Birth Birth After Birth After Birth After Birth
PT (s) 13.00 (1.43) 12.40 (1.46) 11.80 (1.25) 11.90 (1.15) 12.30 (0.79)
aPTT (s) 42.90 (5.80) 42.60 (8.62) 40.40 (7.42) 37.10 (6.52) 35.50 (3.71)
Thrombin 23.50 (2.38) 23.10 (3.07) 24.30 (2.44) 25.10 (2.32) 25.50 (2.86)
time (s)
Factor I 2.83 (0.58) 3.12 (0.75) 2.70 (0.54) 2.43 (0.68) 2.51 (0.68)
(fibrinogen)
(g/L)
Factor II 0.48 (0.11) 0.63 (0.15) 0.68 (0.17) 0.75 (0.15) 0.88 (0.14)
(prothrom
bin) (U/mL)
Factor V 0.72 (0.18) 0.95 (0.25) 0.98 (0.18) 0.90 (0.21) 0.91 (0.18)
(U/mL)
Factor VII 0.66 (0.19) 0.89 (0.27) 0.90 (0.24) 0.91 (0.26) 0.87 (0.20)
(U/mL)
Factor VIII 1.00 (0.39) 0.88 (0.33) 0.91 (0.33) 0.79 (0.23) 0.73 (0.18)
(U/mL)
vWF (U/mL) 1.53 (0.67) 1.40 (0.57) 1.28 (0.59) 1.18 (0.44) 1.07 (0.45)
Factor IX 0.53 (0.19) 0.53 (0.19) 0.51 (0.15) 0.67 (0.23) 0.86 (0.25)
(U/mL)
Factor X 0.40 (0.14) 0.49 (0.15) 0.59 (0.14) 0.71 (0.18) 0.78 (0.20)
(U/mL)
Factor XI 0.38 (0.14) 0.55 (0.16) 0.53 (0.13) 0.69 (0.14) 0.86 (0.24)
(U/mL)
Factor XII 0.53 (0.20) 0.47 (0.18) 0.49 (0.16) 0.67 (0.21) 0.77 (0.19)
(U/mL)
PK (U/mL) 0.37 (0.16) 0.48 (0.14) 0.57 (0.17) 0.73 (0.16) 0.86 (0.15)
HMWK 0.54 (0.24) 0.74 (0.28) 0.77 (0.22) 0.82 (0.32) 0.82 (0.23)
(U/mL)
Factor XIII A 0.79 (0.26) 0.94 (0.25) 0.93 (0.27) 1.04 (0.34) 1.04 (0.29)
subunit
(U/mL)
Age-Specific Coagulation Valuesa—Healthy, Full-term Infants

(continued)
Common
Coagulation Day 1 After Day 5 After Day 30 Day 90 Day 180
Tests Birth Birth After Birth After Birth After Birth
Factor XIII B 0.76 (0.23) 1.06 (0.37) 1.11 (0.36) 1.16 (0.34) 1.10 (0.30)
subunit
(U/mL)
ATIII (U/mL) 0.63 (0.12) 0.67 (0.13) 0.78 (0.15) 0.97 (0.12) 1.04 (0.10)
AMG (U/mL) 1.39 (0.22) 1.48 (0.25) 1.50 (0.22) 1.76 (0.25) 1.91 (0.21)
α2PI (U/mL) 0.85 (0.15) 1.00 (0.15) 1.00 (0.12) 1.08 (0.16) 1.11 (0.14)
C1 INH 0.72 (0.18) 0.90 (0.15) 0.89 (0.21) 1.15 (0.22) 1.41 (0.26)
(U/mL)
AAT (U/mL) 0.93 (0.22) 0.89 (0.20) 0.62 (0.13) 0.72 (0.15) 0.77 (0.15)
Protein C 0.35 (0.09) 0.42 (0.11) 0.43 (0.11) 0.54 (0.13) 0.59 (0.11)
(U/mL)
Protein S 0.36 (0.12) 0.50 (0.14) 0.63 (0.15) 0.86 (0.16) 0.87 (0.16)
(U/mL)
Plasmino 1.95 (0.35) 2.17 (0.38) 1.98 (0.36) 2.48 (0.37) 3.01 (0.40)
gen (U/mL)

p
weight kininogen; PK, prekallikrein; PT, prothrombin time; vWF, von Willebrand factor.
a
Mean ± 1 SD.
Reproduced with permission from Andrew M, Paes B, Milner R, et al. Development of the human
coagulation system in the full-term infant. Blood.1987;70(1):165–172.
Age-Specific Coagulation Valuesa—Childhood Compared With Adults
Common Coagulation 1 to 6 to 11 to
Tests 5 Years 10 Years 16 Years Adult
PT (s) 11.0 11.1 11.2 12.0
(10.6–11.4) (10.1–12.1) (10.2–12.0) (11.0–14.0)
INR 1.00 1.01 1.02 1.10
(0.96–1.04) (0.91–1.11) (0.93–1.10) (1.00–1.30)
aPTT (s)b 30 (24–36) 31 (26–36) 32 (26–37) 33 (27–40)
Factor I (fibrinogen) (g/L) 2.76 2.79 3.00 2.78
(1.70–4.05) (1.57–4.0) (1.54–4.48) (1.56–4.00)
Factor II (prothrombin) 0.94 0.88 0.83 1.08

(U/mL) (0.71–1.16) (0.67–1.07) (0.61–1.04) (0.70–1.46)
Factor V (U/mL) 1.03 0.90 0.77 1.06

(0.79–1.27) (0.63–1.16) (0.55–0.99) (0.62–1.50)
Factor VII (U/mL) 0.82 0.85 0.83 1.05
(0.55–1.16) (0.52–1.20) (0.58–1.15) (0.67–1.43)
Factor VIII (U/mL) 0.90 0.95 0.92 0.99
(0.59–1.42) (0.58–1.32) (0.53–1.31) (0.50–1.49)
vWF (U/mL) 0.82 0.95 1.00 0.92
(0.60–1.20) (0.44–1.44) (0.46–1.53) (0.50–1.58)
Factor IX 0.73 0.75 0.82 1.09
(U/mL) (0.47–1.04) (0.63–0.89) (0.59–1.22) (0.55–1.63)
Factor X 0.88 0.75 0.79 1.06
(U/mL) (0.58–1.16) (0.55–1.01) (0.50–1.17) (0.70–1.52)
Factor XI (U/mL) 0.97 0.86 0.74 0.97
(0.56–1.50) (0.52–1.20) (0.50–0.97) (0.67–1.27)
Factor XII (U/mL) 0.93 0.92 0.81 1.08
(0.64–1.29) (0.60–1.40) (0.34–1.37) (0.52–1.64)
PK (U/mL) 0.95 0.99 0.99 1.12
(0.65–1.30) (0.66–1.31) (0.53–1.45) (0.62–1.62)
HMWK (U/mL) 0.98 0.93 0.91 0.92
(0.64–1.32) (0.60–1.30) (0.63–1.19) (0.50–1.36)
Factor XIII A subunit 1.08 1.09 0.99 1.05
(U/mL) (0.72–1.43) (0.65–1.51) (0.57–1.40) (0.55–1.55)
Age-Specific Coagulation Valuesa—Childhood Compared With Adults

(continued)
Common Coagulation 1 to 6 to 11 to
Tests 5 Years 10 Years 16 Years Adult
ATIII (U/mL) 1.11 1.11 1.05 1.00
(0.82–1.39) (0.90–1.31) (0.77–1.32) (0.74–1.26)
AMG (U/mL) 1.69 1.69 1.56 0.86
(1.14–2.23) (1.28–2.09) (0.98–2.12) (0.52–1.20)
C1 INH (U/mL) 1.35 1.14 1.03 1.00
(0.85–1.83) (0.88–1.54) (0.68–1.50) (0.71–1.31)
AAT (U/mL) 0.93 1.00 1.01 0.93
(0.39–1.47) (0.69–1.30) (0.65–1.37) (0.55–1.30)
Heparin cofactor II (U/mL) 0.88 0.86 0.91 1.08
(0.48–1.28) (0.40–1.32) (0.53–1.29) (0.66–1.26)
Protein C (U/mL) 0.66 0.69 0.83 0.96
(0.40–0.92) (0.45–0.93) (0.55–1.11) (0.64–1.28)
Protein S (total) (U/mL) 0.86 0.78 0.72 0.81
(0.54–1.18) (0.41–1.14) (0.52–0.92) (0.60–1.13)
Protein S (free) (U/mL) 0.45 0.42 0.38 0.45
(0.21–0.69) (0.22–0.62) (0.26–0.55) (0.27–0.61)
Plasminogen (U/mL) 0.98 0.92 0.86 0.99
(0.78–1.18) (0.75–1.08) (0.68–1.03) (0.70–1.22)
tPA (ng/mL) 2.15 2.42 2.16 4.90
(1.00–4.50) (1.00–5.00) (1.00–4.00) (1.40–8.40)
α2PI (U/mL) 1.05 0.99 0.98 1.02
(0.93–1.17) (0.89–1.10) (0.78–1.18) (0.68–1.36)
PAI (U/mL) 5.42 (1.00– 6.79 (2.00– 6.07 (2.00– 3.60
10.00) 12.00) 10.00) (0–11.00)

p
weight kininogen; INR, international normalized ratio; PAI, plasminogen activator inhibitor; PK,
prekallikrein; PT, prothrombin time; tPA, tissue plasminogen activator; vWF, von Willebrand factor.
a
Values given are the mean followed by lower and upper boundary encompassing 95% of
the population.
b
aPTT values may vary depending on reagent.
Reproduced with permission from Andrew M, Vegh P, Johnston M, Bowker J, Ofosu F, Mitchell L.
Maturation of the hemostatic system during childhood. Blood. 1992;80(8):1998–2005.
6. Hyperbilirubinemia Management
RISK NOMOGRAM
25 428
20 95th 342
High risk zone percentile
Serum bilirubin (mg/dl)
one
isk z
15 mediate r 257
inter one
High risk z
mol/L
iate
intermed
Low
10 171
Low risk zone

5 85
0 0
0 12 24 36 48 60 72 84 96 108 120 132 144
Postnatal age (hours)
Nomogram for designation of risk in 2840 well newborns at 36 or more weeks’ gestational age with
birth weight of 2000 g or more or 35 or more weeks’ gestational age and birth weight of 2500 g or
more based on the hour-specific serum bilirubin values.
From Bhutani VK, Johnson L, Sivieri EM. Predictive ability of a predischarge hour-specific serum
bilirubin for subsequent significant hyperbilirubinemia in healthy term and near-term newborns.
Pediatrics. 1999;103(1):6–14.
PHOTOTHERAPY NOMOGRAM
Guidelines for phototherapy in hospitalized infants of 35 or more weeks’ gestation.

From American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management
of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics.
2004;114(1):297–316.
Hyperbilirubinemia Management 111
EXCHANGE TRANSFUSION NOMOGRAM
Guidelines for exchange transfusion in infants 35 or more weeks’ gestation.

From American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management
of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics.
2004;114(1):297–316.
7. Rate and Gap Calculations
GLUCOSE INFUSION RATE
The glucose infusion rate (GIR) can be calculated using the following
formula:
GIR = [(Intravenous Rate [mL/h] × Dextrose Concentration [g/dL]) × 0.167]/
Weight (kg)
• A GIR of 5 to 8 mg/kg/min is typical.

• The maximal GIR needed to optimize nutrition is 14 mg/kg/min.
CALCULATED SERUM OSMOLALITY

The serum osmolality can be calculated using the following formula:
Serum Osmolality = [2 × Serum Sodium (mmol/L)] + [Glucose (mg/dL)/18] +
[Serum Urea Nitrogen (mg/dL)/2.8]
• Reference range value: 275 to 295 mOsm/L.

Osmolal Gap = Measured Osmolality by Laboratory − Calculated Osmolality
• Gap should be less than 10 mOsm.
ANION GAP
The anion gap is the difference between the positive ions in the serum
(sodium [Na]) and the negative ions (chloride [CI] and bicarbonate
[HCO3−]). It can be calculated using the following formula (note that
some formulas include potassium [K+]):
Anion Gap = Na − (HCO3− + CI)
• Normal anion gap = 8 to 12 mEq/L. Check with laboratory staff

for their reference range, as this varies depending on analytical
method (eg, ion-selective electrode methods tend to result in
higher chloride levels than other methods) and equation used.
• Elevated anion gap is greater than 14 mEq/L in children
(depending on laboratory).
8. Nutrition and Formula Information
Preparation of Infant Formula for Standard and Soy Formulasa
Caloric
Concentration Amount of Water to Add
Formula Type (kcal/oz) Formula (oz)
Powder (standard scoop) 19–20 1 scoop 2
24 1 scoop 1.6
27 1 scoop 1.4
30 1 scoop 1.3
Liquid concentrates (40 kcal/oz) 20 8 oz 8
24 8 oz 5.5
27 8 oz 4
30 8 oz 2.5
Does not apply to EnfaCare, Neocate Infant, NeoSure, or EleCare; Enfamil A.R. and Similac For
a
Spit-Up should not be concentrated >24 kcal/oz. Use a packed scoop measure for Nutramigen
and Pregestimil and an unpacked scoop for all other powders.
Data obtained from Mead Johnson Nutrition Web site. https://www.meadjohnson.com/pediatrics/
us-en/product-information/dilutions-and-preparation. Retrieved May 2018.
Common Modular Supplements

Component Calories
Protein Beneprotein 25 kilocalories per scoop
(powder) (6 g protein)
Liquid Protein 4 kcal/mL (1 g protein)
Complete Amino Acid Mix 3.28 kcal/g (0.82 g protein)
Fat MCT oil 7.7 kcal/mL
Liquigen 4.5 kcal/mL
Microlipid 4.5 kcal/mL
Fat and Duocal 25 kilocalories per 5 g scoop (35% fat as
carbohydrate MCT oil)
Abbreviation: MCT, medium-chain triglyceride.

Data obtained from 2018 pediatric nutritional products guide. Abbott Web site. https://static.
abbottnutrition.com/cms-prod/abbottnutrition-2016.com/img/00874%20-%20ANI2017-09-18%20-%
20PEDIATRIC%20NUTRITIONAL%20PRODUCTS%20GUIDE_FINAL_EN_Web_tcm1310-72852.pdf.
Published January 2018; Product guide, 2018. Nestlé Health Science Web site. https://www.
nestlehealthscience.ca/en/resources/documents/2018%20nhs%20product%20guide.pdf.
Published May 2018; and Nutricia product reference guide. Nutricia Advanced Medical Nutrition
Web site. https://www.nutricia-na.com/2017-US_PRG.pdf. Updated September 2017. Retrieved
May 2018.
Enteral Formulas, Including Their Main N
Caloric Osmolality
Concentration Protein Fat Carbohydrates Sodium Potassium Calcium Phosphorous Iron (mOsm/kg
(kcal/oz) (g) (g) (g) (mEq) (mEq) (mg) (mg) (mg) H2O)
A. Infantsa
Human Milk (nutrients per 100 kcal)
Term 20 1.65 5.9 10.8 1.2 2.1 41.9 21.5 0.05 286
Preterm 20 2.1 5.8 9.9 1.6 2.2 37 19 0.18 290
Human Milk and Fortifiers Analysis (nutrients per 100 kcal)
EnfamiI HMF Acidified Liquid + 24 4 6 8.1 2.5 2.5 145 80 1.9 326
preterm human milk (1 packet per
25 mL)b
Similac HMF Concentrated Liquid 24 2.95 5.2 10.4 2.1 3.8 172 98 0.59 385
SimiIac HMF Hydrolyzed Protein 24 3.58 5 10.1 2 3.6 152 85 0.59 450
Concentrated Liquid + preterm
utrient Components
human milk (1 packet per 25 mL)
Similac HMF Powder (1 packet per 23 3 5.3 10.6 2.5 4 175 95 0.55 NA
25 mL)
Preterm Formulas (nutrients per 100 kcal)
Nutrition and Formula Information

Enfamil EnfaCare 22 2.8 5.3 10.4 1.5 2.7 120 66 1.8 250–310
Enfamil Premature 20, 24, 30 3 5.1 11 2.5 2.5 165 83 1.8 240–320
Enfamil Premature 24 Cal High 24 3.5 5.1 10.5 2.5 2.5 165 83 1.8 300
Protein
Similac NeoSure 22 2.8 5.5 10.1 1.4 3.6 105 62 1.8 250
Similac Special Care 20, 24 3 5.43 10.3 1.9 3.3 180 100 1.8 235–280
117
Caloric Osmolality
A. Infantsa (continued)
Preterm Formulas (nutrients per 100 kcal) (continued)
Similac Special Care 24 High Protein 24 3.3 5.43 10 1.9 3.3 180 100 1.8 280
Similac Special Care 30 30 3 6.61 7.73 1.9 NA 3.3 180 100 1.8
Cow’s Milk–Based Formulas (nutrients per 100 kcal)
Enfamil A.R. 20 2.5 5.1 11.3 1.7 2.8 78 53 1.8 230–240
Enfamil for infants, non-GMO Enfam 20 2 5.3 11.3 1.2 2.8 78 43 1.8 300
il, Enfamil NeuroPro
Generic Organic Milk-Based Infant 20 2.2 5.3 10.6 1.2 2.8 78 43 1.8 NA
Formula
Similac Advance, Similac Pro- 19–20 2.07 5.4 11 1.1 2.8 82 44 1.9 310
utrient Components (continued)
Advance, non-GMO Similac
Similac For Spit-Up 19 2.14 5.4 11 1.4 2.8 88 59 1.9 180
Similac Organic 20 2.07 5.4 10.9 1 2.7 78 42 1.8 225
Similac PM 60/40 20 2.2 5.8 10.2 1 2.1 58 28 0.7 280
Similac Sensitive, Similac Pro- 19 2.1 5.4 10.9 1.4 2.8 88 59 1.9 200
Sensitive
Soy-Based Formulas (nutrients per 100 kcal)
Enfamil ProSobee 20 2.5 5.5 10.2 1.9 3 105 69 1.8 170–200
Gerber Good Start Soy 20 2.5 5.1 11.1 1.7 3 105 63 1.8 180
Similac Soy Isomil 19–20 2.45 5.5 10.4 2 2.8 110 79 1.9 200
Caloric Osmolality
Partially Hydrolyzed Formulas (nutrients per 100 kcal)

Enfamil Gentlease 20 2.3 5.3 10.8 1.6 2.8 82 46 1.8 250–260
Gerber Good Start Gentle 20 2.2 5.1 11.6 1.2 2.8 67 38 1.5 250
Gerber Good Start Soothe 20 2.2 5.1 11.2 1.2 2.8 72 40 1.5 195
Similac Total Comfort 19 2.32 5.4 11 2 3.1 105 70 1.9 200
Extensively Hydrolyzed Casein Formulas (nutrients per 100 kcal)
Enfamil Nutramigen with Enflora 20 2.8 5.3 10.3 2 2.8 94 52 1.8 300
LGG
Enfamil Pregestimil 20 2.8 5.6 10.2 2 2.8 94 52 1.8 290–320
Gerber Extensive HA 20 2.6 5.1 10.9 1.7 2.5 90 64 1.8 220
Similac Alimentum 20 2.75 5.5 10.2 1.9 3 105 75 1.8 370
Amino Acid–Based Formulas (nutrients per 100 kcal)
EleCare for infants 20 3.1 4.8 10.7 2 3.9 116 84.2 1.8 350

