Maximum Dose of Paracetamol in Children
The maximum daily dose of paracetamol (acetaminophen) in children is 60-75 mg/kg/day, not to exceed 4000 mg per day in older children and adolescents, with single doses typically ranging from 10-15 mg/kg given at 4-6 hour intervals.
Age-Based Dosing Guidelines
Paracetamol dosing should be carefully calculated based on the child's age and weight:
FDA-Approved Dosing 1:
- Children under 2 years: Consult a doctor
- Children 2-4 years: 160 mg (5 mL) every 4 hours, maximum 5 doses (800 mg) in 24 hours
- Children 4-6 years: 240 mg (7.5 mL) every 4 hours, maximum 5 doses (1200 mg) in 24 hours
- Children 6-12 years: 325 mg (10.15 mL) every 4 hours, maximum 5 doses (1625 mg) in 24 hours
- Children 12+ years and adults: 650 mg (20.3 mL) every 4-6 hours, maximum 6 doses (3900 mg) in 24 hours
Weight-Based Dosing
Weight-based dosing is generally more accurate than age-based dosing:
- Single dose: 10-15 mg/kg per dose 2, 3
- Maximum daily dose: 60-75 mg/kg/day, not to exceed 4000 mg daily 4
Important Considerations
Safety Thresholds
- Single ingestions exceeding 150 mg/kg (or 10 times the therapeutic dose) are potentially toxic 2
- Chronic dosing exceeding 90-140 mg/kg/day for several days carries risk of serious hepatotoxicity 2, 5
Route of Administration
- Oral route: Preferred for most children due to reliable absorption and onset of action
- Rectal route: May have slower and more irregular absorption 4
- Intravenous route: Used in hospital settings when oral administration is not possible
Dosing Intervals
- Standard dosing interval is every 4-6 hours
- Do not exceed recommended number of doses in 24 hours (typically 4-5 doses) 1
Common Pitfalls to Avoid
Dosing errors:
- Using household spoons instead of calibrated measuring devices
- Confusing different formulation strengths (infant vs. children's formulations)
- Administering adult doses to children
Combination products:
- Many over-the-counter cold and flu medications contain paracetamol
- Administering multiple products containing paracetamol can lead to unintentional overdose
Prolonged use:
- Extended use at maximum doses without medical supervision increases risk of hepatotoxicity
- Treatment should be limited to the shortest duration necessary
Special Populations
- Neonates and infants under 3 months: Limited data available; consult a healthcare provider for appropriate dosing 5
- Children with hepatic impairment: Paracetamol is contraindicated in those with significant hepatic insufficiency 4
- Children with renal impairment: Generally safe, but may require dosage adjustment in severe cases 4
Remember that while paracetamol is one of the safest analgesics and antipyretics for children when used appropriately, careful attention to dosing is essential to prevent potential hepatotoxicity.