Pediatric Paracetamol (Acetaminophen) Dosing Guidelines
The recommended pediatric dose of paracetamol (acetaminophen) is 10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours for most children. 1, 2
Age-Based Dosing Guidelines
- Adults and children 12 years and older: 650 mg every 4-6 hours, not to exceed 6 doses in 24 hours 3
- Children 6 to under 12 years: 325 mg every 4 hours, not to exceed 5 doses in 24 hours 3
- Children 4 to under 6 years: 240 mg every 4 hours, not to exceed 5 doses in 24 hours 3
- Children 2 to under 4 years: 160 mg every 4 hours, not to exceed 5 doses in 24 hours 3
- Children under 2 years: Consult a doctor 3
Weight-Based Dosing
Weight-based dosing is more accurate than age-based dosing and should be preferred when possible:
- Standard dose: 10-15 mg/kg every 4-6 hours 1, 2
- Maximum daily dose: Should not exceed 75 mg/kg/day 4
- Maximum frequency: No more than 5 doses in 24 hours for most children 3
Important Safety Considerations
- Overdose risk: Single ingestions of more than 10 times the recommended dose (>100-150 mg/kg) are potentially toxic 1
- Chronic overdose risk: Exposures greater than 75 mg/kg/day for more than 2 days carry risk of serious hepatotoxicity 4
- Monitoring: Consider checking liver transaminases, coagulation factors, and paracetamol serum concentrations in children who have received >75 mg/kg/day for ≥2 days 4
- Neonates and young infants: Limited pharmacokinetic data exists for infants under 3 months; more conservative dosing is recommended 5
Special Populations
- Infants 1-3 months: Some literature suggests 60-65 mg/kg/day in divided doses, though pharmacokinetic data may support slightly higher doses 5
- Neonates (under 1 month): Limited data suggests 30 mg/kg/day achieves effective therapeutic concentrations 5
Practical Recommendations
- Always calculate doses based on the child's weight rather than age when possible 6
- For pain management, paracetamol can be given at 60 mg/kg/day in four divided doses (15 mg/kg per dose) 6
- When prescribing, specify the daily dose, number of divided doses, duration of therapy, and child's weight 6
- For children with risk factors for hepatotoxicity, consider using lower doses or alternative analgesics 4
Remember that paracetamol remains the first-choice over-the-counter treatment for analgesia and antipyresis in children due to its excellent safety profile when used at appropriate doses 1.