Enfamil PurAmino 20 2.8 5.3 10.3 2 2.8 94 52 1.8 350
Neocate Infant 20 2.8 5.1 10.8 1.7 2.8 116 82 1.5 375
Abbreviations: GMO, genetically modified organism; HMF, Human Milk Fortifier; NA, not applicable.
Other specialized formula information available from manufacturer or specialized registered dietitian.
a
Powder product also available.

b
Data obtained from 2018 pediatric nutritional products guide. Abbott Web site. https://static.abbottnutrition.com/cms-prod/abbottnutrition-2016.com/
img/00874%20-%20ANI2017-09-18%20-%20PEDIATRIC%20NUTRITIONAL%20PRODUCTS%20GUIDE_FINAL_EN_Web_tcm1310-72852.pdf. Published January
2018; Pediatric product guide. Mead Johnson Nutrition Web site. https://www.meadjohnson.com/pediatrics/us-en/sites/hcp-usa/files/mjn-2445_lb6_2018_
wo48_lo_09202018.pdf. Updated September 2018; I want the best formula in organic infant.... Earth’s Best Web site. https://www.earthsbest.com/
en/products/category/formula/infant-formula; Nutricia product reference guide. Nutricia Advanced Medical Nutrition Web site. https://www.nutricia-na.com/
2017-US_PRG.pdf. Updated September 2017; and Product guide, 2018. Nestlé Health Science Web site. https://www.nestlehealthscience.ca/en/resources/
documents/2018%20nhs%20product%20guide.pdf. Published May 2018. Retrieved May 2018.
119
Caloric Osmolality
B. Toddlers and Young Children Aged 1 to 10 Years

Toddler Transitional Formulas (nutrients per 100 kcal)
Enfamil Enfagrow 20 2.6 5.3 10.8 1.6 3.3 200 130 1.5 NA
Gerber Good Start Grow 20 3 4 12 1.7 6.7 215 185 2 NA
Nestlé Nido 1+ 20 3.8 4.4 12 2.6 4.3 175 0 1.25 NA
Similac Go & Grow 19 2.6 5.3 .6 1.3 3.9 187 160 2 300
Cow’s Milk–Based Formulas (nutrients per 1 L)
Boost Kid Essentials 30 30 38 135 24 29 1,266 844 11 550–600
Boost Kid Essentials 1.5a 45 42 76 165 30 33 1,477 1,266 11 390
Nutren Juniora 30 30 50 110 20 34 1,200 840 14 350
PediaSurea 30 30 38 139 16.5 38 1,055 844–845 11 450–490
PediaSure 1.5a 45 59 68 160 16.5 42 1,477 1,055 11 370–390
PediaSure Enterala 30 30 38 139 16.5 33.5 1,055 844 11 335–350
Soy-Based Formulas (nutrients per 1 L)
Bright Beginnings Soy Pediatric 30 29 50 108 16 40 1,042 833 15 515
Drink
“Blenderized” Formulas (nutrients per 1 L)
Compleat Pediatric 30 38 38 136 33 44 1,400 1,080 14 400
Compleat Pediatric Reduced 18 30 20 88 33 44 1,400 1,080 14 310
Calorie
Nourish NA 33 39 48 141 48 42 1,076 469 10
PediaSure Harvest 30 38 38 131 25 60 1,392 1,055 11 353
Caloric Osmolality
Semi-elemental Hydrolyzed Formulas (nutrients per 1 L)

PediaSure Peptide 30 30 40.5 134 31 35 1,060 844 14 250
PediaSure Peptide 1.5 45 45 61 201 47 52 1,580 1,265 21 450
Peptamen Juniora 30 30 38 136 20 34 1,120 840 14 260–400
Peptamen Junior 1.5 45 45 68 180 30 51 1,650 1,352 21 450
Amino Acid–Based Formulas (nutrients per 1 L)
EleCare Jr 30 31 49 107 20 39 1,174 854 18 590
Neocate Junior (flavored) 30 35 47 110 22 37 1,200 796 16 630–650
Neocate Junior (unflavored) 30 33 50 104 22 35 1,180 799 16 550
Neocate Splash 30 30 51 105 22 35 1,180 800 150 670–790
Vivonex Pediatric 24 24 23 128 16 32 1,120 960 10 360
Abbreviation: NA, not applicable.

Also available with fiber.
a

Data obtained from Pediatric product guide. Mead Johnson Nutrition Web site. https://www.meadjohnson.com/pediatrics/us-en/sites/hcp-usa/files/mjn-
2445_lb6_2018_wo48_lo_09202018.pdf. Updated September 2018; Product guide, 2018. Nestlé Health Science Web site. https://www.nestlehealthscience.ca/
en/resources/documents/2018%20nhs%20product%20guide.pdf. Published May 2018; Nutricia product reference guide. Nutricia Advanced Medical Nutrition
Web site. https://www.nutricia-na.com/2017-US_PRG.pdf. Updated September 2017; Nuture with Nido. Nestlé Nido Web site. https://www.nestlenido.com/en/
products; 2018 pediatric nutritional products guide. Abbott Web site. https://static.abbottnutrition.com/cms-prod/abbottnutrition-2016.com/img/00874%20
-%20ANI2017-09-18%20-%20PEDIATRIC%20NUTRITIONAL%20PRODUCTS%20GUIDE_FINAL_EN_Web_tcm1310-72852.pdf. Published January 2018; Bright
Beginnings Soy Pediatric Drink ingredients and nutrition. Bright Beginnings Web site. http://brightbeginningssoy.com/ingredients.aspx; and Nourish. Functional
Formularies Web site. https://www.functionalformularies.com/media/wysiwyg/FF_Phase_7b_Nourish_Product_Specs_1.pdf. Retrieved May 2018.
121
Caloric Osmolality
C. Older Children and Adultsa,b

Cow’s Milk–Based Formulas (nutrients per 1 L)
Boost 30 42 17 173 27 50 1,266 1,266 19 625
Boost Breeze 31 38 0 228 15 0 0 633 11 750
Boost Plus 45 59 59 190 37 39 1,477 1,266 19 670
Carnation instant breakfast + 24 48 4 144 31 67 1,850 1,850 17 NA
8 oz skim milk
Carnation instant breakfast ready 30 42 17 171 27 62 1,250 1,250 19 NA
to drink
Ensure 28 38 25 135 37 40 1,266 1,055 19 480
Ensure Clear Therapeutic Nutrition 30 35 0 215 6.5 0 0 0 9 700
Ensure Plus 44 55 46 211 40 43 1,266 1,266 19 680
Fibersource HN 36 54 40 164 49 49 960 960 16 480
Glucerna 1.0 30 42 54 96 40 40 705 705 13 355
Isosource 1.5 45 68 59 176 56 60 1,200 1,200 18 650
Jevity 1.0 Cal 32 44 35 155 40 40 910 760 14 300
Jevity 1.2 Cal 36 56 39 169 59 47 1,200 1,200 18 450
Jevity 1.5 Cal 45 64 50 216 61 55 1,200 1,200 18 525
Nutren 1.0c 30 40 34 136 38 41 800 800 14 330–340
Nutren 1.5 45 68 60 176 56 62 1,200 1,200 20 530
Nutren 2.0 60 84 92 216 65 54 1,600 1,480 24 780
Osmolite 1.0 Cal 32 44 35 144 40 40 760 760 14 300
Caloric Osmolality
Osmolite 1.2 Cal 36 56 39 158 58 46 1,200 1,200 18 360

Osmolite 1.5 Cal 45 63 49 204 61 46 1,000 1,000 18 525
Promotec 30 63 26 130 44 51 1,200 1,200 18 340–380
Repletec 30 64 34 112 38 41 800 800 14 300–330
TwoCal HN 60 84 91 219 64 63 1,050 1,050 19 725
“Blenderized” Formulas (nutrients per 1 L)
Compleat 32 48 40 136 43 40 880 840 14 450
Kate Farms Standard 1.0 30 55 34 117 30 43 1,077 923 19 417–432
Liquid Hope 39 65 56 138 47 69 761 907 16 482
Semi-elemental Hydrolyzed Formulas (nutrients per 1 L)
Kate Farms Peptide Plus 45 74 77 126 47 63 1,077 769 19 569
Peptamenc 30 40 39 128 24 38.5 800 700 18 270–380
Peptamen 1.5c 45 68 56 188 40 52 1,000 1,000 24 550–570

Peptamen AF 36 76 54 112 36 40 800 800 14 390
Vital AF Cal 36 75 54 111 55 43 844 844 15 425
Vital 1.0 Cal 30 40 38 130 46 36 705 705 13 390
Vital 1.5 Cal 45 68 57 187 65 51 1,000 1,000 18 610
Vital Peptide 1.5 Cal 45 68 57 187 66 52 1,308 1,266 18 610
123
Caloric Osmolality
Older Children and Adultsa,b (continued)

Amino Acid–Based Formulas (nutrients per 1 L)
Tolerex 30 21 2 226 22 30 550 551 10 550
Vivonex Plus 30 43 7 193 30 27 567 567 10 650
Vivonex RTF 30 50 12 176 30 31 668 668 12 630
Renal Formulas (nutrients per 1 L)
Nepro 54 81 96 161 46 27 1,060 720 19 745
Novasource Renal 60 91 100 183 41 24 840 819 18 800
Renalcal 60 34 82 292 4 4 60 100 0 600
Suplena 54 45 96 196 35 29 1,055 717 19 780
Abbreviations: DRI, dietary reference intake; NA, not applicable.
a
Volume to meet 100% of the DRI for micronutrients varies by product. Consult the manufacturer information to ensure a nutritionally
complete regimen.
b
Other specialized formula information available from manufacturer or specialized registered dietitian.
c
Also available with fiber.
Data obtained from Product category: adult. Abbott Web site. https://static.abbottnutrition.com/cms-prod/abbottnutrition-2016. com/img/Adult.
pdf. Updated August 3, 2017; Liquid Hope. Functional Formularies Web site. https://www.functionalformularies.com/media/wysiwyg/Phase_K_
LH_SpecSheet_11x17_GRAMS_2.pdf; Compare formulas. Kate Farms Web site. https://www.katefarms.com/compare-formulas; and Product guide,
2018. Nestlé Health Science Web site. https://www.nestlehealthscience.ca/en/resources/documents/2018%20nhs%20product%20guide.pdf.
Published May 2018. Retrieved May 2018.
Nutrition and Formula Information 125
Composition of Fluids Frequently Used in Oral Rehydration

Carbohydrate Sodium Potassium Osmolarity
Solution (g/L) (mEq/L) (mEq/L) (mmol/L)
Enfalyte 30 50 33 160
Pedialyte 25 45 20 250
WHO ORS 111 90 20 311
Abbreviations: ORS, oral rehydration solution; WHO, World Health Organization.

Data obtained from 2018 pediatric nutritional products guide. Abbott Web site. https://static.
abbottnutrition.com/cms-prod/abbottnutrition-2016.com/img/00874%20-%20ANI2017-09-18%20
-%20PEDIATRIC%20NUTRITIONAL%20PRODUCTS%20GUIDE_FINAL_EN_Web_tcm1310-72852.pdf.
Published January 2018; Pediatric product guide. Mead Johnson Nutrition Web site. https://www.
meadjohnson.com/pediatrics/us-en/sites/hcp-usa/files/mjn-2445_lb6_2018_wo48_lo_09202018.
pdf. Updated September 2018; and Oral rehydration salts: production of the new ORS. World
Health Organization Web site. http://apps.who.int/iris/bitstream/handle/10665/69227/WHO_FCH_
CAH_06.1.pdf. Published 2006. Retrieved May 2018.
Fluid Needs by Weight (Holliday-Segar Method)

Weight (kg) Fluid Needs
1–10 100 mL/kg/d
10–20 1,000 mL + 50 mL/kg for each kilogram >10 kg
>20 1,500 mL + 20 mL/kg for each kilogram >20 kg
From Holliday MA, Segar WE. The maintenance need for water in parenteral fluid therapy. Pediatrics.
1957;19(5):823–832.
Common Electrolyte Additives
Product Dose Contents

Morton Plain Table Salt 1
⁄4 tsp Contains 600 mg sodium (26 mEq)
Morton Lite Salt 1
⁄4 tsp Contains 290 mg sodium (13 mEq) and 350 mg
potassium (9 mEq)
Data obtained from Morton Plain Table Salt nutritional facts. Morton Salt Web site. https://www.
mortonsalt.com/article/mortonplain-table-salt-nutritional-facts and Morton Lite Salt Mixture
nutritional facts. Morton Salt Web site. https://www.mortonsalt.com/article/morton-lite-salt-
mixture-nutritional-facts. Retrieved May 2018.
DIETARY REFERENCE INTAKES (DRIS): RECOMMENDED

INTAKES FOR INDIVIDUALS, FOOD AND NUTRITION BOARD,
INSTITUTE OF MEDICINE, 2006
DRIs for Age: Energy and Protein
Infants and Toddlers
Age (mo) DRIs—Energy (kcal/kg/d) DRIs—Protein (g/kg/d)
0–3 102
4–6 82 1.5
7–12 80
13–35 82 1.1
Children and Adolescents

Age (y) DRIs—Energy (kcal/kg/d) DRIs—Protein (g/kg/d)
3 Boy 85
1.1
Girl 82
4–5 Boy 70
0.95
Girl 65
6–7 Boy 64
0.95
Girl 61
8 Boy 59
0.95
Girl 59
9–11 Boy 49
0.95
Girl 42
12–13 Boy 44
0.95
Girl 40
14–16 Boy 39
0.85
Girl 33
17–18 Male 37
0.85
Female 31
>18 Male 36
0.8
Female 34
Reproduced with permission from Texas Children’s Hospital Pediatric Nutrition Reference Guide. 11th
ed. Houston, TX: Texas Children’s Hospital; 2016:19.
Daily Requirements DRIs for Age: Macronutrients and M
Infants Infants Children Children Males Males Females Females Pregnancy Lactation
0–6 mo 7–12 mo 1–3 y 4–8 y 9–13 y 14–18 y 9–13 y 14–18 y ≤18 y ≤18 y
Carbohydrate (g/day) 60a 95a 130 130 130 130 130 130 175 210
Total fiber (g/day) ND ND 19a 25a 31a 38a 26a 26a 28a 29a
Fat (g/day) 31a 30a ND ND ND ND ND ND ND ND
n-6 Polyunsaturated fatty acids 4.4a 4.6a 7a 10a 12a 16a 10a 11a 13a 13a
(g/day) (linoleic acid)
n-3 Polyunsaturated fatty acids 0.5a 0.5a 0.7a 0.9a 1.2a 1.6a 1.0a 1.1a 1.4a 1.3a
(g/day) (α-linolenic acid)
Vitamin A (μg/day)b 400a 500a 300 400 600 900 600 700 750 1,200
Vitamin C (mg/day) 40 a
50a 15 25 45 75 45 65 80 115
Vitamin D (IU/day)c,d 400a 400a 600 600 600 600 600 600 600 600
Vitamin E (mg/day)e 4a 5a 6 7 11 15 11 15 15 19
Vitamin K (μg/day) 2.0a 2.5a 30a 55a 60a 75a 60a 75a 75a 75a
Thiamin (mg/day) 0.2a 0.3a 0.5 0.6 0.9 1.2 0.9 1.0 1.4 1.4
Riboflavin (mg/day) 0.3a 0.4a 0.5 0.6 0.9 1.3 0.9 1.0 1.4 1.6

Niacin (mg/day)f 2a 4a 6 8 12 16 12 14 18 17
Vitamin B6 (mg/day) 0.1a 0.3a 0.5 0.6 1.0 1.3 1.0 1.2 1.9 2.0
icronutrients
Folate (μg/day)g 65a 80a 150 200 300 400 300 400h 600i 500
Vitamin B12 (μg/day) 0.4a 0.5a 0.9 1.2 1.8 2.4 1.8 2.4 2.6 2.8
Pantothenic acid (mg/day) 1.7 a
1.8a 2a 3a 4a 5a 4a 5a 6a 7a
Biotin (μg/day) 5a 6a 8a 12a 20a 25a 20a 25a 30a 35a
Calcium (mg/day) 200 a
260 a
700 a
1,000 a
1,300 a
1,300 1,300 1,300 1,300 1,300
Cholinej (mg/day) 125a 150a 200a 250a 375a 550a 375a 400a 450a 550a
127
Daily Requirements DRIs for Age: Macronutrients and M
0–6 mo 7–12 mo 1–3 y 4–8 y 9–13 y 14–18 y 9–13 y 14–18 y ≤18 y ≤18 y
Chromium (μg/day) 0.2a 5.5a 11a 15a 25a 35a 21a 24a 29a 44a
Copper (μg/day) 200a 220a 340 440 700 890 700 890 1,000 1,300
Fluoride (mg/day) 0.01a 0.5a 0.7a 1a 2a 3a 3a 3a 3a 3a
Iodine (μg/day) 110a 130a 90 90 120 150 120 150 220 290
Iron (mg/day) 0.27a 11 7 10 8 11 8 15 27 10
Magnesium (mg/day) 30a 75a 80 130 240 410 240 360 400 360
Manganese (mg/day) 0.003a 0.6a 1.2a 1.5a 1.9a 2.2a 1.6a 1.6a 2.0a 2.6a
Molybdenum (μg/day) 2a 3a 17 22 34 43 34 43 50 50
Phosphorus (mg/day) 100 a
275a 460 500 1,250 1,250 1,250 1,250 1,250 1,250
Selenium (μg/day) 15a 20a 20 30 40 55 40 55 60 70
Zinc (mg/day) 2a 3 3 5 8 11 8 9 12 13
Potassium (g/day) 0.4a 0.7a 3.0a 3.8a 4.5a 4.7a 4.5a 4.7a 4.7a 5.1a
Sodium (g/day) 0.12a 0.37a 1.0a 1.2a 1.5a 1.5a 1.5a 1.5a 1.5a 1.5a
Chloride (g/day) 0.18a 0.57a 1.5a 1.9a 2.3a 2.3a 2.3a 2.3a 2.3a 2.3a
icronutrients (continued)
Note: This data (taken from the Dietary Reference Intake reports; see www.nas.edu) presents recommended dietary allowances (RDAs) in bold
type, and adequate intakes (AIs) are in ordinary type followed by the symbol (a). ND indicates not determined.
0–6 mo 7–12 mo 1–3 y 4–8 y 9–13 y 14–18 y 9–13 y 14–18 y ≤18 y ≤18 y
a
RDAs and AIs may both be used as goals for individual intake. RDAs are set to meet the needs of almost all (97%–98%) individuals in a group.
For healthy breastfed infants, the AI is the mean intake. The AI for other life stage and gender groups is believed to cover needs of all individuals
in the group, but lack of data or uncertainty in the data prevents being able to specify with confidence the percentage of individuals covered by
this intake.
b
As retinol activity equivalents (RAEs). 1 RAE = 1 μg retinol, 12 μg β-carotene, 24 μg α-carotene, or 24 μg β-cryptoxanthin in foods. The RAE for
dietary provitamin A carotenoids is twofold greater than retinol equivalents (REs), whereas the RAE for preformed vitamin A is the same as RE.
c
As cholecalciferol. 1 μg cholecalciferol = 40 IU vitamin D.
d
In the absence of adequate exposure to sunlight.
e
As α-tocopherol. α-Tocopherol includes RRR-α-tocopherol, the only form of α-tocopherol that occurs naturally in foods, and the
2R-stereoisomeric forms of α-tocopherol (RRR-, RSR-, RRS-, and RSS-α-tocopherol) that occur in fortified foods and supplements. It does not
include the 2S-stereoisomeric forms of α-tocopherol (SRR-, SSR-, SRS-, and SSS-α-tocopherol), also found in fortified foods and supplements.
f
As niacin equivalents (NEs). 1 mg of niacin = 60 mg of tryptophan; 0–6 mo = preformed niacin (not NEs).
g
As dietary folate equivalents (DFEs). 1 DFE = 1 μg food folate = 0.6 μg of folic acid from fortified food or as a supplement consumed with food =
0.5 μg of a supplement taken on an empty stomach.
h
In view of evidence linking folate intake with neural tube defects in the fetus, it is recommended that all women capable of becoming pregnant
consume 400 μg from supplements or fortified foods in addition to intake of food folate from the diet.
i
It is assumed that women will continue consuming 400 μg from supplements or fortified food until their pregnancy is confirmed and they enter
prenatal care, which ordinarily occurs after the end of the periconceptional period—the critical time for formation of the neural tube.
j
Although AIs have been set for choline, there are few data to assess whether a dietary supply of choline is needed at all stages of the life cycle,
and it may be that the choline requirement can be met by endogenous synthesis at some of these stages.
Copyright © 2018 National Academies of Sciences. All rights reserved.
129
FLUORIDE SOURCES AND SUPPLEMENTATION

Topical Fluoride Sources
Source Availability Concentration Typical Dose
Toothpaste OTC 1,000–1,500 ppm Pea sized = 0.25 mg
Toothpaste Prescription 5,000 ppm Pea sized = 1.25 mg
Varnish Professionally applied 22,600 ppm (Na F) 0.2 mL = 4.4 mg
Gel Professionally applied 12,300 ppm (1.23%) 5 mL = 61.5 mg
Gel Prescription 5,000 ppm (0.5% Na F) Thin ribbon = 25 mg
Foam Professionally applied 9,040 ppm (0.9%) 5 mL = 45 mg
Rinse OTC 230 ppm (0.05% Na F) 5 mL = 2.5 mg
Abbreviation: OTC, over the counter.

