In a 2-year-old with bradycardia caused by increased vagal tone, which medication should you administer?

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Bradycardia in a young child caused by increased vagal tone means the heart rate is being slowed by parasympathetic (vagal) influence. The way to reverse this is to block that vagal effect on the heart. Atropine is an anticholinergic medication that blocks muscarinic receptors, removing the parasympathetic brake on the sinoatrial node and allowing the heart to speed up. In a symptomatic 2-year-old, give atropine IV/IO at about 0.02 mg/kg (minimum 0.1 mg, typical initial max around 0.5 mg). If there’s no adequate response, you can escalate with pacing or epinephrine support, but atropine is the first-line choice for vagal bradycardia. Oxygen remains important if hypoxia is present, but it doesn’t directly counteract the vagal mechanism, whereas amiodarone isn’t indicated for this bradycardic scenario.