What is the recommended dose of Tylenol (acetaminophen) for pediatric patients?

Pediatric Acetaminophen Dosing

The recommended dosage of acetaminophen (Tylenol) for pediatric patients is 10-15 mg/kg per dose given every 4-6 hours, not to exceed 5 doses (60-75 mg/kg/day) in a 24-hour period. 1, 2

Dosing by Age Group

Infants and Children

• For infants and children, the standard dose is 10-15 mg/kg every 4-6 hours 1
• Maximum daily dose should not exceed 75 mg/kg/day or 4000 mg/day, whichever is less 2
• For fever reduction, a dose of 10-15 mg/kg has been shown to effectively reduce temperature for approximately 4-6 hours 2

Neonates (0-28 days)

• Lower doses are recommended: 10-15 mg/kg every 6-8 hours 3
• Maximum daily dose should not exceed 60 mg/kg/day 3
• Clearance is reduced in neonates due to immature liver function 3

Administration Routes

Oral Administration

• Oral suspension is the preferred formulation for young children who cannot swallow tablets 4
• Oral route shows more consistent response compared to rectal administration 5
• For children 12 years and older, adult formulations may be used according to weight-based dosing 6

Intravenous Administration

• Reserved for situations where oral or rectal routes are contraindicated 3
• Dosing for IV acetaminophen:
  • Neonates: 12.5 mg/kg every 6 hours or 15 mg/kg every 8 hours 3
  • Infants to adolescents: 12.5 mg/kg every 4 hours or 15 mg/kg every 6 hours 3

Clinical Considerations

Efficacy

• A single dose of 10-15 mg/kg provides effective antipyresis and analgesia 4
• Plasma concentrations between 4-18 mg/L are appropriate for antipyretic effect 5
• Maximum temperature reduction typically occurs about 3 hours after administration 2

Safety Considerations

• Single doses exceeding 10 times the recommended dose (>100-150 mg/kg) are potentially hepatotoxic 4
• Chronic overdosing at >140 mg/kg/day for several days carries risk of serious toxicity 4
• For post-vaccination fever prevention, acetaminophen can be given at the time of vaccination and every 4 hours for 24 hours 7

Special Situations

• For children with history of febrile seizures, acetaminophen at 15 mg/kg can be given prophylactically to reduce fever risk 7
• When treating pain in children with stable neurologic conditions, acetaminophen is generally safe and preferred over NSAIDs 7

Weight-Based Dosing Chart

• <10 kg (0-11 months): 10-15 mg/kg/dose every 4-6 hours 1
• 10-20 kg (1-5 years): 120-250 mg/dose every 4-6 hours 1, 2
• 20-40 kg (6-11 years): 250-500 mg/dose every 4-6 hours 1, 2

• 40 kg (12+ years): 500-1000 mg/dose every 4-6 hours, not to exceed 4000 mg/day 6, 2

Common Pitfalls to Avoid

• Underdosing is common in clinical practice, leading to inadequate fever control or pain relief 5
• Confusing dosing units (mg vs. mL) can lead to medication errors 2
• Administering adult formulations to children without appropriate dose adjustment can lead to overdose 6
• Failure to account for acetaminophen in combination products (cold medicines, sleep aids) can lead to unintentional overdosing 4
• Using both brand name and generic acetaminophen simultaneously can lead to double-dosing 4