From Slayton R. Fluoride facts: what pediatricians need to know about fluoride agents for children,
including supplementation. AAP News. 2010;31:30.
Dietary Fluoride Supplementation Schedule

Age <0.3 ppm F 0.3–0.6 ppm F >0.6 ppm F
Birth–6 months 0 0 0
6 months–3 years 0.25 mg 0 0
3–6 years 0.50 mg 0.25 mg 0
6 years up to at least 16 years 1.00 mg 0.50 mg 0
From American Academy of Pediatric Dentistry Liaison With Other Groups Committee, American
Academy of Pediatric Dentistry Council on Clinical Affairs. Guideline on fluoride therapy. Pediatr Dent.
2008–2009;30(7)(suppl):121–124. Reproduced with permission. Copyright © 2008–2009 American
Academy of Pediatric Dentistry.
9. Umbilical Vein and Artery
Catheterization Measurements
USING BIRTH WEIGHT TO MEASURE CATHETER LENGTH
Before placing an umbilical vein or artery catheter into a newborn as
an elective procedure, you can use the following regression formula
to determine the catheter length in centimeters using birth weight:
Umbilical Artery Catheter Length (cm) = [3 × Birth Weight (kg)] + 9 cm
Umbilical Vein Catheter Length (cm) = [Umbilical Artery Catheter
Length (cm) + 1 cm]/2
You can use this formula to approximate the length necessary for
placement of a high-lying line between the vertebral levels T6 and T10
for umbilical artery lines and for umbilical vein lines above the level of
the diaphragm in the inferior vena cava. Correct placement into small
for gestational age and large for gestational age babies may vary
because the formula is only an approximation. Radiographic confir-
mation of line positioning is important to prevent complications.
Estimate of Insertional Length of Umbilical Catheters Based on Birth Weight

With 95% Confidence Intervals
30
25
20
15
Internal Catheter Length, cm
10
15
10
0
1000 2000 3000 4000 5000 6000
Birth Weight, g
Umbilical catheters (umbilical artery catheter tip inserted between T-6 and T-10; umbilical vein
catheter tip inserted above diaphragm in interior vena cava near or in right atrium). Modified
estimating equations utilizing birth weight (BW) are as follows: umbilical artery length = 2.5*BW +
9.7 (top graph) and umbilical vein length = 1.5*BW + 5.6 (bottom graph), where BW is measured
in kilograms and lengths in centimeters.
From Shukla H, Ferrara A. Rapid estimation of insertional length of umbilical catheters in new
borns. Am J Dis Child. 1986;140(8):786–788. Copyright © 1986 American Medical Association.
All rights reserved.
Umbilical Vein and Artery C
atheterization Measurements 133
USING SHOULDER-UMBILICAL LENGTH TO MEASURE

UMBILICAL ARTERY CATHETER LENGTH
The graph shows the length of catheter necessary to reach the aortic
valve, diaphragm, or bifurcation of aorta. Ideally, the umbilical artery
catheter should reach the level of the diaphragm for a high-lying line.
Measure the shoulder-umbilical length by dropping a vertical line
from the tip of the shoulder to a point vertically beneath it that is level
with the center of the umbilicus. Plot this length on the x-axis of the
graph. Where the line intersects the graph of the diaphragm, plot a
line to the y-axis.
Umbilical Artery Catheter Length
28
26
24
lv e
Va
Umbilical Artery Catheter (cm)
22
c
rti
Ao
20
18
m
16
ag
hr
ap
14
Di
12
orta
10 ofA
n
t io
8 ca
ur
Bif
6
4
8 10 12 14 16 18
Shoulder-Umbilical
Length (cm)
USING SHOULDER-UMBILICAL LENGTH TO MEASURE

UMBILICAL VEIN CATHETER LENGTH
The graph shows the length of catheter necessary to reach the left
side of the atrium and the diaphragm. Ideally, the umbilical vein
catheter should reach the level of the diaphragm.
Measure the shoulder-umbilical length by dropping a vertical line
from the tip of the shoulder to a point vertically beneath it that is level
with the center of the umbilicus. Plot this length on the x-axis of the
graph. Where the line intersects the graph of the diaphragm, plot a
line to the y-axis.
Umbilical Vein Catheter Length
13
12
Umbilical Vein Catheter (cm)
11
10 m
triu
f tA
9
Le
ragm
8
ph
Dia
7
4
8 9 10 11 12 13 14 15 16 17
Shoulder-Umbilical Length (cm)

10. Endotracheal Tube Size and Depth
of Insertion
NEONATAL
Neonatal Endotracheal Tube Size According to Gestational Age and Weight
Endotracheal Tube Size
Weight (g) Gestational Age (wks) (mm ID)
Below 1,000 Below 28 2.5
1,000–2,000 28–34 3.0
>2,000 >34 3.5
Abbreviation: ID, internal diameter.

From American Academy of Pediatrics, American Heart Association. Textbook of Neonatal Resus-
citation. Weiner GM, Zaichkin J, Kattwinkel J, eds. 7th ed. Elk Grove Village, IL: American Academy
of Pediatrics; 2016:122.
Neonatal Endotracheal Tube Depth of Insertion According to Gestational

Age and Weight
Endotracheal Tube Insertion
Gestational Age (wk) Depth at Lips (cm) Weight (g)
23–24 5.5 500–600
25–26 6.0 700–800
27–29 6.5 900–1,000
30–32 7.0 1,100–1,400
33–34 7.5 1,500–1,800
35–37 8.0 1,900–2,400
38–40 8.5 2,500–3,100
41–43 9.0 3,200–4,200
Reproduced with permission from Kempley ST, Moreira JW, Petrone FL. Endotracheal tube length for
neonatal intubation. Resuscitation. 2008;77(3):369–373.
PEDIATRIC
The following tube sizes and depths are based on internal diame-
ter (ID) of the endotracheal tube and apply to children 2 to 10 years
of age.
Tube Size
Uncuffed Endotracheal Tube Size (mm ID) = [Age (y)/4] + 4
Cuffed Endotracheal Tube Size (mm ID) = [Age (y)/4] + 3.5
Typical cuffed inflation pressure should be less than 20 to 25 cm H2O.

Depth of Insertion
Depth of Insertion (cm) = Tube Size (mm ID) × 3 or
Depth of Insertion (cm) for Children >2 Years of Age = [Age (y)/2] + 12
BIBLIOGRAPHY
de Caen AR, Berg MD, Chameides L, et al. Part 12: Pediatric Advanced Life
Support; 2015 American Heart Association guidelines update for cardiopul
monary resuscitation and emergency cardiovascular care. Circulation. 2015;
132(18)(suppl 2):S526–S542
11. Doses and Levels of Common
Medications Requiring
Therapeutic Drug Monitoring
ANTIBIOTICS ........................................................................................................................... 138
AMIKACIN....................................................................................................................... 138
GENTAMICIN................................................................................................................. 140
TOBRAMYCIN................................................................................................................ 142
VANCOMYCIN............................................................................................................... 144
ANTICONVULSANTS............................................................................................................. 146
FOSPHENYTOIN........................................................................................................... 146
LEVETIRACETAM (KEPPRA)...................................................................................... 148
PHENOBARBITAL......................................................................................................... 150
VALPROIC ACID AND DERIVATIVES....................................................................... 152
MISCELLANEOUS.................................................................................................................. 153
DIGOXIN.......................................................................................................................... 153
ENOXAPARIN................................................................................................................. 155
WARFARIN...................................................................................................................... 156
ANTIBIOTICS
Amikacin
NEONATAL DOSING
Dosing Table for Intravenous Systemic Administration

Gestational Age (wk) Postnatal Age (d) Dose (mg/kg) Interval (h)
0–14 15 48
≤29
≥15 15 24
30–34 ≤60 15 24
0–7 15 24
≥35
≥8 17.5 24
INFANT, CHILD, AND ADOLESCENT DOSING
CONVENTIONAL DOSING
• 5 to 7.5 mg/kg per dose every 8 hours
HIGH-DOSE, EXTENDED INTERVAL DOSING (IN PATIENTS WITH NORMAL
RENAL FUNCTION)
• Non–cystic fibrosis: 15 to 20 mg/kg/d every 24 hours
• Cystic fibrosis: 30 mg/kg/d every 24 hours
DOSE ADJUSTMENT REQUIRED FOR RENAL IMPAIRMENT
• Yes
MONITORING
WHEN TO DRAW LEVELS

• Conventional dosing is as follows:
—— Peak: after second dose (See “Timing of Levels.”)
—— Trough: after second dose (just before third dose)
• High-dose, extended interval dosing is as follows:
—— Peak: after first dose (See “Timing of Levels.”)
—— Trough: after the first dose (just before second dose)
• Levels are unnecessary if patient is on antibiotics for 48- to
72-hour rule-out sepsis protocol.
• Consider more-frequent monitoring in hypothermia treatment.
Doses and Levels of Common Medications Requiring T
herapeutic Drug Monitoring 139
TIMING OF LEVELS
• Peak
—— Conventional dosing: 30 minutes after end of 30-minute infusion
—— High-dose, extended interval dosing: 1 hour after 1-hour
infusion
• Trough: 0 to 30 minutes before next dose
GOAL LEVELS
• Peak
—— Conventional dosing
20 to 25 mcg/mL (neonates)
20 to 30 mcg/mL (infants, children, and adolescents)
—— High-dose, extended interval dosing
Non–cystic fibrosis: 20 to 25 mcg/mL (serious infections) or
15 to 20 mcg/mL (urinary tract infection)
Cystic fibrosis: 80 to 120 mcg/mL (Pseudomonas organisms)
or 25 to 40 mcg/mL (all other organisms)
• Trough
Less than 5 mcg/mL (neonates)
4 to 10 mcg/mL (infants, children, and adolescents)
—— High-dose, extended interval dosing: less than 8 mcg/mL
Gentamicin
NEONATAL DOSING

0–14 5 48
≤29
≥15 5 36
0–10 4.5 36
30–34
≥11 5 36
0–7 4 24
≥35
≥8 5 24
CONVENTIONAL DOSING
• Infants and children younger than 5 years: 2.5 mg/kg per dose
every 8 hours
• Children older than 5 years: 2 to 2.5 mg/kg per dose every 8 hours
• For gram-positive synergy: 1 to 2 mg/kg per dose every 8 hours
RENAL FUNCTION)
• Non–cystic fibrosis
—— 3 months to younger than 2 years: 9.5 mg/kg/d every 24 hours
—— 2 to 8 years: 8.5 mg/kg/d every 24 hours
—— Older than 8 years: 7 mg/kg/d every 24 hours
• Cystic fibrosis: 10 to 12 mg/kg/d every 24 hours
• Yes
MONITORING
WHEN TO DRAW LEVELS


• Consider more-frequent monitoring in hypothermia treatment
and after rewarming.
TIMING OF LEVELS
• Peak
—— Conventional dosing: 30 minutes after end of 30-minute
infusion
infusion
GOAL LEVELS
• Peak
6 to 12 mcg/mL (3–5 is an acceptable range for gram-
positive synergy.)
Non–cystic fibrosis: 10 to 20 mcg/mL (serious infections)
Cystic fibrosis: 20 to 30 mcg/mL
• Trough
Less than 2 mcg/mL (infants, children, and adolescents)
Tobramycin
NEONATAL DOSING

0–14 5 48
≤29
≥15 5 36
0–10 4.5 36
30–34
≥11 5 36
0–7 4 24
≥35
≥8 5 24
CONVENTIONAL DOSING
• Infants and children younger than 5 years: 2.5 mg/kg per dose
every 8 hours
• Children older than 5 years: 2 to 2.5 mg/kg per dose every 8 hours
RENAL FUNCTION)
• Non–cystic fibrosis
—— 3 months to younger than 2 years: 9.5 mg/kg/d every 24 hours
—— 2 to 8 years: 8.5 mg/kg/d every 24 hours
—— Older than 8 years: 7 mg/kg/d every 24 hours
• Cystic fibrosis: 10 to 12 mg/kg/d every 24 hours
• Yes
MONITORING
WHEN TO DRAW LEVELS


• Consider more-frequent monitoring in hypothermia treatment and
after rewarming.
TIMING OF LEVELS
• Peak
—— Conventional dosing: 30 minutes after end of 30-minute infusion
infusion
GOAL LEVELS
• Peak
6 to 12 mcg/mL (3–5 is an acceptable range for gram-
positive synergy.)
Non–cystic fibrosis: 10 to 20 mcg/mL (serious infections)
Cystic fibrosis: 20 to 30 mcg/mL
• Trough
Less than 2 mcg/mL (infants, children, and adolescents)
Vancomycin
NEONATAL DOSING
• Meningitis: 15 mg/kg per dose
• Bacteremia: 10 mg/kg per dose
Dosing Table for Intravenous Administration
Weight (kg) Postnatal Age (d) Interval (h)
<1.2 ≤28 18–24
0–6 12–18
1.2–2
≥7 8–12
0–6 8–12
>2
≥7 6–8
CONVENTIONAL DOSING
• 15 to 20 mg/kg per dose every 6 to 8 hours (Consider every
6 hours for patients >2 months who do not have a history of
cardiac abnormalities.)
• Yes
MONITORING
WHEN TO DRAW LEVELS

• Trough: before third dose (for neonates) or fourth dose (for
infants, children, and adolescents) (See “Timing of Levels.”)
TIMING OF LEVELS
GOAL LEVELS
• Trough (for neonates): 5 to 15 mcg/mL
• Trough (for infants, children, and adolescents): 10 to 15 mcg/mL

—— Consider higher goal of 15 to 20 mcg/mL for serious infec-
tions or anatomical sites with difficult penetration (eg,
meningitis, osteomyelitis, bacteremia, endocarditis, hospital-
acquired pneumonia caused by Staphylococcus aureus) upon
recommendation from pediatric infectious diseases specialist
or clinical pharmacist.
ANTICONVULSANTS
In the Anticonvulsants section, EEG indicates electroencephalo-
graphic; IM, intramuscular(ly); IV, intravenous(ly).
Fosphenytoin
Note: All dosing is expressed in phenytoin equivalents (PE). 1 mg of
fosphenytoin PE = 1 mg of phenytoin.
NEONATAL DOSING
LOADING DOSE
• 15 to 20 mg PE/kg IM or IV infusion over at least 10 minutes
MAINTENANCE DOSE
• 4 to 8 mg PE/kg/d IM or IV infusion at a rate of 1 to 2 mg
PE/kg/min every 24 hours. Begin maintenance 24 hours after
loading dose.
LOADING DOSE
• Status epilepticus: 15 to 20 mg PE/kg IV
• Non-emergent: 10 to 20 mg PE/kg IV or IM
MAINTENANCE DOSE
• 4 to 6 mg PE/kg/d IV in 2 to 3 divided doses
MONITORING
WHEN TO DRAW LEVELS

• Monitor the drug via phenytoin levels in serum (as total or free).
• Consider obtaining a level 2 hours (if IV infusion) or 4 hours
(if IM infusion) after administration of the loading dose.
• Achieving a steady state takes about 1 week, but you may want
to obtain a level if patient continues to seize.
• Maintenance doses may be titrated if patient is symptomatic,
even if levels are pending.
• Consider obtaining serum albumin level.
TIMING OF LEVELS
• Trough: before steady-state dose
GOAL LEVELS
• Total
—— First week after birth: 6 to 15 mcg/mL
—— After 7 days of birth: 10 to 20 mcg/mL
• Free (unbound): 1 to 2 mcg/mL
Levetiracetam (Keppra)
NEONATAL DOSING
Note: Limited data available; dose not established.
• Intravenous: 10 mg/kg/d divided twice daily; increase dosage by
10 mg/kg over 3 days to 30 mg/kg/d. Additional increases up to
45 to 60 mg/kg/d have been used with persistent seizure activity or
clinical EEG findings. For treatment of status epilepticus, loading
doses of 20 to 30 mg/kg per dose have been used by some centers.
• Oral: Initial, 10 mg/kg/d in 1 to 2 divided doses; increase daily by
10 mg/kg to 30 mg/kg/d (maximum reported dosage: 60 mg/kg/d).
PARTIAL ONSET SEIZURES

• Infants between the ages of 1 month and 6 months: 7 mg/kg per
dose twice daily; can increase dosage every 2 weeks by 7 mg/kg
per dose twice daily, as tolerated, to the recommended dosage
of 20 mg/kg per dose twice daily. Additional increases up to 45
to 60 mg/kg/d have been used with persistent seizure activity or
clinical EEG findings. Commonly accepted maximum dosage at
most centers is 60 mg/kg/d.
• Infants older than 6 months and adolescents younger than
16 years: 10 mg/kg per dose IV or orally twice daily. May
increase dosage every 2 weeks by 10 mg/kg per dose, if
tolerated, to a maximum of 60 mg/kg/d.
• Adolescents 16 years and older: 500 mg twice daily; may increase
every 2 weeks by 500 mg per dose to the recommended dosage of
1,500 mg twice daily. Efficacy of dosages other than 3,000 mg/d
has not been established. The same dosage is indicated for
myoclonic seizures in this patient population.
SEIZURE PROPHYLAXIS
• Loading dose: 20 mg/kg IV
• Maintenance dose: 10 mg/kg per dose twice daily for 7 days
STATUS EPILEPTICUS
Note: Limited data available; dose not established.
• Loading dose of 60 mg/kg per dose (maximum dose: 4,500 mg)
given IV, followed by IV or oral maintenance dosing determined
by clinical response; reported IV maintenance dosage is 30 to
55 mg/kg/d divided twice daily; some institutions may choose to
administer lower loading doses.
MONITORING
TIMING OF CONCENTRATIONS
• Trough: are not routinely measured but may be useful in accessing
magnitude of dosing adjustments, drug adherence, or both
GOAL CONCENTRATIONS
• Therapeutic: none established
Phenobarbital
NEONATAL DOSING
ANTICONVULSANT
• Loading dose: 15 to 20 mg/kg IV, given slowly over 10 to
15 minutes.
• Refractory seizures: Additional doses of 5 to 10 mg/kg, up to
a total of 40 mg/kg.
• Maintenance dose: 3 to 4 mg/kg/d, beginning 12 to 24 hours
after the loading dose. Increase to 5 mg/kg/d if needed (usually
by second week of therapy).
• Frequency and route: Every 24 hours. An IV infusion at a rate
of no faster than 1 mg/kg/min (most rapid control of seizures),
IM, orally, or rectally.
NEONATAL ABSTINENCE SYNDROME
• Loading dose: 16 mg/kg IV or orally on day 1.
• Maintenance dose: 1 to 4 mg/kg per dose orally every 12 hours.
• Weaning that is based on abstinence scoring can be achieved by
decreasing dose 20% every other day.
LOADING DOSE
• 15 to 20 mg/kg (maximum: 1,000 mg per dose)
Maintenance Dose
Age Maintenance Dosing
Infant 5–6 mg/kg/d divided in 1–2 doses
Children 1–5 y 6–8 mg/kg/d divided in 1–2 doses
Children 5–12 y 4–6 mg/kg/d divided in 1–2 doses
Adolescents >12 y 1–3 mg/kg/d divided in 1–2 doses
MONITORING
WHEN TO DRAW LEVELS

• Achieving a steady state takes 1 to 2 weeks, but you may want
to obtain a level if patient continues to seize.
• Maintenance doses may be titrated if patient is symptomatic,

even if levels are pending.
TIMING OF LEVELS
GOAL LEVELS
• Trough: 15 to 40 mcg/mL
Valproic Acid and Derivatives

Note: Because of the risk of valproic acid–associated hepatotoxicity in
patients younger than 2 years, valproic acid is not the preferred agent
in this population.
SEIZURE DISORDER
• Oral: 10 to 15 mg/kg/d divided 3 to 4 times daily (valproic acid)
or twice daily (divalproex sodium). Dosages can be increased at
weekly intervals to a maximum dosage of 60 mg/kg/d.
• Intravenous: Total daily dose IV is equal to total daily dose orally;
however, IV infusion should be divided into a frequency of every
6 hours.
REFRACTORY STATUS EPILEPTICUS
• Loading dose: 20 to 40 mg/kg (maximum: 3,000 mg)
• Followed by maintenance dosing via intermittent or continuous
infusion (1 mg/kg/h)
MONITORING
WHEN TO DRAW LEVELS

• Drug is monitored via trough valproic acid levels.
• Should also consider obtained liver enzyme levels, serum ammonia
level, and complete blood cell and platelet counts.
TIMING OF LEVELS
GOAL LEVELS
• Therapeutic: 50 to 100 mcg/mL (Therapeutic levels are not well
established; higher goal levels may be indicated in certain patients,
but should consider a neurology consultation.)
MISCELLANEOUS
In the Miscellaneous section, INR indicates international normalized
ratio; SQ, subcutaneous(ly).
Digoxin
Neonatal, Infant, Child, and Adolescent Dosing
Total Digitalizing Dose (mcg/kg) Maintenance
Maintenance Oral (mcg/
Patient Age Loading IVa Loading Orala IV (mcg/kg/d)b kg/d)b
Preterm 15–25 20–30 4–6 5–7.5
neonate
Term neonate 20–30 25–35 5–8 8–10
1–24 mo 30–50 35–60 9–15 10–15
2–5 y 25–35 30–45 6–9 8–10
5–10 y 15–30 20–35 4–8 5–10
>10 y 8–12 10–15 2–3 2.5–5
Abbreviation: IV, intravenous.

Do not give total loading dose all at once. Total digitalizing dose should be given in 3 doses at 6- to
a
8-hour intervals. The first dose is 50% of the total. The second and third doses are 25% of the total dose.
Divide every 12 h.
b
MONITORING
WHEN TO DRAW LEVELS

• After a loading dose, draw serum levels 12 to 24 hours after
loading dose is completed.
• Maintenance therapy: Consider obtaining after 3 to 5 days of
therapy (see “Timing of Levels” later in this section).
• Routine monitoring is not required for patients with normal
kidney function and basic metabolic panel values that are within
reference range.
• Monitoring is recommended with electrolyte abnormalities,
changes in kidney function, and if concern for therapeutic levels,
when treating arrhythmias.
TIMING OF LEVELS
• Loading dose: 12 to 24 hours after loading dose is completed.
• Maintenance dose: Draw trough levels just before next dose
(minimum 6–8 hours after the previous dose).
GOAL LEVELS
• Heart failure: 0.5–0.9 ng/mL
• Toxic: greater than 2 ng/mL
Enoxaparin
NEONATAL, INFANT, CHILD, AND ADOLESCENT DOSING
PROPHYLAXIS
• Neonates and infants younger than 2 months: 0.75 mg/kg per dose
SQ every 12 hours
• Infants 2 months and older, children, and adolescents: 0.5 mg/kg
per dose SQ every 12 hours
TREATMENT
• Neonates and infants younger than 2 months: 1.5 to 2 mg/kg per
dose SQ every 12 hours
• Infants 2 months and older, children, and adolescents: 1 mg/kg per
dose SQ every 12 hours
MONITORING
WHEN TO DRAW LEVELS

• After the second dose
TIMING OF LEVELS
• 4 to 6 hours after SQ administration
GOAL LEVELS
• Prophylaxis: 0.1–0.3 U/mL
• Treatment: 0.5–1 U/mL
Warfarin
NEONATAL, INFANT, CHILD, AND ADOLESCENT DOSING

• Initiation of therapy: Consider 0.2 mg/kg once on day 1 to load
(maximum: 10 mg per dose), then start 0.1 mg/kg daily on day 2,
monitoring and adjusting according to INR (usual range: 0.05–0.3
mg/kg/d).
MONITORING
WHEN TO DRAW INR

• The INR should be drawn daily upon initiation of therapy.
• Because of long half-life of warfarin, medication should be
adjusted according to amount of warfarin received in the
previous 5 to 7 days.
• Once patient is receiving a stable dose with INR in range
(see “Goal INR” later in this section), please monitor at least
monthly or with any changes in diet, medications, or over-the-
counter supplements.
GOAL INR
• Treatment and prophylaxis of thromboembolic events: 2 to 3
• Mechanical mitral valves or ventricular assist devices: 2.5 to 3.5
Note: Goals may change depending on patient tolerance of anti
coagulation and clotting events.
RESOURCES
Glauser T, Shinnar S, Gloss D, et al. Evidence-based guideline: treatment of
convulsive status epilepticus in children and adults; report of the Guideline
Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48–61
Lexicomp Online. Hudson, OH: Lexicomp Inc; 2013. http://online.lexi.com.
Accessed February 6, 2019
Mark LF, Solomon A, Northington FJ, Lee CK. Gentamicin pharmacoki-
netics in neonates undergoing therapeutic hypothermia. Ther Drug Monit.
2013;35(2):217–222
12. Appendixes
ACETAMINOPHEN TOXICITY NOMOGRAM................................................................... 158
RABIES GUIDELINES............................................................................................................. 159
RABIES POSTEXPOSURE PROPHYLAXIS SCHEDULE—

UNITED STATES, 2010................................................................................................ 159
IMMUNIZATION SCHEDULES............................................................................................. 160
RECOMMENDED IMMUNIZATION SCHEDULE FOR

CHILDREN AND ADOLESCENTS AGED 18 YEARS OR
YOUNGER—UNITED STATES, 2018........................................................................ 160
CATCH-UP IMMUNIZATION SCHEDULE FOR PERSONS

AGED 4 MONTHS–18 YEARS WHO START LATE OR WHO
ARE MORE THAN 1 MONTH BEHIND—UNITED STATES, 2018...................... 162
VACCINES THAT MIGHT BE INDICATED FOR CHILDREN

AND ADOLESCENTS AGED 18 YEARS OR YOUNGER
BASED ON MEDICAL INDICATIONS........................................................................ 163
BRIGHT FUTURES/AMERICAN ACADEMY OF PEDIATRICS

RECOMMENDATIONS FOR PREVENTIVE PEDIATRIC
HEALTH CARE (PERIODICITY SCHEDULE).................................................... SEE INSERT.
FRENCH CATHETER SCALE............................................................................... SEE INSERT.

ACETAMINOPHEN TOXICITY NOMOGRAM
Rumack Matthew Nomogram

1000 1000
Acetaminophen plasma concentration (g/mL)
500 500
200 200
100 100
Po
ssi
50 ble 50
he
pa Probable hepatic toxicity
tic
tox
20 icit 20
y
No hepatic toxicity
10 10
5 25% 5
2 2
4 8 12 16 20 24
Hours after ingestion
Modified from Rumack BH, Matthew H. Acetaminophen poisoning and toxicity. Pediatrics.
1975;55(6):871–876.
Appendixes 159
RABIES GUIDELINES
Rabies Postexposure Prophylaxis Schedule—United States, 2010
Vaccination
Status Intervention Regimena
Not previously Wound All PEP should begin with immediate thorough
vaccinated cleansing cleansing of all wounds with soap and water. If avail
able, a virucidal agent (eg, povidone-iodine solution)
should be used to irrigate the wounds.
HRIG Administer 20 IU per kilogram of body weight. If ana
tomically feasible, the full dose should be infiltrated
around and into the wound(s), and any remaining
volume should be administered at an anatomical
site (IM) distant from vaccine administration. Also,
HRIG should not be administered in the same syringe
as vaccine. Because rabies immunoglobulin might
partially suppress active production of rabies virus
antibody, no more than the recommended dose
should be administered.
Vaccine HDCV or PCECV at 1.0 mL IM (deltoid areab), 1 each
on days 0,c,d 3d, 7d, and 14d
Previously Wound All PEP should begin with immediate thorough
vaccinatede cleansing cleansing of all wounds with soap and water. If
available, a virucidal agent such as povidone-iodine
solution should be used to irrigate the wounds.
HRIG HRIG should not be administered.
Vaccine HDCV or PCECV at 1.0 mL IM (deltoid areab), 1 each
on days 0c,d and 3d
Abbreviations: HDCV, human diploid cell vaccine; HRIG, human rabies immunoglobulin; IM, intramuscularly;
PCECV, purified chick embryo cell vaccine; PEP, postexposure prophylaxis; RVA, rabies vaccine adsorbed.
a
These regimens are applicable for people in all age-groups, including children.
b
The deltoid area is the only acceptable site of vaccination for adults and older children. For younger children,
the outer aspect of the thigh may be used. Vaccine should never be administered in the gluteal area.
c
Day 0 is the day dose 1 of vaccine is administered.
d
For people with immunosuppression, rabies PEP should be administered using all 5 doses of vaccine on days
0, 3, 7, 14, and 28.
e
Any person with a history of pre-exposure vaccination with HDCV, PCECV, or RVA; prior PEP with HDCV,
PCECV, or RVA; or previous vaccination with any other type of rabies vaccine and a documented history of
antibody response to the prior vaccination.
From Rupprecht CE, Briggs D, Brown CM, et al; Centers for Disease Control and Prevention. Use of a reduced
(4-dose) vaccine schedule for postexposure prophylaxis to prevent human rabies: recommendations of the
Advisory Committee on Immunization Practices. MMWR Recomm Rep. 2010;59(RR–2):1–9. Erratum in: MMWR
Recomm Rep. 2010;59(16):493.
Recommended Immunization Schedule for
IMMUNIZATION SCHEDULES
Children and Adolescents Aged 18 Years or Younger, UNITED STATES, 2018
The table below shows vaccine acronyms, and brand names for vaccines routinely recommend-
ed for children and adolescents. The use of trade names in this immunization schedule is for
• Consult relevant ACIP statements for detailed recommendations identification purposes only and does not imply endorsement by the ACIP or CDC.
(www.cdc.gov/vaccines/hcp/acip-recs/index.html). Vaccine type Abbreviation Brand(s)
• When a vaccine is not administered at the recommended age, Diphtheria, tetanus, and acellular pertussis vaccine DTaP Daptacel
Infanrix
administer at a subsequent visit.
Diphtheria, tetanus vaccine DT No Trade Name
• Use combination vaccines instead of separate injections when Haemophilus influenzae type B vaccine Hib (PRP-T) ActHIB
appropriate. Hib (PRP-OMP)
Hiberix
PedvaxHIB
• Report clinically significant adverse events to the Vaccine Adverse Hepatitis A vaccine HepA Havrix
Event Reporting System (VAERS) online (www.vaers.hhs.gov) or by Vaqta
Hepatitis B vaccine HepB Engerix-B
telephone (800-822-7967). Recombivax HB
• Report suspected cases of reportable vaccine-preventable diseases Human papillomavirus vaccine HPV Gardasil 9
to your state or local health department. Influenza vaccine (inactivated) IIV Multiple
• For information about precautions and contraindications, see www. Measles, mumps, and rubella vaccine MMR M-M-R II
Meningococcal serogroups A, C, W, Y vaccine MenACWY-D Menactra
cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html. MenACWY-CRM Menveo
Meningococcal serogroup B vaccine MenB-4C Bexsero
MenB-FHbp Trumenba
Approved by the Pneumococcal 13-valent conjugate vaccine PCV13 Prevnar 13
Pneumococcal 23-valent polysaccharide vaccine PPSV23 Pneumovax
Advisory Committee on Immunization Practices Poliovirus vaccine (inactivated) IPV IPOL
(www.cdc.gov/vaccines/acip) Rotavirus vaccines RV1 Rotarix
RV5 RotaTeq
American Academy of Pediatrics Tetanus, diphtheria, and acellular pertussis vaccine Tdap Adacel
(www.aap.org) Boostrix
Tetanus and diphtheria vaccine Td Tenivac
No Trade Name
American Academy of Family Physicians Varicella vaccine VAR Varivax
(www.aafp.org)
Combination Vaccines
DTaP, hepatitis B and inactivated poliovirus vaccine DTaP-HepB-IPV Pediarix
American College of Obstetricians and Gynecologists
DTaP, inactivated poliovirus and Haemophilus influenzae DTaP-IPV/Hib Pentacel
(www.acog.org) type B vaccine
This schedule includes recommendations in effect as of January 1, 2018. DTaP and inactivated poliovirus vaccine DTaP-IPV Kinrix
Quadracel
Measles, mumps, rubella, and varicella vaccines MMRV ProQuad
U.S. Department of Health and Human Services

Centers for Disease Control and Prevention
Figure 1. Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger—United States, 2018.
(FOR THOSE WHO FALL BEHIND OR START LATE, SEE THE CATCH-UP SCHEDULE [FIGURE 2]).
These recommendations must be read with the footnotes that follow. For those who fall behind or start late, provide catch-up vaccination at the earliest opportunity as indicated by the green bars in Figure 1.
To determine minimum intervals between doses, see the catch-up schedule (Figure 2). School entry and adolescent vaccine age groups are shaded in gray.
19-23
Vaccine Birth 1 mo 2 mos 4 mos 6 mos 9 mos 12 mos 15 mos 18 mos 2-3 yrs 4-6 yrs 7-10 yrs 11-12 yrs 13-15 yrs 16 yrs 17-18 yrs
mos
Hepatitis B1 (HepB) 1st dose 2nd dose 3rd dose
Rotavirus2 (RV) RV1 (2-dose See

1st dose 2nd dose footnote 2
series); RV5 (3-dose series)
Diphtheria, tetanus, & acellular

1st dose 2nd dose 3rd dose 4th dose 5th dose
pertussis3 (DTaP: <7 yrs)
Haemophilus influenzae type b4 See 3rd or 4th dose,

1st dose 2nd dose
(Hib) footnote 4 See footnote 4
Pneumococcal conjugate5
1st dose 2nd dose 3rd dose 4th dose
(PCV13)
Inactivated poliovirus6
1st dose 2nd dose 3rd dose 4th dose
(IPV: <18 yrs)
Annual vaccination (IIV)

Influenza7 (IIV) Annual vaccination (IIV) 1 or 2 doses 1 dose only
Measles, mumps, rubella8 (MMR) See footnote 8 1st dose 2nd dose
Varicella9 (VAR) 1st dose 2nd dose
Hepatitis A1 0 (HepA) 2-dose series, See footnote 10
Meningococcal1 1 (MenACWY-D
See footnote 11 1st dose 2nd dose
>9 mos; MenACWY-CRM ≥2 mos)
Tetanus, diphtheria, & acellular

