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

Pediatric Dosing of Paracetamol (Acetaminophen)

The recommended pediatric dose of paracetamol (acetaminophen) is 10-15 mg/kg per dose given every 4-6 hours, not to exceed 5 doses in 24 hours for most children. 1

Age-Based Dosing Guidelines

For oral administration, the FDA-approved dosing guidelines are:

• Children 6 to under 12 years: 10.15 mL (325 mg) every 4 hours, not to exceed 5 doses in 24 hours 2
• Children 4 to under 6 years: 7.5 mL (240 mg) every 4 hours, not to exceed 5 doses in 24 hours 2
• Children 2 to under 4 years: 5 mL (160 mg) every 4 hours, not to exceed 5 doses in 24 hours 2
• Children under 2 years: Consult a doctor 2

Weight-Based Dosing

Weight-based dosing is more accurate than age-based dosing and should be prioritized when possible:

• Standard dose: 10-15 mg/kg per dose every 4-6 hours 1, 3
• Maximum daily dose: Should not exceed 60-75 mg/kg/day 1, 4

Important Considerations

1. Avoid overdosing: Single ingestions of more than ten times the recommended dose (>100-150 mg/kg) are potentially toxic 1

2. Risk of chronic overdose: Exposures greater than 140 mg/kg/day for several days carry a risk of serious hepatotoxicity 1

3. Weight considerations: For overweight or obese children, dosing should be calculated using ideal body weight rather than actual weight to prevent inadvertent overdosing 4

4. Documentation: Always document the child's weight when prescribing paracetamol 4

5. Maximum doses:

   • Do not exceed 5 doses in 24 hours for most children 2
   • The maximum daily dose should be limited to 75 mg/kg/day to avoid potential hepatotoxicity 4

Clinical Pearls

• Paracetamol remains the first-line choice for treatment of both fever and pain in children due to its favorable safety profile when used appropriately 1

• When treating fever associated with discomfort, paracetamol offers effective relief 1

• For mild to moderate pain, paracetamol alone or in combination with other analgesics is effective 1

• Careful recording of dose times is essential to avoid accidentally exceeding the maximum recommended dose, especially if combined with other medications containing paracetamol 5

• Many dosing schedules recommend inadequate amounts of paracetamol. Weight-based dosing schedules are more accurate than age-based schedules 3

Common Pitfalls to Avoid

1. Exceeding maximum doses: Studies have shown that the recommended maximum number of doses in 24 hours is exceeded in approximately 8% of children 5

2. Using actual weight in obese children: This can lead to inadvertently high doses; use ideal body weight instead 4

3. Inadequate documentation: Failure to document weight and height can lead to dosing errors 4

4. Ambiguous dosing instructions: Clear instructions should specify the daily dose, frequency, and duration of therapy 6

5. Failure to consider combined sources of paracetamol: Many over-the-counter preparations contain paracetamol, which can lead to unintentional overdosing if multiple products are used simultaneously