Conceptual Overview
The Broselow Pediatric Emergency Tape is a length-based resuscitation tool that estimates a child's weight based on their height and provides pre-calculated medication doses, fluid volumes, and equipment sizes for each weight range. Developed by Dr. James Broselow and Robert Luten in the 1980s, it remains one of the most widely used pediatric emergency tools in the world.
The premise is simple: in an emergency, you often don't know a child's weight. Asking a caregiver gives you pounds (which need conversion) or an unreliable guess. Formulas require mental math under pressure. The Broselow tape eliminates the math: lay it next to the child, read the color zone, and all doses and equipment sizes are pre-determined.
How it works: Place the tape alongside the child (head at the red arrow end, read color at the feet). The color zone corresponds to a weight range, which maps to pre-calculated doses for every resuscitation medication and correctly sized equipment. No math required.
The tape is designed for children from birth to approximately 36 kg (roughly age 12). Children who exceed the tape's length should be dosed using standard adult protocols.
Color Zones & Weight Ranges
Each color zone represents a weight range and age approximation. The zones progress from smallest (gray) to largest (green) as the child's length increases.
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| Color Zone | Weight (kg) | Length (cm) | Approximate Age |
|---|---|---|---|
| Gray | 3-5 kg | 46.5-54 cm | Newborn |
| Pink | 6-7 kg | 54-61 cm | ~3-4 months |
| Red | 8-9 kg | 61-70 cm | ~6-9 months |
| Purple | 10-11 kg | 70-80 cm | ~10-12 months |
| Yellow | 12-14 kg | 80-95 cm | ~1-2 years |
| White | 15-18 kg | 95-107 cm | ~3-4 years |
| Blue | 19-22 kg | 107-118 cm | ~5-6 years |
| Orange | 24-28 kg | 118-131 cm | ~7-9 years |
| Green | 30-36 kg | 131-143 cm | ~10-12 years |
Memorize the color order: Gray → Pink → Red → Purple → Yellow → White → Blue → Orange → Green. Smallest to largest. The mnemonic some providers use: "Guys Prefer Red Porsches, Yet Women Buy Orange-Green" — it's not elegant, but it sticks.
Key Medication Doses by Zone
The following table shows critical resuscitation medication doses for each Broselow color zone. These are the doses that are pre-printed on the tape itself.
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| Medication | Gray (3-5 kg) |
Pink (6-7 kg) |
Red (8-9 kg) |
Purple (10-11 kg) |
Yellow (12-14 kg) |
White (15-18 kg) |
|---|---|---|---|---|---|---|
| Epinephrine 0.01 mg/kg (1:10,000) |
0.05 mg 0.5 mL |
0.07 mg 0.7 mL |
0.09 mg 0.9 mL |
0.1 mg 1 mL |
0.13 mg 1.3 mL |
0.17 mg 1.7 mL |
| Atropine 0.02 mg/kg min 0.1 mg |
0.1 mg | 0.14 mg | 0.18 mg | 0.2 mg | 0.26 mg | 0.34 mg |
| Amiodarone 5 mg/kg |
25 mg | 35 mg | 45 mg | 50 mg | 65 mg | 85 mg |
| Adenosine (1st) 0.1 mg/kg |
0.5 mg | 0.7 mg | 0.9 mg | 1 mg | 1.3 mg | 1.7 mg |
| D10W 5 mL/kg |
25 mL | 35 mL | 45 mL | 50 mL | 65 mL | 85 mL |
| NS Bolus 20 mL/kg |
100 mL | 140 mL | 180 mL | 200 mL | 260 mL | 340 mL |
| Defib 2 J/kg |
10 J | 14 J | 18 J | 20 J | 26 J | 34 J |
Reference only: This table provides representative mid-zone doses for educational purposes. During an actual resuscitation, always use the actual Broselow tape (or your institution's color-coded resuscitation system) to determine exact doses. The tape provides doses calculated to the specific weight assigned to each zone.
Equipment Sizing by Zone
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| Equipment | Gray (3-5) |
Pink (6-7) |
Red (8-9) |
Purple (10-11) |
Yellow (12-14) |
White (15-18) |
Blue (19-22) |
|---|---|---|---|---|---|---|---|
| ETT (cuffed) | 3.0 | 3.5 | 3.5 | 4.0 | 4.0 | 4.5 | 5.0 |
| Blade | Miller 0 | Miller 1 | Miller 1 | Miller 1-2 | Miller 2 / Mac 2 | Miller 2 / Mac 2 | Mac 2 |
| LMA | 1 | 1.5 | 1.5 | 2 | 2 | 2.5 | 2.5 |
| OPA | 50 mm | 60 mm | 60 mm | 70 mm | 80 mm | 80 mm | 90 mm |
| Suction | 6-8 Fr | 8 Fr | 8-10 Fr | 10 Fr | 10 Fr | 10-12 Fr | 12 Fr |
| BVM | Infant | Infant | Child | Child | Child | Child | Child/Adult |
| BP Cuff | Neonatal | Infant | Infant | Child | Child | Child | Child/Small Adult |
Broselow-organized equipment carts: Many pediatric EDs and EMS systems use color-coded equipment drawers that match the Broselow zones. When you identify the child's color zone, you pull the matching drawer and everything inside — ETT, blade, LMA, suction catheter, OPA, pre-calculated drug doses — is the correct size. Some systems use color-coded tackle boxes or pouches for prehospital use. This is the gold standard for reducing errors under pressure.
Proper Use of the Broselow Tape
Step-by-Step Application
- Position the child supine on a flat surface. Remove shoes/hats.
- Place the red arrow (or marked end) at the top of the child's head.
- Extend the tape along the child's side to the heel of the foot (not the toes).