Tdap
pertussis1 3 (Tdap: >7 yrs)
See footnote
Human papillomavirus1 4 (HPV) 14
See footnote 12
Meningococcal B1 2
Appendixes
Pneumococcal polysaccharide5
See footnote 5
(PPSV23)
Range of recommended Range of recommended ages Range of recommended ages Range of recommended ages for non-high-risk No recommendation
ages for all children for catch-up immunization for certain high-risk groups groups that may receive vaccine, subject to
individual clinical decision making
NOTE: The above recommendations must be read along with the footnotes of this schedule.
161
FIGURE 2. Catch-up immunization schedule for persons aged 4 months–18 years who start late or who are more than 1 month behind—United States, 2018.
The figure below provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine series does not need to be restarted, regardless of the time that has elapsed between
IMMUNIZATION SCHEDULES (continued)

doses. Use the section appropriate for the child’s age. Always use this table in conjunction with Figure 1 and the footnotes that follow.
Children age 4 months through 6 years
Minimum Minimum Interval Between Doses
Vaccine Age for
Dose 1 Dose 1 to Dose 2 Dose 2 to Dose 3 Dose 3 to Dose 4 Dose 4 to Dose 5
Hepatitis B1 Birth 4 weeks 8 weeks and at least 16 weeks after first dose.
Minimum age for the final dose is 24 weeks.
6 weeks
Maximum age 4 weeks2
Rotavirus2 for first dose is 4 weeks Maximum age for final dose is 8 months, 0 days.
14 weeks, 6 days
Diphtheria, tetanus, and 6 weeks 4 weeks 4 weeks 6 months 6 months3
acellular pertussis3
4 weeks4
if current age is younger than 12 months and first dose was administered at younger than age 7 months,
4 weeks and at least 1 previous dose was PRP-T (ActHib, Pentacel, Hiberix) or unknown.
if first dose was administered 8 weeks and age 12 through 59 months (as final dose)4
before the 1 birthday.
st
8 weeks (as final dose)
• if current age is younger than 12 months and first dose was administered at age 7 through 11
Haemophilus influenzae 8 weeks (as final dose) months; This dose only necessary for chil-
type b4 6 weeks if first dose was administered at age OR dren age 12 through 59 months
12 through 14 months. who received 3 doses before the 1st
• if current age is 12 through 59 months and first dose was administered before the 1st birthday, and birthday.
No further doses needed if first second dose administered at younger than 15 months;
dose was administered at age 15 OR
months or older.
• if both doses were PRP-OMP (PedvaxHIB; Comvax) and were administered before the 1st birthday.
No further doses needed if previous dose was administered at age 15 months or older.
4 weeks
if first dose administered before the
1st birthday. 4 weeks
if current age is younger than 12 months and previous dose given at <7 months old. 8 weeks (as final dose)
8 weeks (as final dose for healthy
children) 8 weeks (as final dose for healthy children) This dose only necessary for chil-
Pneumococcal dren aged 12 through 59 months
conjugate5 6 weeks if first dose was administered at the if previous dose given between 7-11 months (wait until at least 12 months old);
who received 3 doses before age 12
1 birthday or after.
st
OR months or for children at high risk
No further doses needed if current age is 12 months or older and at least 1 dose was given before age 12 months. who received 3 doses at any age.
for healthy children if first dose was No further doses needed for healthy children if previous dose administered at age 24 months or older.
administered at age 24 months or
older.
4 weeks6 if current age is < 4 years 6 months6 (minimum age 4 years for
Inactivated poliovirus6 6 weeks 4 weeks6
6 months (as final dose) if current age is 4 years or older final dose).
Measles, mumps, rubella8 12 months 4 weeks
Varicella9 12 months 3 months
Hepatitis A10 12 months 6 months
Meningococcal11
(MenACWY-D ≥9 mos; 6 weeks 8 weeks11 See footnote 11 See footnote 11
MenACWY-CRM ≥2 mos)
Children and adolescents age 7 through 18 years
Meningococcal11
Not Applicable 8 weeks11
(MenACWY-D ≥9 mos;
(N/A)
MenACWY-CRM ≥2 mos)
4 weeks
Tetanus, diphtheria; if first dose of DTaP/DT was administered before the 1st birthday. 6 months if first dose of DTaP/DT
tetanus, diphtheria, and 7 years13 4 weeks was administered before the 1st
acellular pertussis13 6 months (as final dose) birthday.
if first dose of DTaP/DT or Tdap/Td was administered at or after the 1st birthday.
Human papillomavirus14 9 years Routine dosing intervals are recommended.14
Hepatitis A10 N/A 6 months
Hepatitis B1 N/A 4 weeks 8 weeks and at least 16 weeks after first dose.
A fourth dose of IPV is indicated if all
6 months6 previous doses were administered
Inactivated poliovirus6 N/A 4 weeks A fourth dose is not necessary if the third dose was administered at age 4 years or older and at least 6 months at <4 years or if the third dose was
after the previous dose. administered <6 months after the
second dose.
Measles, mumps, rubella8 N/A 4 weeks
3 months if younger than age 13
Varicella9 N/A years.
4 weeks if age 13 years or older.
Figure 3. Vaccines that might be indicated for children and adolescents aged 18 years or younger based on medical indications
HIV infection
CD4+ count†
<15% or ≥15% or
Immunocompromised total CD4 total CD4 Kidney failure, end- CSF leaks/ Asplenia and persistent Chronic
status (excluding HIV cell count of cell count of stage renal disease, on Heart disease, cochlear complement component liver
VACCINE d INDICATION f Pregnancy infection) <200/mm3 ≥200/mm3 hemodialysis chronic lung disease implants deficiencies disease Diabetes
Hepatitis B1
Rotavirus2
SCID*
Diphtheria, tetanus, & acellular pertussis3
(DTaP)
Haemophilus influenzae type b4
Pneumococcal conjugate5
Inactivated poliovirus6
Influenza7
Measles, mumps, rubella8
Varicella9
Hepatitis A1 0
Meningococcal ACWY1 1
Tetanus, diphtheria, & acellular pertussis1 3

(Tdap)
Human papillomavirus1 4
Meningococcal B1 2
Pneumococcal polysaccharide5
Appendixes
Recommended for persons with Vaccination is recommended,
Vaccination according to the and additional doses may be
an additional risk factor for which No recommendation Contraindicated Precaution for vaccination
routine schedule recommended the vaccine would be indicated necessary based on medical
condition. See footnotes.
*Severe Combined Immunodeficiency
†
For additional information regarding HIV laboratory parameters and use of live vaccines; see the General Best Practice Guidelines for Immunization “Altered Immunocompetence” at: www.cdc.gov/vaccines/hcp/acip-recs/gener-
al-recs/immunocompetence.html; and Table 4-1 (footnote D) at: www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html.
163
Footnotes — Recommended Immunization Schedule for Children and Adolescents Aged 18 Years or Younger, UNITED STATES, 2018

For further guidance on the use of the vaccines mentioned below, see: www.cdc.gov/vaccines/hcp/acip-recs/index.html.
For vaccine recommendations for persons 19 years of age and older, see the Adult Immunization Schedule.
Additional information
• For information on contraindications and precautions for the use of a vaccine, consult the General Best Practice Guidelines for Immunization and relevant ACIP
statements, at www.cdc.gov/vaccines/hcp/acip-recs/index.html.
• For calculating intervals between doses, 4 weeks = 28 days. Intervals of >4 months are determined by calendar months.
• Within a number range (e.g., 12–18), a dash (–) should be read as “through.”
• Vaccine doses administered ≤4 days before the minimum age or interval are considered valid. Doses of any vaccine administered ≥5 days earlier than the minimum
interval or minimum age should not be counted as valid and should be repeated as age-appropriate. The repeat dose should be spaced after the invalid dose by
the recommended minimum interval. For further details, see Table 3-1, Recommended and minimum ages and intervals between vaccine doses, in General Best Practice
Guidelines for Immunization at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/timing.html.
• Information on travel vaccine requirements and recommendations is available at wwwnc.cdc.gov/travel/.
• For vaccination of persons with immunodeficiencies, see Table 8-1, Vaccination of persons with primary and secondary immunodeficiencies, in General Best Practice
Guidelines for Immunization, at www.cdc.gov/vaccines/hcp/acip-recs/general-recs/immunocompetence.html; and Immunization in Special Clinical Circumstances. (In:
Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2015 report of the Committee on Infectious Diseases. 30th ed. Elk Grove Village, IL: American Academy of
Pediatrics, 2015:68-107).
• The National Vaccine Injury Compensation Program (VICP) is a no-fault alternative to the traditional legal system for resolving vaccine injury claims. All routine child and
adolescent vaccines are covered by VICP except for pneumococcal polysaccharide vaccine (PPSV23). For more information; see www.hrsa.gov/vaccinecompensation/
index.html.
1. Hepatitis B (HepB) vaccine. (minimum age: birth) • Infants who did not receive a birth dose should Catch-up vaccination:
Birth Dose (Monovalent HepB vaccine only): begin the series as soon as feasible (see Figure 2). • Do not start the series on or after age 15 weeks, 0
• Mother is HBsAg-Negative: 1 dose within 24 • Administration of 4 doses is permitted when a days.
hours of birth for medically stable infants >2,000 combination vaccine containing HepB is used after • The maximum age for the final dose is 8 months, 0
grams. Infants <2,000 grams administer 1 dose at the birth dose. days.
chronological age 1 month or hospital discharge. • Minimum age for the final (3rd or 4th) dose: 24 • For other catch-up guidance, see Figure 2.
• Mother is HBsAg-Positive: weeks.
 Give HepB vaccine and 0.5 mL of HBIG (at • Minimum Intervals: Dose 1 to Dose 2: 4 weeks / 3. Diphtheria, tetanus, and acellular pertussis (DTaP)
separate anatomic sites) within 12 hours of Dose 2 to Dose 3: 8 weeks / Dose 1 to Dose 3: 16 vaccine. (minimum age: 6 weeks [4 years for
birth, regardless of birth weight. weeks. (When 4 doses are given, substitute “Dose Kinrix or Quadracel])
 Test for HBsAg and anti-HBs at age 9–12 4” for “Dose 3” in these calculations.) Routine vaccination:
months. If HepB series is delayed, test 1–2 Catch-up vaccination: • 5-dose series at 2, 4, 6, and 15–18 months, and 4–6
months after final dose. • Unvaccinated persons should complete a 3-dose years.
• Mother’s HBsAg status is unknown: series at 0, 1–2, and 6 months.  Prospectively: A 4th dose may be given as
 Give HepB vaccine within 12 hours of birth, • Adolescents 11–15 years of age may use an
regardless of birth weight. early as age 12 months if at least 6 months
alternative 2-dose schedule, with at least 4 months have elapsed since the 3rd dose.
 For infants <2,000 grams, give 0.5 mL of HBIG between doses (adult formulation Recombivax
in addition to HepB vaccine within 12 hours of  Retrospectively: A 4th dose that was
HB only).
birth. inadvertently given as early as 12 months may
• For other catch-up guidance, see Figure 2.
 Determine mother’s HBsAg status as soon as be counted if at least 4 months have elapsed
possible. If mother is HBsAg-positive, give 0.5 2. Rotavirus vaccines. (minimum age: 6 weeks) since the 3rd dose.
mL of HBIG to infants >2,000 grams as soon as Routine vaccination: Catch-up vaccination:
possible, but no later than 7 days of age. Rotarix: 2-dose series at 2 and 4 months. • The 5th dose is not necessary if the 4th dose was
Routine Series: RotaTeq: 3-dose series at 2, 4, and 6 months. administered at 4 years or older.
• A complete series is 3 doses at 0, 1–2, and 6–18 • For other catch-up guidance, see Figure 2.
If any dose in the series is either RotaTeq or
months. (Monovalent HepB vaccine should be
unknown, default to 3-dose series.
used for doses given before age 6 weeks.)
4. Haemophilus influenzae type b (Hib) vaccine. • HIV infection Cerebrospinal fluid leak; cochlear implant:
(minimum age: 6 weeks) 12–59 months Age 2–5 years:
Routine vaccination:  Unvaccinated or only 1 dose before 12 • Any incomplete* schedules with:
• ActHIB, Hiberix, or Pentacel: 4-dose series at 2, 4, months: Give 2 doses 8 weeks apart.  3 PCV13 doses: 1 dose of PCV13 (at least 8
6, and 12–15 months.  2 or more doses before 12 months: Give 1 weeks after any prior PCV13 dose).
• PedvaxHIB: 3-dose series at 2, 4, and 12–15 months. dose, at least 8 weeks after previous dose.  <3 PCV13 doses: 2 doses of PCV13, 8 weeks
Catch-up vaccination: Unimmunized* persons 5–18 years after the most recent dose and given 8 weeks
• 1st dose at 7–11 months: Give 2nd dose at least 4  Give 1 dose apart.
weeks later and 3rd (final) dose at 12–15 months or • Immunoglobulin deficiency, early component • No history of PPSV23: 1 dose of PPSV23 (at least 8
8 weeks after 2nd dose (whichever is later). complement deficiency weeks after any prior PCV13 dose).
• 1st dose at 12–14 months: Give 2nd (final) dose at 12–59 months Age 6–18 years:
least 8 weeks after 1st dose.  Unvaccinated or only 1 dose before 12 • No history of either PCV13 or PPSV23: 1 dose of
• 1st dose before 12 months and 2nd dose before months: Give 2 doses, 8 weeks apart. PCV13, 1 dose of PPSV23 at least 8 weeks later.
15 months: Give 3rd (final) dose 8 weeks after 2nd  2 or more doses before 12 months: Give 1 • Any PCV13 but no PPSV23: 1 dose of PPSV23 at
dose. dose, at least 8 weeks after previous dose. least 8 weeks after the most recent dose of PCV13
• 2 doses of PedvaxHIB before 12 months: Give 3rd • PPSV23 but no PCV13: 1 dose of PCV13 at least 8
(final) dose at 12–59 months and at least 8 weeks *Unimmunized = Less than routine series (through 14
weeks after the most recent dose of PPSV23.
after 2nd dose. months) OR no doses (14 months or older)
Sickle cell disease and other hemoglobinopathies;
• Unvaccinated at 15–59 months: 1 dose.
5. Pneumococcal vaccines. (minimum age: 6 weeks anatomic or functional asplenia; congenital
• For other catch-up guidance, see Figure 2.
[PCV13], 2 years [PPSV23]) or acquired immunodeficiency; HIV infection;
Special Situations: chronic renal failure; nephrotic syndrome;
• Chemotherapy or radiation treatment Routine vaccination with PCV13:
• 4-dose series at 2, 4, 6, and 12–15 months. malignant neoplasms, leukemias, lymphomas,
12–59 months Hodgkin disease, and other diseases associated
 Unvaccinated or only 1 dose before 12 months: Catch-up vaccination with PCV13:
with treatment with immunosuppressive drugs
Give 2 doses, 8 weeks apart • 1 dose for healthy children aged 24–59 months
or radiation therapy; solid organ transplantation;
 2 or more doses before 12 months: Give 1 dose, with any incomplete* PCV13 schedule
multiple myeloma:
at least 8 weeks after previous dose. • For other catch-up guidance, see Figure 2.
Age 2–5 years:
Doses given within 14 days of starting therapy or Special situations: High-risk conditions:
• Any incomplete* schedules with:
during therapy should be repeated at least 3 months Administer PCV13 doses before PPSV23 if
 3 PCV13 doses: 1 dose of PCV13 (at least 8
after therapy completion. possible.
weeks after any prior PCV13 dose).
• Hematopoietic stem cell transplant (HSCT) Chronic heart disease (particularly cyanotic
 <3 PCV13 doses: 2 doses of PCV13, 8 weeks
• 3-dose series with doses 4 weeks apart starting 6 to congenital heart disease and cardiac failure);
after the most recent dose and given 8 weeks
12 months after successful transplant (regardless of chronic lung disease (including asthma treated
apart.
Hib vaccination history). with high-dose, oral, corticosteroids); diabetes
mellitus: • No history of PPSV23: 1 dose of PPSV23 (at least 8
• Anatomic or functional asplenia (including sickle
weeks after any prior PCV13 dose) and a 2nd dose
cell disease) Age 2–5 years:
of PPSV23 5 years later.
12–59 months • Any incomplete* schedules with:
 Unvaccinated or only 1 dose before 12 months:  3 PCV13 doses: 1 dose of PCV13 (at least 8 Age 6–18 years:
Give 2 doses, 8 weeks apart. weeks after any prior PCV13 dose). • No history of either PCV13 or PPSV23: 1 dose of
PCV13, 2 doses of PPSV23 (1st dose of PPSV23
 2 or more doses before 12 months: Give 1 dose,  <3 PCV13 doses: 2 doses of PCV13, 8 weeks administered 8 weeks after PCV13 and 2nd dose of
at least 8 weeks after previous dose. after the most recent dose and given 8 weeks
Appendixes
PPSV23 administered at least 5 years after the 1st
Unimmunized* persons 5 years or older apart. dose of PPSV23).
 Give 1 dose • No history of PPSV23: 1 dose of PPSV23 (at least 8 • Any PCV13 but no PPSV23: 2 doses of PPSV23 (1st
• Elective splenectomy weeks after any prior PCV13 dose). dose of PPSV23 to be given 8 weeks after the most
Unimmunized* persons 15 months or older Age 6-18 years: recent dose of PCV13 and 2nd dose of PPSV23
 Give 1 dose (preferably at least 14 days before • No history of PPSV23: 1 dose of PPSV23 (at least 8 administered at least 5 years after the 1st dose of
procedure). weeks after any prior PCV13 dose). PPSV23).
165

