What is the recommended dose of Tylenol (acetaminophen) for a 20kg child?

Acetaminophen Dosing for a 20 kg Child

For a 20 kg child, the recommended dose of Tylenol (acetaminophen) is 10-15 mg/kg, which equals 200-300 mg per dose, given every 4-6 hours as needed, not to exceed 5 doses (60 mg/kg/day) in 24 hours.

Dosing Guidelines

• The standard pediatric dosing range for acetaminophen is 10-15 mg/kg per dose 1, 2
• For a 20 kg child, this translates to:
  • At 10 mg/kg: 200 mg per dose
  • At 15 mg/kg: 300 mg per dose
• Doses can be administered every 4-6 hours as needed 1
• Maximum daily dose should not exceed 60 mg/kg/day (1200 mg for a 20 kg child) 1

Administration Considerations

• Acetaminophen comes in various formulations for children:
  • Liquid/elixir (typically 160 mg/5 mL)
  • Chewable tablets (typically 80 mg or 160 mg)
  • Suppositories (various strengths)
• For liquid formulations, use a proper measuring device (not household spoons) to ensure accurate dosing 3

Efficacy Considerations

• Research suggests that the 15 mg/kg dose may be more effective for achieving therapeutic plasma concentrations (10-20 μg/mL) needed for antipyresis 4
• The 10 mg/kg dose may not consistently reach therapeutic plasma concentrations in all children 4

Safety Considerations

• Acetaminophen is generally safe when used at recommended doses 1
• Toxicity risk increases with doses exceeding 200 mg/kg in a single ingestion 3
• Repeated supratherapeutic ingestions of ≥150 mg/kg/day over 48 hours or ≥100 mg/kg/day over 72 hours can lead to hepatotoxicity 3
• Avoid using adult formulations for children to prevent dosing errors 5

Common Pitfalls to Avoid

• Using age-based rather than weight-based dosing can lead to underdosing or overdosing 4
• Confusion between different formulation strengths (e.g., infant drops vs. children's liquid) can lead to dosing errors 5
• Administering doses more frequently than every 4 hours can lead to toxicity 1
• Simultaneous use of multiple acetaminophen-containing products (including combination cold/flu medications) can lead to unintentional overdose 3

Monitoring

• Monitor for effectiveness in reducing fever or pain
• Watch for any signs of adverse effects, though these are rare at therapeutic doses 1
• If symptoms persist despite appropriate dosing, consult a healthcare provider

Remember that acetaminophen is an effective and safe medication for children when used at appropriate doses based on the child's weight.