Paracetamol (Acetaminophen) Dosing in Children
The recommended dose of paracetamol (acetaminophen) for children is 10-15 mg/kg per dose every 4-6 hours, with a maximum daily dose of 60-75 mg/kg/day, not to exceed 5 doses in 24 hours. 1, 2, 3
Age-Based Dosing Guidelines
| Age | Single Dose | Maximum Frequency | Maximum Daily Doses |
|---|---|---|---|
| Under 2 years | Consult a doctor | - | - |
| 2-4 years | 5 mL (160 mg) | Every 4 hours | 5 doses in 24 hours |
| 4-6 years | 7.5 mL (240 mg) | Every 4 hours | 5 doses in 24 hours |
| 6-12 years | 10.15 mL (325 mg) | Every 4 hours | 5 doses in 24 hours |
| 12+ years and adults | 20.3 mL (650 mg) | Every 4-6 hours | 6 doses in 24 hours |
Weight-Based Dosing
- For more precise dosing, use 10-15 mg/kg per dose 2, 4, 3
- This approach is more accurate than age-based dosing, particularly for children who are underweight or overweight
- For overweight or obese children, calculate dose based on ideal body weight rather than actual weight to prevent overdosing 5
Route of Administration
- Oral administration is preferred and most common
- Rectal administration results in slower and more irregular absorption 3
- Intravenous paracetamol should follow the same weight-based dosing principles but is generally reserved for hospital settings
Safety Considerations
Maximum Daily Dose
- Do not exceed 75 mg/kg/day in children 6
- Higher doses (>75 mg/kg/day) for more than 2 days may cause liver injury 6
- Single doses should not exceed 15 mg/kg to avoid toxicity 2
Warning Signs of Toxicity
- Monitor for signs of liver injury if higher than recommended doses have been given:
- Vomiting
- Right upper quadrant abdominal pain
- Jaundice
- Elevated liver enzymes
High-Risk Scenarios
- Repeated supratherapeutic dosing (>75 mg/kg/day for ≥2 days) significantly increases risk of hepatotoxicity 6
- Single ingestions of more than 10 times the recommended dose are potentially toxic 2
- Chronic overdosing (>140 mg/kg/day for several days) carries risk of serious toxicity 2
Clinical Pearls
- Paracetamol remains the first-line choice for treatment of both fever and pain in children 2
- When used at recommended doses, paracetamol has few side effects and is well tolerated 2
- There is no direct correlation between serum concentrations and analgesic or antipyretic effect 3
- For children under 2 years of age, always consult a doctor before administering paracetamol 1
- Document patient weight for accurate dosing, particularly important for overweight children 5
Remember that while fever alone requires no treatment, paracetamol is appropriate when fever is associated with discomfort or pain 2.