• PPSV23 but no PCV13: 1 dose of PCV13 at least 8 7. Influenza vaccines. (minimum age: 6 months) Catch-up vaccination:
weeks after the most recent PPSV23 dose and a 2nd Routine vaccination: • Ensure persons 7–18 years without evidence of
dose of PPSV23 to be given 5 years after the 1st dose • Administer an age-appropriate formulation and immunity (see MMWR 2007;56[No. RR-4], at
of PPSV23 and at least 8 weeks after a dose of PCV13. dose of influenza vaccine annually. www.cdc.gov/mmwr/pdf/rr/rr5604.pdf ) have 2
Chronic liver disease, alcoholism:  Children 6 months–8 years who did not doses of varicella vaccine:
Age 6–18 years: receive at least 2 doses of influenza vaccine  Ages 7–12: routine interval 3 months
• No history of PPSV23: 1 dose of PPSV23 (at least 8 before July 1, 2017 should receive 2 doses (minimum interval: 4 weeks).
weeks after any prior PCV13 dose). separated by at least 4 weeks.  Ages 13 and older: minimum interval 4 weeks.
*Incomplete schedules are any schedules where  Persons 9 years and older 1 dose
10. Hepatitis A (HepA) vaccine. (minimum age: 12
PCV13 doses have not been completed according to • Live attenuated influenza vaccine (LAIV) not
months)
ACIP recommended catch-up schedules. The total recommended for the 2017–18 season.
number and timing of doses for complete PCV13 • For additional guidance, see the 2017–18 ACIP Routine vaccination:
series are dictated by the age at first vaccination. See influenza vaccine recommendations (MMWR • 2 doses, separated by 6-18 months, between the
Tables 8 and 9 in the ACIP pneumococcal vaccine August 25, 2017;66(2):1-20: www.cdc.gov/mmwr/ 1st and 2nd birthdays. (A series begun before the
recommendations (www.cdc.gov/mmwr/pdf/rr/ volumes/66/rr/pdfs/rr6602.pdf ). 2nd birthday should be completed even if the child
rr5911.pdf ) for complete schedule details. (For the 2018–19 season, see the 2018–19 ACIP turns 2 before the second dose is given.)
influenza vaccine recommendations.) Catch-up vaccination:
6. Inactivated poliovirus vaccine (IPV). (minimum • Anyone 2 years of age or older may receive HepA
age: 6 weeks) 8. Measles, mumps, and rubella (MMR) vaccine. vaccine if desired. Minimum interval between
Routine vaccination: (minimum age: 12 months for routine vaccination) doses is 6 months.
• 4-dose series at ages 2, 4, 6–18 months, and 4–6 years. Routine vaccination: Special populations:
Administer the final dose on or after the 4th birthday • 2-dose series at 12–15 months and 4–6 years. Previously unvaccinated persons who should be
and at least 6 months after the previous dose. • The 2nd dose may be given as early as 4 weeks after vaccinated:
Catch-up vaccination: the 1st dose. • Persons traveling to or working in countries with
• In the first 6 months of life, use minimum ages and Catch-up vaccination: high or intermediate endemicity
intervals only for travel to a polio-endemic region or • Unvaccinated children and adolescents: 2 doses at • Men who have sex with men
during an outbreak. least 4 weeks apart. • Users of injection and non-injection drugs
• If 4 or more doses were given before the 4th birthday, • Persons who work with hepatitis A virus in a
International travel:
give 1 more dose at age 4–6 years and at least 6 research laboratory or with non-human primates
• Infants 6–11 months: 1 dose before departure.
months after the previous dose. • Persons with clotting-factor disorders
Revaccinate with 2 doses at 12–15 months (12
• A 4th dose is not necessary if the 3rd dose was given • Persons with chronic liver disease
months for children in high-risk areas) and 2nd dose
on or after the 4th birthday and at least 6 months • Persons who anticipate close, personal contact
as early as 4 weeks later.
after the previous dose. (e.g., household or regular babysitting) with an
• Unvaccinated children 12 months and older: international adoptee during the first 60 days after
• IPV is not routinely recommended for U.S. residents 2 doses at least 4 weeks apart before departure.
18 years and older. arrival in the United States from a country with high
Mumps outbreak: or intermediate endemicity (administer the 1st dose
Series Containing Oral Polio Vaccine (OPV), either • Persons ≥12 months who previously received as soon as the adoption is planned—ideally at least
mixed OPV-IPV or OPV-only series: ≤2 doses of mumps-containing vaccine and are 2 weeks before the adoptee’s arrival).
• Total number of doses needed to complete the series identified by public health authorities to be at
is the same as that recommended for the U.S. IPV increased risk during a mumps outbreak should 11. Serogroup A, C, W, Y meningococcal vaccines.
schedule. See www.cdc.gov/mmwr/volumes/66/wr/ receive a dose of mumps-virus containing vaccine. (Minimum age: 2 months [Menveo], 9 months
mm6601a6.htm?s_cid=mm6601a6_w. [Menactra].
• Only trivalent OPV (tOPV) counts toward the 9. Varicella (VAR) vaccine. (minimum age: 12 months) Routine:
U.S. vaccination requirements. For guidance to Routine vaccination: • 2-dose series: 11-12 years and 16 years.
assess doses documented as “OPV” see www. • 2-dose series: 12–15 months and 4–6 years. Catch-Up:
cdc.gov/mmwr/volumes/66/wr/mm6606a7. • The 2nd dose may be given as early as 3 months • Age 13-15 years: 1 dose now and booster at age
htm?s_cid=mm6606a7_w. after the 1st dose (a dose given after a 4-week 16-18 years. Minimum interval 8 weeks.
• For other catch-up guidance, see Figure 2. interval may be counted). • Age 16-18 years: 1 dose.
Special populations and situations: 12. Serogroup B meningococcal vaccines (minimum • Children 7–10 years who receive Tdap
Anatomic or functional asplenia, sickle cell disease, age: 10 years [Bexsero, Trumenba]. inadvertently or as part of the catch-up series may
HIV infection, persistent complement component Clinical discretion: Adolescents not at increased receive the routine Tdap dose at 11–12 years.
deficiency (including eculizumab use): risk for meningococcal B infection who want • DTaP inadvertently given after the 7th birthday:
• Menveo  Child 7–10: DTaP may count as part of
MenB vaccine.
 1st dose at 8 weeks: 4-dose series at 2, 4, 6, and 12 catch-up series. Routine Tdap dose at 11-12
months. MenB vaccines may be given at clinical discretion to
may be given.
 1st dose at 7–23 months: 2 doses (2nd dose at adolescents 16–23 years (preferred age 16–18 years)
 Adolescent 11–18: Count dose of DTaP as the
least 12 weeks after the 1st dose and after the 1st who are not at increased risk.
adolescent Tdap booster.
birthday). • Bexsero: 2 doses at least 1 month apart.
• Trumenba: 2 doses at least 6 months apart. If the • For other catch-up guidance, see Figure 2.
 1st dose at 24 months or older: 2 doses at least 8
weeks apart. 2nd dose is given earlier than 6 months, give a 3rd 14. Human papillomavirus (HPV) vaccine (minimum
• Menactra dose at least 4 months after the 2nd. age: 9 years)
 Persistent complement component deficiency: Special populations and situations: Routine and catch-up vaccination:
 9–23 months: 2 doses at least 12 weeks apart Anatomic or functional asplenia, sickle cell • Routine vaccination for all adolescents at 11–12
 24 months or older: 2 doses at least 8 weeks disease, persistent complement component years (can start at age 9) and through age 18 if
apart deficiency (including eculizumab use), serogroup not previously adequately vaccinated. Number of
 Anatomic or functional asplenia, sickle cell B meningococcal disease outbreak doses dependent on age at initial vaccination:
disease, or HIV infection: • Bexsero: 2-dose series at least 1 month apart.  Age 9–14 years at initiation: 2-dose series
 24 months or older: 2 doses at least 8 weeks • Trumenba: 3-dose series at 0, 1-2, and 6 months. at 0 and 6–12 months. Minimum interval: 5
apart. Note: Bexsero and Trumenba are not months (repeat a dose given too soon at least
 Menactra must be administered at least 4 12 weeks after the invalid dose and at least 5
interchangeable.
weeks after completion of PCV13 series. months after the 1st dose).
For additional meningococcal vaccination
Children who travel to or live in countries where  Age 15 years or older at initiation: 3-dose
information, see meningococcal MMWR publications
meningococcal disease is hyperendemic or series at 0, 1–2 months, and 6 months.
at: www.cdc.gov/vaccines/hcp/acip-recs/vacc-
epidemic, including countries in the African Minimum intervals: 4 weeks between 1st and
meningitis belt or during the Hajj, or exposure to an specific/mening.html. 2nd dose; 12 weeks between 2nd and 3rd
outbreak attributable to a vaccine serogroup: dose; 5 months between 1st and 3rd dose
13. Tetanus, diphtheria, and acellular pertussis
• Children <24 months of age: (repeat dose(s) given too soon at or after the
(Tdap) vaccine. (minimum age: 11 years for
 Menveo (2-23 months): minimum interval since the most recent dose).
routine vaccinations, 7 years for catch-up
 1st dose at 8 weeks: 4-dose series at 2, 4, 6, and • Persons who have completed a valid series with
vaccination)
12 months. any HPV vaccine do not need any additional doses.
 1st dose at 7-23 months: 2 doses (2nd dose at Routine vaccination: Special situations:
least 12 weeks after the 1st dose and after the • Adolescents 11–12 years of age: 1 dose. • History of sexual abuse or assault: Begin series at
1st birthday). • Pregnant adolescents: 1 dose during each age 9 years.
 Menactra (9-23 months): pregnancy (preferably during the early part of • Immunocompromised* (including HIV) aged
 2 doses (2nd dose at least 12 weeks after the gestational weeks 27–36). 9–26 years: 3-dose series at 0, 1–2 months, and 6
1st dose. 2nd dose may be administered as • Tdap may be administered regardless of the months.
early as 8 weeks after the 1st dose in travelers). interval since the last tetanus- and diphtheria- • Pregnancy: Vaccination not recommended,
• Children 2 years or older: 1 dose of Menveo or toxoid-containing vaccine. but there is no evidence the vaccine is harmful.
Menactra. Catch-up vaccination: No intervention is needed for women who
Appendixes
Note: Menactra should be given either before or at • Adolescents 13–18 who have not received Tdap: inadvertently received a dose of HPV vaccine
the same time as DTaP. For MenACWY booster dose 1 dose, followed by a Td booster every 10 years. while pregnant. Delay remaining doses until after
recommendations for groups listed under “Special • Persons aged 7–18 years not fully immunized pregnancy. Pregnancy testing not needed before
populations and situations” above, and additional vaccination.
with DTaP: 1 dose of Tdap as part of the catch-up
meningococcal vaccination information, see *See MMWR, December 16, 2016;65(49):1405–1408,
series (preferably the first dose). If additional doses at www.cdc.gov/mmwr/volumes/65/wr/pdfs/
meningococcal MMWR publications at: www.cdc.gov/
are needed, use Td. mm6549a5.pdf.
vaccines/hcp/acip-recs/vacc-specific/mening.html. CS270457-M
167
Index
A immunization schedules for,
Acetaminophen toxicity, 158 160–167
Achondroplasia, 31 iron levels in, 78
Activity, APGAR score, 7 lactate dehydrogenase (LDH) levels
Activity, FLACC Pain Scale, 10 in, 78
Adolescents lactate (serum) levels in, 78
age-specific leukocyte differential lactate dehydrogenase (LDH) levels
for, 98 in, 78
alanine aminotransferase (ALT) levetiracetam (Keppra) dosing for,
levels in, 73 148
aldolase levels in, 73 lipase levels in, 78
alkaline phosphatase (ALP) levels lymphocyte subset counts in periph-
in, 73 eral blood in, 99–101
amikacin dosing for, 138 magnesium levels in, 79
ammonia levels in, 73 methemoglobin levels in, 79
amylase levels in, 73 osmolality (serum or plasma) levels
aspartate aminotransferase (AST) in, 79
levels in, 74 phenobarbital dosing for, 150
bicarbonate levels in, 74 phosphate levels in, 79
bilirubin (total) levels in, 74 prealbumin levels in, 80
cerebrospinal fluid levels in, 70–71 protein electrophoresis in, 80
calcium (total and ionized) levels pyruvate levels in, 81
in, 74, 75 rheumatoid factor (RF) levels in, 81
chloride levels in, 75 thyroid function values in, 86
creatine kinase levels in, 75 tobramycin dosing for, 142
creatinine (enzymatic) levels in, 76 transferrin levels in, 81
dietary reference intakes (DRIs) triglyceride levels in, 81
for, 126 troponin I levels in, 82
digoxin dosing for, 153 urea nitrogen (BUN) levels in, 82
enoxaparin dosing for, 155 uric acid levels in, 82
ferritin levels in, 76 valproic acid and derivatives dosing
fosphenytoin dosing for, 146 for, 152
gentamicin dosing for, 140 vancomycin dosing for, 144
γ-glutamyltransferase (GGT) levels vitamin A (retinol) levels in, 82
in, 77 vitamin B1 (thiamine) levels in, 82
haptoglobin levels in, 77 vitamin B2 (riboflavin) levels in, 82
hematology values in, 94–95 vitamin B12 (cobalamin) levels in, 82
vitamin C (ascorbic acid) levels
in, 82
170 Index
Adolescents (continued) lactate dehydrogenase (LDH) levels

vitamin D (total) (25-hydroxyvitamin in, 78
D) levels in, 83 lipase levels in, 78
vitamin E (tocopherol) levels in, 83 lipid levels in, 79
warfarin dosing for, 156 magnesium levels in, 79
zinc levels in, 83 methemoglobin levels in, 79
Adults osmolality (serum or plasma) levels
alanine aminotransferase (ALT) in, 79
levels in, 73 phosphate levels in, 79
aldolase levels in, 73 prealbumin levels in, 80
alkaline phosphatase (ALP) levels protein electrophoresis in, 80
in, 73 pyruvate levels in, 81
ammonia levels in, 73 rheumatoid factor (RF) levels in, 81
amylase levels in, 73 total iron-binding capacity (TIBC)
arterial blood gases in, 74 in, 81
aspartate aminotransferase (AST) transferrin levels in, 81
levels in, 74 triglyceride levels in, 81
bicarbonate levels in, 74 troponin I levels in, 82
bilirubin (total) levels in, 74 urea nitrogen (BUN) levels in, 82
cerebrospinal fluid levels in, 70–71 uric acid levels in, 82
calcium (total and ionized) levels vitamin A (retinol) levels in, 82
in, 74, 75 vitamin B1 (thiamine) levels in, 82
chloride levels in, 75 vitamin B2 (riboflavin) levels in, 82
coagulation values in, 107–108 vitamin B12 (cobalamin) levels in, 82
cow’s milk–based formulas for, vitamin C (ascorbic acid) levels
122–123 in, 82
C-reactive protein levels in, 75 vitamin D (total) (25-hydroxyvitamin
creatine kinase levels in, 75 D) levels in, 83
creatinine (enzymatic) levels in, 76 vitamin E (tocopherol) levels in, 83
erythrocyte sedimentation rate zinc levels in, 83
(ESR) in, 76 Age-specific leukocyte differential
ferritin levels in, 76 for children and teens, 98
folate levels in, 76 for infants and toddlers, 96–97
formulas for, 122–124 Alanine aminotransferase (ALT), 73
γ-glutamyltransferase (GGT) levels Aldolase, 73
in, 77 Alkaline phosphatase (ALP), 73
haptoglobin levels in, 77 Amikacin, 138–139
hematology values in, 94–95 Amino acid–based formulas
iron levels in, 78 for infants, 119
lactate (serum) levels in, 78 for older children and adults, 124
for toddlers and young children, 121
Index 171
Ammonia, 73 nomograms, 59–63

Amylase, 73 children younger than 1 year, 63
Anion gap, 113 during first 12 hours after birth,
Antibiotic dosing 59
amikacin, 138–139 preterm and full-term new-
gentamicin, 140–141 borns, 60–62
tobramycin, 142–143 Blood urea nitrogen (BUN). See Urea
vancomycin, 144–145 nitrogen (BUN)
Anticonvulsant dosing BMI. See Body mass index (BMI)
fosphenytoin, 146–147 Body mass index (BMI)
levetiracetam (Keppra), 148–149 boys, 28
phenobarbital, 150–151 girls, 30
valproic acid and derivatives, 152 in pediatric malnutrition indica-
APGAR score, 7 tors, 46
Appearance, APGAR score, 7 Body surface area (BSA), 19
Arterial blood gases, 74 Boys
Ascorbic acid, 82 blood pressure levels in, 64–65
Aspartate aminotransferase (AST), 74 clinical chemistry in
alanine aminotransferase
B (ALT), 73
Ballard score, New, 8–9 alkaline phosphatase (ALP), 73
Basophils aspartate aminotransferase
in children and teens, 98 (AST), 74
in infants and toddlers, 96–97 calcium (ionized), 75
Behavior creatine kinase, 75
Pediatric Early Warning Score creatinine (enzymatic), 76
(PEWS), 16 ferritin, 76
/state, NPASS, 11, 14 glucose, 77
Beneprotein, 116 iron, 78
Bicarbonate, 74 lactate dehydrogenase (LDH),
Bilirubin (total and conjugated), 74 78
Birth weight used in measuring cathe- phosphate, 79
ter length, 131–132 prealbumin, 80
“Blenderized” formulas, 120, 123 triglycerides, 81
Blood gases, arterial. See Arterial blood uric acid, 82
gases growth charts for
Blood pressure, 59–68 body mass index-for-age, 28
levels by age and height percentile with Down syndrome, 32–35
in boys, 64–65 Fenton preterm growth chart, 21
in girls, 66–68 head circumference-for-age and
weight-for-length, 23
172 Index
Boys, growth charts for (continued) bilirubin (total) levels in, 74

length-for-age and weight-for- calcium (total and ionized) levels
age, 24 in, 74, 75
stature-for-age and weight-for- with cerebral palsy, 40
age, 27 cerebrospinal fluid levels in, 70–71
mean stretched penile length of, chloride levels in, 75
55–56 coagulation values in, 107–108
mid-upper arm circumference of, cow’s milk–based formulas for, 120,
42–43 122–123
thyroid function values in, 86 creatine kinase levels in, 75
BSA. See Body surface area (BSA) creatinine (enzymatic) levels in, 76
dietary reference intakes (DRIs)
C for, 126
Calcium digoxin dosing for, 153
ionized, 75 with Down syndrome, 31–39
total, 74 endotracheal tube size and depth of
Calculated serum osmolality, 113 insertion for, 136
Carbon monoxide (carboxyhemo enoxaparin dosing for, 155
globin), 75 erythrocyte sedimentation rate
Cardiovascular system, Pediatric Early (ESR) in, 76
Warning Score (PEWS), ferritin levels in, 76
16–17 folate levels in, 76
Casein, 119 formulas for older, 122–124
Celsius conversion, 1, 2 formulas for toddlers and young,
Cerebral palsy, 40 120–121
Cerebrospinal fluid levels, 70–71 fosphenytoin dosing for, 146
Children gentamicin dosing for, 140
age-specific leukocyte differential, γ-glutamyltransferase (GGT) levels
96–98 in, 77
alanine aminotransferase (ALT) growth charts for special health care
levels in, 73 needs, 31–40
aldolase levels in, 73 growth hormone deficiency in,
alkaline phosphatase (ALP) levels 87–91
in, 73 haptoglobin levels in, 77
amikacin dosing for, 138 hematology values in, 94–95
ammonia levels in, 73 immunization schedules for,
amylase levels in, 73 160–167
arterial blood gases in, 74 iron levels in, 78
aspartate aminotransferase (AST) lactate (serum) levels in, 78
levels in, 74 lactate dehydrogenase (LDH) levels
bicarbonate levels in, 74 in, 78
Index 173
lead levels in, 78 Cholesterol, 79

levetiracetam (Keppra) dosing for, Clinical chemistry
148 alanine aminotransferase (ALT), 73
lipase levels in, 78 aldolase, 73
lipid levels in, 79 alkaline phosphatase (ALP), 73
lymphocyte subset counts in periph- ammonia, 73
eral blood in, 99–101 amylase, 73
magnesium levels in, 79 arterial blood gases, 74
methemoglobin levels in, 79 aspartate aminotransferase (AST),
osmolality (serum or plasma) levels 74
in, 79 bicarbonate, 74
phenobarbital dosing for, 150 bilirubin (total and conjugated), 74
phosphate levels in, 79 calcium
potassium levels in, 80 ionized, 75
prealbumin levels in, 80 total, 74
protein electrophoresis in, 80 carbon monoxide (carboxyhemo-
pyruvate levels in, 81 globin), 75
rheumatoid factor (RF) levels in, 81 chloride, 75
sodium levels in, 81 C-reactive protein, 75
thyroid function values in, 86 creatine kinase, 75
tobramycin dosing for, 142 creatinine (enzymatic), 76
transferrin levels in, 81 erythrocyte sedimentation rate
triglyceride levels in, 81 (ESR), 76
troponin I levels in, 82 ferritin, 76
urea nitrogen (BUN) levels in, 82 folate, 76
uric acid levels in, 82 glucose, 77
valproic acid and derivatives dosing γ-glutamyltransferase (GGT), 77
for, 152 haptoglobin, 77
vancomycin dosing for, 144 hemoglobin A1c, 77
vitamin A (retinol) levels in, 82 hemoglobin F, 77
vitamin B1 (thiamine) levels in, 82 iron, 78
vitamin B2 (riboflavin) levels in, 82 lactate (serum), 78
vitamin B12 (cobalamin) levels in, 82 lactate dehydrogenase (LDH), 78
vitamin C (ascorbic acid) levels lead, 78
in, 82 lipase, 78
vitamin D (total) (25-hydroxyvitamin lipids, 79
D) levels in, 83 magnesium, 79
vitamin E (tocopherol) levels in, 83 methemoglobin, 79
warfarin dosing for, 156 for newborns, 83–84
zinc levels in, 83 osmolality (serum or plasma), 79
Chloride, 75 phosphate, 79
174 Index
Clinical chemistry (continued) Cow’s milk–based formulas

