What is the recommended dosing for acetaminophen (paracetamol) in pediatric patients?

Acetaminophen Dosing for Pediatric Patients

The recommended dosing for acetaminophen in pediatric patients is 10-15 mg/kg per dose every 4-6 hours, with a maximum of 5 doses (60-75 mg/kg/day) in a 24-hour period. 1, 2

Dosing Guidelines by Age Group

Infants and Children

• For infants and children, administer 10-15 mg/kg per dose every 4-6 hours 1, 2
• Maximum daily dose should not exceed 75 mg/kg/day or 4 grams per day, whichever is less 2
• For fever reduction, a minimum of 10 mg/kg is required to maintain temperature reduction for approximately 6 hours 3
• Some clinicians recommend an initial loading dose of 25 mg/kg followed by maintenance doses of 12.5 mg/kg every 6 hours for more consistent fever control 3

Neonates (0-28 days)

• For neonates, a more conservative approach is recommended: 12.5 mg/kg every 6 hours or 15 mg/kg every 8 hours 4
• Total daily dose should not exceed 60 mg/kg/day in this age group 4

Administration Routes and Formulations

Oral Administration

• Oral suspension is preferred for young children and provides more consistent absorption compared to suppositories 3
• For children unable to swallow tablets, liquid formulations should be used with appropriate measuring devices (not household spoons) 2

Intravenous Administration

• Intravenous acetaminophen may be used when oral or rectal routes are contraindicated 4
• Dosing for IV administration:
  • Neonates: 12.5 mg/kg every 6 hours or 15 mg/kg every 8 hours 4
  • Infants (29 days to <2 years): 12.5 mg/kg every 4 hours or 15 mg/kg every 6 hours 4
  • Children (2 to <12 years): 12.5 mg/kg every 4 hours or 15 mg/kg every 6 hours 4
  • Adolescents (≥12 years): 12.5 mg/kg every 4 hours or 15 mg/kg every 6 hours 4

Safety Considerations

Overdose Prevention

• Single ingestions of more than ten times the recommended dose (>150 mg/kg) are potentially toxic 2
• Chronic exposure to >140 mg/kg/day for several days carries risk of serious hepatotoxicity 2
• Parents should be educated about proper dosing to avoid both underdosing and overdosing 5
• Studies show that approximately 27% of children receive underdoses (<10 mg/kg) and 12% receive overdoses (>20 mg/kg) when parents administer acetaminophen 5

Special Populations

• For children with hepatic impairment, doses should be reduced and intervals extended 6
• For children with renal impairment, standard dosing can generally be used, but monitoring for accumulation is recommended in severe cases 6

Common Dosing Errors to Avoid

• Administering doses too frequently (some parents give doses as often as every 2-3 hours) 5
• Using household teaspoons instead of calibrated measuring devices 2
• Confusing different concentration formulations (infant drops vs. children's liquid) 2
• Administering adult formulations to children without appropriate dose adjustment 7

Weight-Based Dosing Algorithm

1. Calculate the child's weight in kilograms
2. Multiply weight by 10-15 mg/kg to determine appropriate single dose
3. Administer no more frequently than every 4 hours
4. Do not exceed 5 doses in 24 hours
5. Ensure total daily dose does not exceed 75 mg/kg/day or 4 grams (whichever is less) 1, 2

Remember that acetaminophen remains the first-line choice for treatment of both fever and pain in pediatric patients due to its favorable safety profile when used at recommended doses 2.