At what temperature should Panadol (acetaminophen) be initiated in a child with fever?

Panadol (Acetaminophen) Initiation for Children with Fever

Panadol (acetaminophen) should be initiated in children when fever reaches 38°C (100.4°F) or higher, not at 100.2°F. 1

Evidence-Based Temperature Threshold

The clinical practice guidelines clearly define fever in children as a temperature of 38°C (100.4°F) or higher. This threshold is consistently referenced throughout the medical literature as the standard definition of fever requiring intervention.

Guidelines Support:

• The American College of Emergency Medicine clinical policy specifically defines fever as "temperature greater than 38°C (>100.4°F)" 1
• Pediatric fever management protocols consistently use 38°C (100.4°F) as the threshold for defining fever 2

Dosing and Administration

When initiating Panadol (acetaminophen) for fever management:

• Dosage: 15 mg/kg per dose 3
• Frequency: Every 4-6 hours, not to exceed recommended daily doses 3
• Age-specific considerations:
  • Children under 2 years: Consult a doctor
  • Children 2-4 years: 5 mL (160 mg) every 4 hours
  • Children 4-6 years: 7.5 mL (240 mg) every 4 hours
  • Children 6-12 years: 10.15 mL (325 mg) every 4 hours 3

Clinical Decision Algorithm

1. Measure temperature accurately:

   • Use rectal temperature as the gold standard for infants and young children 2
   • Confirm fever ≥38°C (100.4°F)

2. Assess for high-risk features:

   • Breathing difficulties
   • Severe earache
   • Vomiting >24 hours
   • Drowsiness
   • Chronic co-morbid disease 1

3. Initiate treatment:

   • For fever ≥38°C (100.4°F) without high-risk features: Panadol (acetaminophen) 15 mg/kg
   • For fever with high-risk features: Consider medical evaluation and possible antibiotic therapy in addition to antipyretics 1

Important Clinical Considerations

Effectiveness

• Paracetamol (acetaminophen) is effective in reducing fever but may be less effective than ibuprofen in some studies 4
• The response to antipyretics does not correlate with the likelihood of serious bacterial infection 1, 5
• Fever reduction with antipyretics does not indicate a lower likelihood of serious bacterial infection 2

Common Pitfalls to Avoid

1. Do not use antipyretic response to guide diagnosis: Multiple studies have consistently found no correlation between fever reduction with antipyretic medication and the likelihood of serious bacterial infection 1, 5

2. Avoid exceeding recommended doses: Studies show that the maximum recommended number of doses is exceeded in 8-11% of children 6

3. Do not use aspirin in children under 16 years due to risk of Reye's syndrome 1

4. Avoid physical cooling methods as they cause discomfort 2

5. Do not initiate treatment below the fever threshold: Treating at 100.2°F rather than waiting for 100.4°F provides no clinical benefit and may lead to unnecessary medication administration

Special Situations

For children with high fever (>38.5°C) and additional risk factors:

• Consider medical evaluation
• Ensure adequate fluid intake to prevent dehydration
• Provide clear return precautions to caregivers 2

For immunocompromised children or those with underlying medical conditions:

• More aggressive evaluation and management may be required
• Lower threshold for medical evaluation 2