potassium, 80 for infants, 118
prealbumin, 80 for older children and adults,
protein electrophoresis, 80 122–123
pyruvate, 81 for toddlers and young children,
rheumatoid factor (RF), 81 120
sodium, 81 C-reactive protein, 75
total iron-binding capacity (TIBC), Creatine kinase, 75
81 Creatinine (enzymatic), 76
transferrin, 81 Croup score, 18
triglycerides, 81 Crying/irritability, NPASS, 11, 13
troponin I, 82 Cry, FLACC Pain Scale, 10
urea nitrogen (BUN), 82
uric acid, 82 D
vitamin A (retinol), 82 Diabetes mellitus and hemoglobin
vitamin B1 (thiamine), 82 A1c, 77
vitamin B2 (riboflavin), 82 Dietary reference intakes (DRIs),
vitamin B12 (cobalamin), 82 126–129
vitamin C (ascorbic acid), 82 for children and adolescents, 126
vitamin D (total) (25-hydroxyvitamin for infants and toddlers, 126
D), 83 for macronutrients and micro
vitamin E (tocopherol), 83 nutrients, 127–129
zinc, 83 Digoxin, 153–154
Coagulation values Diphtheria, tetanus, and acellular
in childhood compared with adults, pertussis (DTaP) vaccine,
107–108 161, 162, 163, 164
in healthy, full-term infants, Dosing
105–106 antibiotics
in healthy preterm infants, 102–104 amikacin, 138–139
Cobalamin, 82 gentamicin, 140–141
Complete Amino Acid Mix, 116 tobramycin, 142–143
Consolability, FLACC Pain Scale, 10 vancomycin, 144–145
Conversions, 1–5 anticonvulsants
formulas for, 1 fosphenytoin, 146–147
temperature, 1 levetiracetam (Keppra),
Cord blood, 83–84 148–149
arterial blood gases in, 74 phenobarbital, 150–151
protein electrophoresis in, 80 valproic acid and derivatives,
Cornelia de Lange syndrome, 31 152
Cortisol, 91 digoxin, 153–154
Index 175
enoxaparin, 155 FLACC Pain Scale, 10

warfarin, 156 Fluid(s)
Down syndrome, 31 needs by weight, 125
growth charts for boys with, 32–35 oral rehydration, 125
growth charts for girls with, 36–39 Fluoride sources and supplementation,
Duocal, 116 130
Folate, 76
E Forearm length, 49
Ear above eyeline level measure Formulas
birth weight, 54 amino acid–based, 119, 121, 124
gestational age, 53 “blenderized,” 120, 123
Electrolyte additives, 125 common modular supplements, 116
Endotracheal tube size and depth of cow’s milk–based, 118, 120, 122–123
insertion enteral, 117–124
neonatal, 135 extensively hydrolyzed casein, 119
pediatric, 136 infant, 117–119
Energy, dietary reference intakes liquid, 115
(DRIs) for, 126 modular supplementation, 116
Enoxaparin, 155 older children and adults, 122–124
Enteral formulas, 117–124 partially hydrolyzed, 119
Eosinophils powdered, 115
in children and teens, 98 preparation of, 115
in infants and toddlers, 96–97 preterm, 117–118
Erythrocyte sedimentation rate (ESR), renal, 124
76 semi-elemental hydrolyzed, 121, 123
Exchange transfusion nomogram, 111 soy-based, 115, 118, 120
Extensively hydrolyzed casein formulas, toddler and young children,
119 120–121
Extremities/tone, NPASS, 11, 15 Formulas, conversion, 1
Eye opening, Glasgow Coma Scale, 17 Fosphenytoin, 146–147
F G
Face, FLACC Pain Scale, 10 Gentamicin, 140–141
Facial expression, NPASS, 11, 14 γ-glutamyltransferase (GGT), 77
Fahrenheit conversion, 1, 2 Girls
Fenton preterm growth charts blood pressure levels in, 66–68
boys, 21 clinical chemistry in
girls, 22 alanine aminotransferase
Ferritin, 76 (ALT), 73
Fibrinolysis, 104, 106, 108 alkaline phosphatase (ALP), 73
176 Index
Girls, clinical chemistry in (continued) boys

aspartate aminotransferase body mass index-for-age, 28
(AST), 74 with Down syndrome, 32–35
calcium (ionized), 75 Fenton preterm, 21
creatine kinase, 75 head circumference-for-age and
creatinine (enzymatic), 76 weight-for-length, 23
ferritin, 76 length-for-age and weight-for-
glucose, 77 age, 24
iron, 78 stature-for-age and weight-for-
lactate dehydrogenase (LDH), age, 27
78 for children with cerebral palsy, 40
phosphate, 79 for children with Down syndrome,
prealbumin, 80 31–39
triglycerides, 81 for children with special health care
uric acid, 82 needs, 31–40
growth charts for Fenton preterm, 21–22
body mass index-for-age, 30 girls
with Down syndrome, 36–39 body mass index-for-age, 30
Fenton preterm growth chart, Fenton preterm, 22
22 head circumference-for-age and
head circumference-for-age and weight-for-length, 25
weight-for-length, 25 length-for-age and weight-for-
length-for-age and weight-for- age, 26
age, 26 stature-for-age and weight-for-
stature-for-age and weight-for- age, 29
age, 29 mid-upper arm circumference, 41
mid-upper arm circumference of, pediatric malnutrition indicators,
44–45 46
thyroid function values in, 86 Growth hormones (GH), 87–91
Glasgow Coma Scale, 17–18 Growth measures, 47
Glucose, 77 ear above eyeline level (birth
infusion rate (GIR), 113 weight), 54
Grimace, APGAR score, 7 ear above eyeline level (gestational
Gross Motor Function Classification age), 53
System, 40 forearm length, 49
Growth charts long-bone length
average growth velocity by age- lower limb, 51
group, 20 upper limb, 50
body surface area, 19 lower leg length, 52
mean stretched penile length, 55–56
Index 177
primary teeth eruption chart, 57 Hyperbilirubinemia management,

upper arm length, 48 109–111
H I
Haemophilus influenzae type b vaccine, Immunization schedules, 160–167
161, 162, 163, 165 Inactivated poliovirus (IPV) vaccine,
Haptoglobin, 77 161, 162, 163, 166
HDL. See High-density lipoprotein (HDL) Infants. See also Newborns
Head circumference age-specific leukocyte differential
with Down syndrome, 34, 38 for, 96–97
growth charts, 20, 34, 38 alanine aminotransferase (ALT)
Height levels in, 73
conversion formulas, 1 aldolase levels in, 73
growth charts, 20 alkaline phosphatase (ALP) levels
in pediatric malnutrition indica- in, 73
tors, 46 amikacin dosing for, 138
and weight for children with cere- ammonia levels in, 73
bral palsy, 40 amylase levels in, 73
Hematocrit aspartate aminotransferase (AST)
in children, teens, and young levels in, 74
adults, 94 bilirubin (total) levels in, 74
in infants and toddlers, 92–93 blood pressure nomograms for, 63
Hematology values cerebrospinal fluid levels in, 70–71
in children, teens and young adults, calcium (total and ionized) levels
94–95 in, 74, 75
in infants and toddlers, 92–93 chloride levels in, 75
Hemoglobin coagulation values in, 105–106
in children, teens, and young cow’s milk–based formulas for, 118
adults, 94 creatine kinase levels in, 75
in infants and toddlers, 92–93 creatinine (enzymatic) levels in, 76
Hemoglobin A1c, 77 dietary reference intakes (DRIs)
Hemoglobin F, 77 for, 126
Hepatitis A vaccine, 161, 162, 163, 166 digoxin dosing for, 153
Hepatitis B vaccine, 161, 162, 163, 164 enoxaparin dosing for, 155
High-density lipoprotein (HDL), 79 extensively hydrolyzed casein for-
HIV infection, 165 mulas for, 119
Holliday-Segar method, 125 ferritin levels in, 76
Human milk, 117 formulas for, 117–119
Human papillomavirus (HPV) vaccine, fosphenytoin dosing for, 146
161, 162, 163, 167 gentamicin dosing for, 140
178 Index
Infants (continued) vancomycin dosing for, 144

glucose levels in, 77 vitamin A (retinol) levels in, 82
γ-glutamyltransferase (GGT) levels vitamin B1 (thiamine) levels in, 82
in, 77 vitamin B2 (riboflavin) levels in, 82
haptoglobin levels in, 77 vitamin C (ascorbic acid) levels
hematology values for, 92–93 in, 82
hemoglobin F levels in, 77 vitamin D (total) (25-hydroxyvitamin
iron levels in, 78 D) levels in, 83
lactate (serum) levels in, 78 vitamin E (tocopherol) levels in, 83
lactate dehydrogenase (LDH) levels warfarin dosing for, 156
in, 78 zinc levels in, 83
levetiracetam (Keppra) dosing for, Influenza (IIV) vaccine, 161, 163, 166
148 Insulin-like growth factor, 88–90
lipase levels in, 78 Iron, 78
lymphocyte subset counts in periph-
eral blood in, 99–101 L
magnesium levels in, 79 Lactate (serum), 78
methemoglobin levels in, 79 Lactate dehydrogenase (LDH), 78
osmolality (serum or plasma) levels LDL. See Low-density lipoprotein (LDL)
in, 79 Lead, 78
phenobarbital dosing for, 150 Legs, FLACC Pain Scale, 10
phosphate levels in, 79 Length-for-age percentiles
potassium levels in, 80 boys, 24, 33
prealbumin levels in, 80 girls, 26, 37
protein electrophoresis in, 80 in pediatric malnutrition indica-
pyruvate levels in, 81 tors, 46
rheumatoid factor (RF) levels in, 81 Lethal carbon monoxide (carboxyhe-
sodium levels in, 81 moglobin) levels, 75
soy-based formulas for, 115, 118 Levetiracetam (Keppra), 148–149
thyroid function values in, 86 Life Expectancy Project Web site, 40
tobramycin dosing for, 142 Lipase, 78
total iron-binding capacity (TIBC) Lipids, 79
in, 81 Liquid formula, 115
transferrin levels in, 81 Liquid Protein, 116
triglyceride levels in, 81 Liquigen, 116
troponin I levels in, 82 Long-bone length
urea nitrogen (BUN) levels in, 82 lower limb, 51
uric acid levels in, 82 upper limb, 50
valproic acid and derivatives dosing Low-density lipoprotein (LDL), 79
for, 152 Lower leg length, 52
Index 179
Lymphocytes Milligram and milliequivalent conver-

in children and teens, 98 sions, 1
in infants and toddlers, 96–97 Milligram and millimole conversions, 1
Lymphocyte subset counts in periph- Milliosmoles, 1
eral blood, 99–101 Modular supplements, formula, 116
Monocytes
M in children and teens, 98
Macronutrients and micronutrients, in infants and toddlers, 96–97
daily requirements for, Mosteller’s formula, 19
127–129 Motor response, Glasgow Coma Scale,
Magnesium, 79 18
Malnutrition indicators, pediatric, 46
Marfan syndrome, 31 N
Maturational assessment of gestational Neonatal, Pain, Agitation, and Sedation
age, 8–9 Scale (NPASS), 11–15
MCT oil, 116 Neurological impairment carbon mon-
Mean corpuscular hemoglobin oxide (carboxyhemoglobin)
concentration levels, 75
in children, teens, and young Neutrophils
adults, 95 in children and teens, 98
in infants and toddlers, 92–93 in infants and toddlers, 96–97
Mean corpuscular volume Newborns
in children, teens, and young amikacin dosing for, 138
adults, 94 ammonia levels in, 73
in infants and toddlers, 92–93 amylase levels in, 73
Mean platelet volume (MPV) in arterial blood gases in, 74
children, teens, and young aspartate aminotransferase (AST)
adults, 95 levels in, 74
Mean stretched penile length, 55–56 bilirubin (total and conjugated)
Measles, mumps, rubella (MMR) vac- levels in, 74
cine, 161, 162, 163, 166 blood analytes for, 83–84
Meningococcal B vaccine, 161, 163, 167 blood pressure nomograms, 59–63
Meningococcal (MenACWY-D) vaccine, calcium (total and ionized) levels
161, 162, 163 in, 74, 75
Methemoglobin, 79 C-reactive protein levels in, 75
Microlipid, 116 creatine kinase levels in, 75
Mid-upper arm circumference, 41 creatinine (enzymatic) levels in, 76
in boys, 42–43 digoxin dosing for, 153
in girls, 44–45 endotracheal tube size and depth of
in pediatric malnutrition insertion for, 135
indicators, 46
180 Index
Newborns (continued) vancomycin dosing for, 144

enoxaparin dosing for, 155 vitamin A (retinol) levels in, 82
ferritin levels in, 76 vitamin B1 (thiamine) levels in, 82
folate levels in, 76 vitamin B2 (riboflavin) levels in, 82
fosphenytoin dosing for, 146 vitamin B12 (cobalamin) levels in, 82
gentamicin dosing for, 140 vitamin C (ascorbic acid) levels
glucose levels in, 77 in, 82
γ-glutamyltransferase (GGT) levels vitamin D (total) (25-hydroxyvitamin
in, 77 D) levels in, 83
growth curve of, 21–26, 32–39 vitamin E (tocopherol) levels in, 83
haptoglobin levels in, 77 warfarin dosing for, 156
hematology values in, 92–93 zinc levels in, 83
hemoglobin F levels in, 77 Nomograms
iron levels in, 78 acetaminophen toxicity, 158
lactate (serum) levels in, 78 blood pressure, 59–63
lactate dehydrogenase (LDH) levels exchange transfusion, 111
in, 78 hyperbilirubinemia risk, 109
levetiracetam (Keppra) dosing for, phototherapy, 110
148 Nonsmokers, carbon monoxide
lipase levels in, 78 (carboxyhemoglobin) levels
lymphocyte subset counts in periph- in, 75
eral blood in, 99–101 Normoblasts
magnesium levels in, 79 in infants and toddlers, 96–97
methemoglobin levels in, 79 NPASS. See Neonatal, Pain, Agitation,
osmolality (serum or plasma) levels and Sedation Scale (NPASS)
in, 79 Nutrition
phenobarbital dosing for, 150 amino acid–based formulas, 119,
phosphate levels in, 79 121, 124
potassium levels in, 80 “blenderized” formulas, 120, 123
prealbumin levels in, 80 calorie concentration and prepara-
preterm (See Preterm infants) tion of formulas, 115
protein electrophoresis in, 80 common electrolyte additives, 125
pyruvate levels in, 81 composition of fluids for oral rehy-
rheumatoid factor (RF) levels in, 81 dration, 125
sodium levels in, 81 cow’s milk–based formulas, 118,
thyroid function values in, 86 120, 122
tobramycin dosing for, 142 dietary reference intakes (DRIs),
triglyceride levels in, 81 126–129
troponin I levels in, 82 enteral formulas, 117–124
urea nitrogen (BUN) levels in, 82 fluid needs by weight, 125
uric acid levels in, 82
Index 181
fluoride sources and supplementa- Phosphate, 79

tion, 130 Phototherapy nomogram, 110
human milk, 117 Platelets
modular supplements in formula, in children, teens, and young
116 adults, 95
partially hydrolyzed formulas, 119 in infants and toddlers, 92–93
preterm formulas, 117 Pneumococcal conjugate (PCV13) vac-
renal formulas, 124 cine, 161, 162, 163, 165
semi-elemental hydrolyzed formu- Pneumococcal polysaccharide
las, 121, 123 (PPSV23) vaccine, 161, 163
soy-based formulas, 115, 118, 120 Potassium, 80
toddler transitional formulas, 120 Powdered formula, 115
Prader-Willi syndrome, 31
O Prealbumin, 80
Oral rehydration fluids, 125 Preterm infants
Osmolality (serum or plasma), 79 blood pressure nomograms for, 63
calculated, 113 cerebrospinal fluid levels in, 70–71
coagulation values in, 102–104
P Fenton growth charts for, 21–22
Pain/agitation, assessment of, 11, 12–13 formulas for, 117–118
Pain scales, 10–17 protein electrophoresis in, 80
FLACC, 10 thyroid function values in, 87
Neonatal, Pain, Agitation, and Primary teeth eruption chart, 57
Sedation Scale (NPASS), Protein
11–15 dietary reference intakes (DRIs)
Pediatric Early Warning Score for, 126
(PEWS), 16–17 Liquid, 116
Wong-Baker FACES Pain Rating modular supplements in formula,
Scale, 10 116
Paralysis/neuromuscular blockade, Protein electrophoresis, 80
assessment of, 13 Pulse, APGAR score, 7
Partially hydrolyzed formulas, 119 Pyruvate, 81
Pediatric Early Warning Score (PEWS),
16–17 R
Pediatric malnutrition indicators, 46 Rabies guidelines, 159
PediTools, 31, 41 Rate and gap calculations, 113
Penile length, 55–56 Red blood cells
PEWS. See Pediatric Early Warning in children, teens, and young
Score (PEWS) adults, 94
Phenobarbital, 150–151 in infants and toddlers, 92–93
182 Index
Red cell distribution (RDW) in Sedation, assessment of, 11, 12

children, teens, and young Semi-elemental hydrolyzed formulas
adults, 94 for older children and adults, 123
Reference range values, laboratory, 69–71 for toddlers and young children,
age-specific leukocyte differential, 121
96–98 17α-hydroxyprogesterone, 91
cerebrospinal fluid, 70–71 Shoulder-umbilical length used to
clinical chemistry, 73–84 measure umbilical artery
coagulation values, 102–108 catheter length, 133
cortisol, 91 Shoulder-umbilical length used to mea-
growth hormones, 87–91 sure umbilical vein catheter
hematology, 92–95 length, 134
insulin-like growth factor, 88–90 Smokers, carbon monoxide (carboxy-
lymphocyte subset counts in periph- hemoglobin) levels in, 75
eral blood, 99–101 Sodium, 81
17α-hydroxyprogesterone, 91 Soy-based formulas, 115
thyroid function values, 86–87 for infants, 118
Renal formulas, 124 for toddlers and young children,
Respiration 120
APGAR score, 7 Stature-for-age and weight-for-age
croup score, 18 percentiles
Pediatric Early Warning Score boys, 27
(PEWS), 16–17 girls, 29
Reticulocytes
in infants and toddlers, 92–93 T
Retinol, 82 Table salt, 125
Rheumatoid factor (RF), 81 Teeth eruption chart, 57
Riboflavin, 82 Temperature conversions, 1
Rotavirus vaccine, 161, 162, 163, 164 Tetanus, diphtheria, and acellular
Rubinstein-Taybi syndrome, 31 pertussis (Tdap) vaccine,
161, 162, 163, 167
S Thiamine, 82
Salt, 125 Thyroid function values, 86–87
Scales and scoring, 7–18 Thyroid-stimulating hormone (TSH),
APGAR, 7 86–87
croup score, 18 Thyroxine, 86–87
Glasgow Coma Scale, 17–18 Tobramycin, 142–143
maturational assessment of gesta- Tocopherol, 83
tional age, 8–9
pain, 10–17
Index 183
Toddlers Vital signs, NPASS, 11, 15

dietary reference intakes (DRIs) Vitamin A (retinol), 82
for, 126 Vitamin B1 (thiamine), 82
formulas for young children and, Vitamin B2 (riboflavin), 82
120–121 Vitamin B12 (cobalamin), 82
Toddler transitional formulas, 120 Vitamin C (ascorbic acid), 82
Total iron-binding capacity (TIBC), 81 Vitamin D (total) (25-hydroxyvitamin
Transferrin, 81 D), 83
Triglycerides, 81 Vitamin E (tocopherol), 83
Triiodothyronine, 86
Trisomy 21 syndrome, 31 W
Troponin I, 82 Warfarin, 156
Turner syndrome, 31 Weight
25-hydroxyvitamin D, 83 conversions, 1, 3–5
growth charts, 20
U and height for children with cere-
Umbilical vein and artery catheteriza- bral palsy, 40
tion measurements in pediatric malnutrition indica-
using birth weight to measure cathe- tors, 46
ter length in, 131–132 Weight-for-age percentiles
using shoulder-umbilical length to boys, 24, 32
measure umbilical artery girls, 26, 36
catheter length, 133 Weight-for-length percentiles
using shoulder-umbilical length boys with Down syndrome, 35
to measure umbilical vein girls with Down syndrome, 39
catheter length, 134 White blood cells
Upper arm length, 48 in children, teens, and young
Urea nitrogen (BUN), 82 adults, 95
Uric acid, 82 in infants and toddlers, 92–93
Williams syndrome, 31
V Wong-Baker FACES Pain Rating Scale,
Valproic acid and derivatives, 152 10
Vancomycin, 144–145
Varicella (VAR) vaccine, 161, 162, 163, Z
166 Zinc, 83
Verbal response, Glasgow Coma Scale,
17
Recommendations for Preventive Pediatric Health Care
Bright Futures/American Academy of Pediatrics
Each child and family is unique; therefore, these Recommendations for Preventive Pediatric Health These recommendations represent a consensus by the American Academy of Pediatrics (AAP) The recommendations in this statement do not indicate an exclusive course of treatment or standard
Care are designed for the care of children who are receiving competent parenting, have no and Bright Futures. The AAP continues to emphasize the great importance of continuity of care of medical care. Variations, taking into account individual circumstances, may be appropriate.
manifestations of any important health problems, and are growing and developing in a satisfactory in comprehensive health supervision and the need to avoid fragmentation of care. Copyright © 2019 by the American Academy of Pediatrics, updated March 2019.
fashion. Developmental, psychosocial, and chronic disease issues for children and adolescents may Refer to the specific guidance by age as listed in the Bright Futures Guidelines (Hagan JF, Shaw JS, No part of this statement may be reproduced in any form or by any means without prior written
require frequent counseling and treatment visits separate from preventive care visits. Additional Duncan PM, eds. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents. permission from the American Academy of Pediatrics except for one copy for personal use.
visits also may become necessary if circumstances suggest variations from normal. 4th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2017).
INFANCY EARLY CHILDHOOD MIDDLE CHILDHOOD ADOLESCENCE

