Sedative (Procedural) Pregnancy: C — crosses placenta; neonatal withdrawal reported

Chloral Hydrate

Brand names: Chloral Elixir Paediatric, Welldorm

Adult dose

Dose: Insomnia: 0.5–1g orally

Route: Oral

Frequency: Once at night

Adult use largely obsolete — primarily used in children for procedural sedation.

Paediatric dose

Dose: 50 mg/kg

Route: Oral or PR

Frequency: Single dose (procedural)

Max: 1000mg

Procedural sedation (EEG, MRI): 50–100mg/kg oral. Max 1g total. Give 30–45 min before procedure. Must be administered in setting with resuscitation capability.

Paediatric weight-based calculator

Patient weight (kg)

Procedural sedation (EEG, MRI): 50–100mg/kg oral. Max 1g total. Give 30–45 min before procedure. Must be administered in setting with resuscitation capability.

Clinical pearls

Must be used in setting with resuscitation equipment and skilled staff
Used for natural-sleep EEG recordings and MRI sedation in children <3 years
Child must be kept awake before procedure (sleep deprivation enhances effect)
Schedule 3 controlled drug in UK — record keeping required
Being superseded by dexmedetomidine and melatonin for procedural sedation

Contraindications

Respiratory depression
Severe hepatic or renal disease
Acute intermittent porphyria
Gastritis (oral route)

Side effects

Respiratory depression
Nausea and vomiting
Paradoxical agitation
Cardiorespiratory depression (overdose)
Gastric irritation

Interactions

CNS depressants (opioids, benzodiazepines) — additive respiratory depression
Warfarin — brief potentiation of anticoagulant effect

Monitoring

SpO2 (continuous monitoring for 2h post-dose)
HR and RR
Level of consciousness
Recovery before discharge

Reference: BNFc; RCPCH/RCR Sedation Guidelines; BNF for Children. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways