Introduction: during medical emergencies in children, accurate and appropriate weight estimations may ultimately influence the outcome by facilitating the delivery of safe and effective doses of medications. Children at the extremes of habitus, especially obese children, are more at risk of an inaccurate weight estimation and therefore may be more at risk of medication errors. The objective was therefore to develop an algorithm to guide accurate emergency weight estimation in obese children.

Methods: relevant medical evidence was reviewed regarding weight estimation and its role and timing in the resuscitation of obese children. This was used as the basis for a weight-estimation algorithm.

Results: there was limited evidence regarding the way the weight-estimation systems should be used in obese children other than that the dual length- and habitus-based systems were the most accurate. The methods included in the algorithm were the Broselow tape, the Mercy method, parental estimates, the paediatric advanced weight prediction in the emergency room/ eXtra Length-eXtra Large (PAWPER XL) tape and the Traub-Johnson formula. The algorithm recognised several ways in which weight estimation could be tailored to the clinical scenario to estimate both ideal and total body weight.

Conclusion: weight-estimation in obese children must be conducted appropriately to avoid medication errors. This algorithm provides a framework to achieve this.