AGE1 Prenatal2 Newborn3 3-5 d4 By 1 mo 2 mo 4 mo 6 mo 9 mo 12 mo 15 mo 18 mo 24 mo 30 mo 3y 4y 5y 6y 7y 8y 9y 10 y 11 y 12 y 13 y 14 y 15 y 16 y 17 y 18 y 19 y 20 y 21 y
HISTORY
Initial/Interval l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
MEASUREMENTS
Length/Height and Weight l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
Head Circumference l l l l l l l l l l l
Weight for Length l l l l l l l l l l
Body Mass Index5 l l l l l l l l l l l l l l l l l l l l l
Blood Pressure6 ê ê ê ê ê ê ê ê ê ê ê ê l l l l l l l l l l l l l l l l l l l
SENSORY SCREENING
Vision7 ê ê ê ê ê ê ê ê ê ê ê ê l l l l ê l ê l ê l ê ê l ê ê ê ê ê ê
Hearing l8

l9

ê ê ê ê ê ê ê ê ê l l l ê l ê l l10 l l
DEVELOPMENTAL/BEHAVIORAL HEALTH
Developmental Screening11 l l l
Autism Spectrum Disorder Screening12 l l
Developmental Surveillance l l l l l l l l l l l l l l l l l l l l l l l l l l l l
Psychosocial/Behavioral Assessment13 l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
Tobacco, Alcohol, or Drug Use Assessment 14
ê ê ê ê ê ê ê ê ê ê ê
Depression Screening15 l l l l l l l l l l
Maternal Depression Screening16 l l l l
PHYSICAL EXAMINATION 17
l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
PROCEDURES18
Newborn Blood l19

l20

Newborn Bilirubin21 l
Critical Congenital Heart Defect22 l
Immunization23 l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
Anemia24 ê l ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê
Lead25 ê ê l or ê26 ê l or ê26 ê ê ê ê
Tuberculosis27 ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê
Dyslipidemia28 ê ê ê ê l ê ê ê ê ê l
Sexually Transmitted Infections29 ê ê ê ê ê ê ê ê ê ê ê
HIV30 ê ê ê ê l ê ê ê
Cervical Dysplasia31 l
ORAL HEALTH 32

l33

l 33 ê ê ê ê ê ê ê ê
Fluoride Varnish34 l
Fluoride Supplementation35 ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê ê
ANTICIPATORY GUIDANCE l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l l
1. If a child comes under care for the first time at any point on the schedule, or if any items are not accomplished at the 6. Screening should occur per “Clinical Practice Guideline for Screening and Management of High Blood Pressure in 12. Screening should occur per “Identification and Evaluation of Children With Autism Spectrum Disorders”
suggested age, the schedule should be brought up-to-date at the earliest possible time. Children and Adolescents” (http://pediatrics.aappublications.org/content/140/3/e20171904). Blood pressure (http://pediatrics.aappublications.org/content/120/5/1183.full).
measurement in infants and children with specific risk conditions should be performed at visits before age 3 years.
2. A prenatal visit is recommended for parents who are at high risk, for first-time parents, and for those who request a 13. This assessment should be family centered and may include an assessment of child social-emotional health, caregiver
conference. The prenatal visit should include anticipatory guidance, pertinent medical history, and a discussion of 7. A visual acuity screen is recommended at ages 4 and 5 years, as well as in cooperative 3-year-olds. Instrument-based depression, and social determinants of health. See “Promoting Optimal Development: Screening for Behavioral and
benefits of breastfeeding and planned method of feeding, per “The Prenatal Visit” (http://pediatrics.aappublications.org/ screening may be used to assess risk at ages 12 and 24 months, in addition to the well visits at 3 through 5 years of age. Emotional Problems” (http://pediatrics.aappublications.org/content/135/2/384) and “Poverty and Child Health in the
content/124/4/1227.full). See “Visual System Assessment in Infants, Children, and Young Adults by Pediatricians” (http://pediatrics.aappublications. United States” (http://pediatrics.aappublications.org/content/137/4/e20160339).
org/content/137/1/e20153596) and “Procedures for the Evaluation of the Visual System by Pediatricians”
3. Newborns should have an evaluation after birth, and breastfeeding should be encouraged (and instruction and support 14. A recommended assessment tool is available at http://www.ceasar-boston.org/CRAFFT/index.php.
(http://pediatrics.aappublications.org/content/137/1/e20153597).
should be offered).
15. Recommended screening using the Patient Health Questionnaire (PHQ)-2 or other tools available in the GLAD-PC
8. Confirm initial screen was completed, verify results, and follow up, as appropriate. Newborns should be screened,
4. Newborns should have an evaluation within 3 to 5 days of birth and within 48 to 72 hours after discharge from the toolkit and at http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Documents/MH_
per “Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs”
hospital to include evaluation for feeding and jaundice. Breastfeeding newborns should receive formal breastfeeding ScreeningChart.pdf. )
(http://pediatrics.aappublications.org/content/120/4/898.full).
evaluation, and their mothers should receive encouragement and instruction, as recommended in “Breastfeeding and
16. Screening should occur per “Incorporating Recognition and Management of Perinatal and Postpartum Depression Into
the Use of Human Milk” (http://pediatrics.aappublications.org/content/129/3/e827.full). Newborns discharged less than 9. Verify results as soon as possible, and follow up, as appropriate.
Pediatric Practice” (http://pediatrics.aappublications.org/content/126/5/1032).
48 hours after delivery must be examined within 48 hours of discharge, per “Hospital Stay for Healthy Term Newborns”
10. Screen with audiometry including 6,000 and 8,000 Hz high frequencies once between 11 and 14 years, once between
(http://pediatrics.aappublications.org/content/125/2/405.full). 17. At each visit, age-appropriate physical examination is essential, with infant totally unclothed and older children
15 and 17 years, and once between 18 and 21 years. See “The Sensitivity of Adolescent Hearing Screens Significantly
undressed and suitably draped. See “Use of Chaperones During the Physical Examination of the Pediatric Patient”
5. Screen, per “Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child Improves by Adding High Frequencies” (http://www.jahonline.org/article/S1054-139X(16)00048-3/fulltext).
(http://pediatrics.aappublications.org/content/127/5/991.full).
and Adolescent Overweight and Obesity: Summary Report” (http://pediatrics.aappublications.org/content/120/
11. See “Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for
Supplement_4/S164.full). 18. These may be modified, depending on entry point into schedule and individual need.
Developmental Surveillance and Screening” (http://pediatrics.aappublications.org/content/118/1/405.full). (continued)
BFNC 2019.PSMAR
KEY: l = to be performed ê = risk assessment to be performed with appropriate action to follow, if positive l = range during which a service may be provided 3-351/0319
(continued)
19. Confirm initial screen was accomplished, verify results, and follow up, as appropriate. 28. See “Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children
The Recommended Uniform Screening Panel (https://www.hrsa.gov/advisory- and Adolescents” (http://www.nhlbi.nih.gov/guidelines/cvd_ped/index.htm).
committees/heritable-disorders/rusp/index.html), as determined by The Secretary’s
29. Adolescents should be screened for sexually transmitted infections (STIs) per
Advisory Committee on Heritable Disorders in Newborns and Children, and state
recommendations in the current edition of the AAP Red Book: Report of the
newborn screening laws/regulations (http://genes-r-us.uthscsa.edu/home) establish
Committee on Infectious Diseases.
the criteria for and coverage of newborn screening procedures and programs.
30. Adolescents should be screened for HIV according to the USPSTF recommendations
20. Verify results as soon as possible, and follow up, as appropriate.
(http://www.uspreventiveservicestaskforce.org/uspstf/uspshivi.htm) once between
21. Confirm initial screening was accomplished, verify results, and follow up, the ages of 15 and 18, making every effort to preserve confidentiality of the
as appropriate. See “Hyperbilirubinemia in the Newborn Infant ≥35 Weeks’ adolescent. Those at increased risk of HIV infection, including those who are sexually
Gestation: An Update With Clarifications” (http://pediatrics.aappublications.org/ active, participate in injection drug use, or are being tested for other STIs, should be
content/124/4/1193). tested for HIV and reassessed annually.
22. Screening for critical congenital heart disease using pulse oximetry should be 31. See USPSTF recommendations (http://www.uspreventiveservicestaskforce.org/
performed in newborns, after 24 hours of age, before discharge from the hospital, uspstf/uspscerv.htm). Indications for pelvic examinations prior to age 21 are noted in
per “Endorsement of Health and Human Services Recommendation for Pulse “Gynecologic Examination for Adolescents in the Pediatric Office Setting”
Oximetry Screening for Critical Congenital Heart Disease” (http://pediatrics. (http://pediatrics.aappublications.org/content/126/3/583.full).
aappublications.org/content/129/1/190.full).
32. Assess whether the child has a dental home. If no dental home is identified, perform
23. Schedules, per the AAP Committee on Infectious Diseases, are available at a risk assessment (http://www2.aap.org/oralhealth/docs/RiskAssessmentTool.pdf )
http://redbook.solutions.aap.org/SS/Immunization_Schedules.aspx. Every visit and refer to a dental home. Recommend brushing with fluoride toothpaste in the
should be an opportunity to update and complete a child’s immunizations. proper dosage for age. See “Maintaining and Improving the Oral Health of Young
Children” (http://pediatrics.aappublications.org/content/134/6/1224).
24. Perform risk assessment or screening, as appropriate, per recommendations in
the current edition of the AAP Pediatric Nutrition: Policy of the American Academy 33. Perform a risk assessment (http://www2.aap.org/oralhealth/docs/
of Pediatrics (Iron chapter). RiskAssessmentTool.pdf). See “Maintaining and Improving the Oral Health of
Young Children” (http://pediatrics.aappublications.org/content/134/6/1224).
25. For children at risk of lead exposure, see “Prevention of Childhood Lead Toxicity”
(http://pediatrics.aappublications.org/content/138/1/e20161493) and “Low 34. See USPSTF recommendations (http://www.uspreventiveservicestaskforce.org/
Level Lead Exposure Harms Children: A Renewed Call for Primary Prevention” uspstf/uspsdnch.htm). Once teeth are present, fluoride varnish may be applied
(http://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_030712.pdf ). to all children every 3–6 months in the primary care or dental office. Indications
for fluoride use are noted in “Fluoride Use in Caries Prevention in the Primary Care
26. Perform risk assessments or screenings as appropriate, based on universal screening
Setting” (http://pediatrics.aappublications.org/content/134/3/626).
requirements for patients with Medicaid or in high prevalence areas.
35. If primary water source is deficient in fluoride, consider oral fluoride supplementation.
27. Tuberculosis testing per recommendations of the AAP Committee on Infectious
See “Fluoride Use in Caries Prevention in the Primary Care Setting” (http://pediatrics.
Diseases, published in the current edition of the AAP Red Book: Report of the
aappublications.org/content/134/3/626).
Committee on Infectious Diseases. Testing should be performed on recognition
of high-risk factors.
Summary of Changes Made to the

Bright Futures/AAP Recommendations for Preventive Pediatric Health Care
(Periodicity Schedule)
This schedule reflects changes approved in December 2018 and published in March 2019.
For updates and a list of previous changes made, visit www.aap.org/periodicityschedule.
CHANGES MADE IN DECEMBER 2018
BLOOD PRESSURE
• Footnote 6 has been updated to read as follows: “Screening should occur per ‘Clinical Practice Guideline for Screening and Management
of High Blood Pressure in Children and Adolescents’ (http://pediatrics.aappublications.org/content/140/3/e20171904). Blood pressure
measurement in infants and children with specific risk conditions should be performed at visits before age 3 years.”
ANEMIA
• Footnote 24 has been updated to read as follows: “Perform risk assessment or screening, as appropriate, per recommendations in the
current edition of the AAP Pediatric Nutrition: Policy of the American Academy of Pediatrics (Iron chapter).”
LEAD
• Footnote 25 has been updated to read as follows: “For children at risk of lead exposure, see ‘Prevention of Childhood Lead Toxicity’
(http://pediatrics.aappublications.org/content/138/1/e20161493) and ‘Low Level Lead Exposure Harms Children:
A Renewed Call for Primary Prevention’ (https://www.cdc.gov/nceh/lead/ACCLPP/Final_Document_030712.pdf ).”
This program is supported by the Health Resources and

Services Administration (HRSA) of the U.S. Department of
Health and Human Services (HHS) as part of an award totaling
$5,000,000 with 10 percent financed with non-governmental
sources. The contents are those of the author(s) and do not
necessarily represent the official views of, nor an endorsement, by
HRSA, HHS, or the U.S. Government. For more information,
please visit HRSA.gov.
for Pediatric Care Reference
Range Values
2nd Edition
Editor: • Growth hormone values

• Hematology values
Lamia Soghier, MD, MEd, FAAP Includes
• Lymphocyte subset counts
for Pediatric Care

Contributing editors: • Nutrition, formula French
preparation, and caloric catheter scale
intake values sample
• Rate and gap calculations
Completely revised, the second edition of this • Thyroid function
quick-access resource provides commonly • Umbilical vein and artery catheterization 2ND EDITION
used ranges and values spanning birth through measurements
young adulthood. Data needed for treatment • And more...
of preterm and other newborns is highlighted
Assessment and management
throughout.
2ND EDITION
tools you’ll use again and again
New in the second edition Save time and simplify clinical problem-
• Expanded sections on antibiotics and anti- solving with a full set of easy-to-use tools.
convulsant medications and other commonly • APGAR and New Ballard newborn scoring
used drugs with recommended serum drug • Blood pressure nomograms
target levels. • Glucose infusion rate calculators
• Preterm and neonatal populations are high-
Soghier • Fratantoni • Reyes

• Growth charts
lighted to assist pediatricians responsible for • Hyperbilirubinemia management charts
complex dosing for this age-group. • Metric conversion tables
• Updated reference ranges for nutritional • Pain scales
requirements for growing infants, toddlers, • American Academy of Pediatrics schedules
children, and adolescents. including
Look here for practice-focused —Immunization schedules
help with —Periodicity schedule
• Blood pressure ranges
• Body surface area calculation For other pediatric resources,
• Bone age metrics visit the American Academy of
• Cerebrospinal fluid values Pediatrics at shop.aap.org.
• Clinical chemistry values
• Dosages and levels of common antibiotics
and antiseizure medications
ISBN 978-1-61002-280-4 Lamia Soghier, MD, MEd, FAAP

90000> AAP Editor
9 781610 022804 Contributing Editors

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Published by the American Academy of Pediatrics

The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians,

Christine Reyes, MD, FCAP

Laura Leathers, PharmD, BCPPS

Sara Rooney, PharmD, BCPS, BCPPS

Victoria C. Snelgrove, RD, LD, CNSC, CLC

2. Scales and Scoring.........................................................................7

CDC 2 to 20 Years: Boys—Stature-for-age and

Pediatric Malnutrition Indicators......................................................... 46

5. Laboratory Reference Range Values..........................................69

7. Rate and Gap Calculations........................................................113

8. Nutrition and Formula Information.........................................115

9. Umbilical Vein and Artery ­Catheterization Measurements....131

10. Endotracheal Tube Size and Depth of Insertion...................135

11. Doses and Levels of C ­ ommon ­Medications

Catch-up Immunization Schedule for Persons

As we strive to improve the health of all children, we hope this

Lamia M. Soghier, MD, MEd, FAAP

Fahrenheit to Celsius Conversion

Reference Range Values for Pediatric Care

Pulse Absent <100 beats/min >100 beats/min

Severely depressed 0–3

Moderately depressed 4–6

Excellent condition 7–10

AGE WHEN EXAMINED

40-50 mm: 1 transverse

lids fused lids open sl. curved well-curved formed

GENITALS testes in testes testes

© 1983 Wong-Baker FACES Foundation. www.WongBakerFACES.org. Used with permission.

FLACC Pain Scale

Scales and Scoring

Neonatal Pain, Agitation, and Sedation Scale (NPASS) (continued)

• More frequent pain assessment indications are

Neonatal Pain, Agitation, and Sedation Scale (NPASS) (continued)

Pediatric Early Warning Score (PEWS)

Pediatric Early Warning Score (PEWS) (continued)

Abbreviations: Fio2, fraction of inspired oxygen; neb, nebulization.

GLASGOW COMA SCALE

Glasgow Coma Scale for Children (continued)

Alternative (Mosteller’s formula)

Nomogram and equation to determine body surface area.

Abbreviation: NA, not applicable.

Abbreviation: WHO, World Health Organization.

Pediatric Nutrition, 7th Edition

22 Reference Range Values for Pediatric Care

Abbreviation: WHO, World Health Organization.

WHO Birth to 24 Months: Boys

Abbreviations: circ., circumference; WHO, World Health Organization.

WHO Birth to 24 Months: Boys

Abbreviations: circ., circumference; WHO, World Health Organization.

WHO Birth to 24 Months: Girls

Abbreviations: circ., circumference; WHO, World Health Organization.

WHO Birth to 24 Months: Girls

Abbreviations: circ., circumference; WHO, World Health Organization.

CDC 2 to 20 Years: Boys

CDC 2 to 20 Years: Boys

Date Age Weight Stature BMI* Comments

CDC 2 to 20 Years: Girls

CDC 2 to 20 Years: Girls

GROWTH CHARTS FOR CHILDREN WITH SPECIAL HEALTH

Abbreviation: circ., circumference.

Abbreviation: circ., circumference.

9. Umbilical Vein and Artery Catheterization Measurements....131

11. Doses and Levels of C ommon Medications

40-50 mm: 1 transverse