What is the recommended dosage of paracetamol (acetaminophen) for pediatric patients?

Recommended Paracetamol (Acetaminophen) Dosage for Pediatric Patients

The recommended paracetamol dosage for pediatric patients is 10-15 mg/kg per dose every 4-6 hours, not to exceed 5 doses in 24 hours, with children under 2 years requiring physician consultation. 1

Age-Based Dosing Guidelines

Infants and Young Children

• Children under 2 years of age: Consult a physician for appropriate dosing 1
• Children 2 to under 4 years: 5 mL (160 mg) every 4 hours, maximum 5 doses in 24 hours 1
• Children 4 to under 6 years: 7.5 mL (240 mg) every 4 hours, maximum 5 doses in 24 hours 1

Older Children

• Children 6 to under 12 years: 10.15 mL (325 mg) every 4 hours, maximum 5 doses in 24 hours 1
• Children 12 years and older: 20.3 mL (650 mg) every 4-6 hours, maximum 6 doses in 24 hours 1

Weight-Based Dosing

Weight-based dosing is more accurate than age-based dosing and should be used whenever possible:

• Standard dose: 10-15 mg/kg/dose every 4-6 hours 2, 3
• Maximum daily dose: Should not exceed 75 mg/kg/day 4
• Toxic threshold: Doses exceeding 75 mg/kg/day for more than 2 days may cause liver injury 4

Safety Considerations

Dosing Precautions

• Never exceed 5 doses in a 24-hour period for children under 12 years 1
• Never exceed 6 doses in a 24-hour period for children 12 years and older 1
• Avoid cumulative doses exceeding 75 mg/kg/day to prevent hepatotoxicity 4

Warning Signs of Toxicity

• Monitor for signs of liver injury when doses exceed 75 mg/kg/day for ≥2 days 4
• Signs of toxicity include:
  • Vomiting
  • Right upper quadrant abdominal pain
  • Jaundice
  • Elevated liver transaminases

Special Populations

Neonates and Infants Under 3 Months

• Limited data exists for this age group 5
• For infants 1-3 months, some literature suggests 60-65 mg/kg/day divided into multiple doses 5
• For neonates in first 2 weeks, approximately 30 mg/kg/day has been reported to achieve therapeutic concentrations 5
• Always consult with a pediatrician before administering paracetamol to infants under 3 months

Clinical Application

1. Calculate the child's weight in kilograms
2. Determine the appropriate dose (10-15 mg/kg)
3. Ensure the total daily dose does not exceed 75 mg/kg/day
4. Administer at appropriate intervals (every 4-6 hours)
5. Do not exceed the maximum number of doses per day

Common Pitfalls to Avoid

• Using age-based dosing when weight-based dosing is available
• Exceeding the maximum daily dose
• Continuing treatment beyond 2-3 days without medical reassessment
• Failing to account for paracetamol in combination medications
• Using adult formulations without proper dose adjustment for children

By following these guidelines, clinicians can safely and effectively administer paracetamol to pediatric patients for pain relief and fever reduction while minimizing the risk of adverse effects.