Paracetamol Dosing for a 20 kg Child
For a 20 kg child, the recommended paracetamol (acetaminophen) dose is 10-15 mg/kg every 4-6 hours, which equals 200-300 mg per dose, with a maximum of 4 doses per day. 1, 2
Dosing Guidelines
- The optimal single dose range for paracetamol in children is 10-15 mg/kg given at 4-hour intervals 2
- For a 20 kg child, this translates to 200-300 mg per dose 1
- Maximum daily dosage should not exceed 60 mg/kg/day, which would be 1200 mg for a 20 kg child 3
- Dosing frequency should be limited to every 4-6 hours, with no more than 4 doses in 24 hours 1
Administration Routes
- Oral route: Preferred for routine fever and pain management 3
- Effervescent or liquid formulations may provide faster onset of action compared to conventional tablets 3
- Rectal route can be used when oral administration is not possible, but absorption is slower and more irregular 3
Safety Considerations
- Warning: Single ingestions exceeding 10 times the recommended dose (>100-150 mg/kg) are potentially toxic 1
- Chronic overdosing at >140 mg/kg/day for several days carries risk of serious hepatotoxicity 1
- Paracetamol is generally well-tolerated when used at recommended doses 1
- Pharmacy and nursing staff should verify doses to prevent inadvertent overdosing 4
Clinical Pearls
- Paracetamol remains the first-line choice for both fever and pain management in children 1
- There is no direct correlation between serum concentrations and analgesic or antipyretic effect 3
- For optimal antipyretic effect, some studies suggest a loading dose of 25 mg/kg (500 mg for a 20 kg child) followed by maintenance doses of 12.5 mg/kg (250 mg) every 6 hours 5
- When treating fever associated with discomfort, paracetamol offers effective symptom relief 1
Common Pitfalls to Avoid
- Underdosing is common in clinical practice, which may lead to inadequate pain or fever control 2, 5
- Using age-based rather than weight-based dosing can lead to inaccurate dosing 2
- Failing to account for all sources of paracetamol (including combination products) can lead to unintentional overdosing 4
- Exceeding the maximum daily dose of 60 mg/kg/day (1200 mg for a 20 kg child) increases risk of hepatotoxicity 3, 4