- Read the color zone at the child's heel. If the child falls between two zones, use the smaller (lower-weight) zone — it's safer to underdose slightly than overdose.
- Document the color zone and estimated weight on the code sheet.
- Use the tape's printed reference for all doses, equipment sizes, and fluid volumes.
Common Errors
- Measuring to the toes instead of the heel — overestimates length by 2-3 cm
- Not aligning the tape at the top of the head — misalignment shifts the entire zone
- Using the tape on children > 143 cm (36 kg) — these children exceed the tape; use adult dosing
- Rounding up to a larger zone — when in doubt, use the smaller zone
- Not accounting for obesity — length-based estimation assumes a normal body habitus; obese children may be significantly heavier than their length predicts
Broselow and obesity: The Broselow tape underestimates weight in obese children by as much as 20-30%. Studies have shown that in the era of rising childhood obesity, length-based weight estimation is less accurate than it was when the tape was developed. For obese children, consider using actual measured weight (if available) or adjusting doses upward. Some institutions have adopted the Handtevy system as an alternative that accounts for habitus.
Limitations & Alternatives
Known Limitations
- Accuracy: The Broselow tape estimates weight within 10-20% of actual weight in roughly 60-70% of children. Accuracy is highest in the middle zones and decreases at the extremes.
- Obesity bias: Systematically underestimates weight in overweight/obese children (which are increasingly common)
- Population variability: Developed on US population data; may be less accurate in other demographic populations
- Upper limit: Only valid for children up to 143 cm / 36 kg; larger children need adult protocols
- Does not replace clinical judgment: The tape is a starting point, not a substitute for clinical assessment and dose adjustment
Alternative Systems
| System | Method | Strengths |
|---|---|---|
| Handtevy | Age + habitus-based; uses actual weight when available | Accounts for obesity; customizable per institution; digital integration |
| PAWPER XL | Length + habitus score (1-7) | Best documented accuracy; adjusts for body habitus; developed in South Africa |
| Mercy method | Humeral length + mid-arm circumference | Does not require full body length; useful when patient cannot be fully extended |
| Age-based formulas | Weight = (Age × 2) + 8 (or similar) | No equipment needed; quick mental estimation |
The best weight is an actual weight: If you can weigh the child — do it. A measured weight eliminates all estimation error. Many modern stretchers and beds have integrated scales. Even in the ED, laying a child on a scale takes 10 seconds. If the parent says "he was 10 kg at his well-child visit last week," that's good enough. Broselow is for when you truly have NO weight information and can't get one.
Quick Reference
How to Use the Broselow Tape
- Red arrow at top of head
- Extend to heel (not toes)
- Read color zone at feet
- If between zones → use the smaller zone
- Use printed doses and equipment sizes for that zone
Color Zone Order (smallest → largest)
Gray → Pink → Red → Purple → Yellow → White → Blue → Orange → Green
Weight Ranges
- Gray: 3-5 kg (newborn)
- Pink: 6-7 kg (~3-4 months)
- Red: 8-9 kg (~6-9 months)
- Purple: 10-11 kg (~10-12 months)
- Yellow: 12-14 kg (~1-2 years)
- White: 15-18 kg (~3-4 years)
- Blue: 19-22 kg (~5-6 years)
- Orange: 24-28 kg (~7-9 years)
- Green: 30-36 kg (~10-12 years)
Key Reminders
- Does NOT account for obesity — underestimates weight in obese children
- Valid only to 143 cm / 36 kg
- Always use actual weight when available
- Check your institution's tape version — updated periodically
Clinical Pearls
Set up before you need it: During a pediatric resuscitation, someone should Broselow the child within the first 30 seconds — before the first medication is needed. Assign this to a specific team member (often the person at the head or the recorder). Having the color zone identified early means you're pulling the right drawer and pre-drawing medications before they're called for.
Broselow + pre-made syringes = zero math: Many institutions have adopted color-coded, pre-made medication syringes that match Broselow zones. When the child is identified as "Pink zone," you grab the pre-filled syringe labeled "Pink — Epinephrine 0.07 mg" and push it. No calculations, no concentration conversions, no human math error. This is the safest possible system for pediatric resuscitation drug delivery.
Parent-reported weight is acceptable: If a parent says "she weighs 12 kg — we were just at the pediatrician yesterday," that's a valid weight. Caregiver-reported weight (when confident and recent) is more accurate than any estimation method. Don't dismiss it. Document it. Use it. Of course, a parent panicking and guessing "I think about 30 pounds?" is less reliable, but any specific, recent, confident weight report from a caregiver beats Broselow.
References
- Broselow JB, Luten RC. The Broselow Pediatric Emergency Tape. Vital Signs Inc; Updated 2019.
- Ralston M, Hazinski MF, et al. Pediatric Advanced Life Support (PALS) Provider Manual. American Heart Association; 2020.
- Wells M, Goldstein LN, Bentley A, et al. The accuracy of the Broselow tape as a weight estimation tool and a drug-dosing guide: a systematic review and meta-analysis. Resuscitation. 2017;121:9-33.
- Abdel-Rahman SM, Ridge AL. An improved pediatric weight estimation strategy. Open Med Dev J. 2012;4:87-97.
- Wells M, Goldstein LN, Bentley A. The accuracy of emergency weight estimation systems in children — a systematic review and meta-analysis. Int J Emerg Med. 2017;10(1):29.
Medical Disclaimer
- For Educational Purposes Only: This content is intended for educational reference and should not be used for clinical decision-making.
- Not a Substitute for Professional Judgment: Always consult your local protocols, institutional guidelines, and supervising physicians.
- Verify Before Acting: Users are responsible for verifying information through authoritative sources before any clinical application.
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