What is the first drug of choice for a child in symptomatic bradycardia?

In cases of symptomatic bradycardia in children, the first drug of choice is atropine. Atropine works by inhibiting the effects of the vagus nerve on the heart, which increases heart rate by blocking the action of acetylcholine at parasympathetic sites in smooth muscle and secretory glands. It is particularly effective in increasing heart rate in children who exhibit signs of poor perfusion due to bradycardia.

While epinephrine and dopamine can be used in other emergency situations such as severe bradycardia (especially if the child is not responding to atropine or if there is an underlying condition that requires further intervention), they are not the first-line treatment for symptomatic bradycardia. Aspirin is not indicated in this scenario, as it is primarily used for its antiplatelet effects and is not a treatment for bradycardia.

Atropine remains the cornerstone of therapy because it specifically targets the mechanism of bradycardia and is effective in restoring a more appropriate heart rate quickly, making it critical in the acute management of the condition.