What is the initial naloxone dose for pediatric reversal?

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Opioid reversal in children is most reliable when you use a weight-based approach and titrate to effect. The starting bolus of naloxone at 0.1 mg/kg provides enough receptor antagonism to rapidly restore respiratory drive in most pediatric patients without introducing excessive sympathetic stimulation that can accompany larger initial doses. This dose balances efficacy with safety across a wide pediatric weight range.

If the child doesn’t respond adequately, you titrate upward in small increments (often 0.1 mg/kg every 2–3 minutes) until there is clear improvement in ventilation and consciousness. Do not exceed about 2 mg per dose initially, and monitor for re-narcotization because naloxone acts shorter than many opioids. Use the fastest route available (IV if possible; IM or intranasal if IV access isn’t immediate) and provide ongoing supportive care.