Pediatric Paracetamol (Acetaminophen) Dosing Guidelines
The recommended pediatric dosage of paracetamol (acetaminophen) is 10-15 mg/kg per dose given every 4-6 hours, not to exceed 5 doses in 24 hours. 1, 2
Age-Based Dosing Guidelines
- Children under 2 years: Consult a doctor for appropriate dosing 3
- Children 2 to under 4 years: 5 mL (160 mg) every 4 hours, not to exceed 5 doses in 24 hours 3
- Children 4 to under 6 years: 7.5 mL (240 mg) every 4 hours, not to exceed 5 doses in 24 hours 3
- Children 6 to under 12 years: 10.15 mL (325 mg) every 4 hours, not to exceed 5 doses in 24 hours 3
- Children 12 years and older: 20.3 mL (650 mg) every 4-6 hours, not to exceed 6 doses in 24 hours 3
Weight-Based Dosing Considerations
- The standard recommended dose range is 10-15 mg/kg per dose 1, 2
- Maximum daily dose should not exceed 60-75 mg/kg/day 1
- Never exceed 90 mg/kg/day due to risk of hepatic toxicity 4
- Children weighing more than 40 kg should be dosed as adults 5
Administration Forms
- Available preparations include liquid suspensions/elixirs, chewable tablets, and regular tablets 5
- Use appropriate measuring devices for liquid formulations to ensure accurate dosing 5
- For infants and young children, liquid formulations are preferred for ease of administration and dosing accuracy 1
Safety Considerations
- Single ingestions of more than ten times the recommended dose (>150 mg/kg) are potentially hepatotoxic 1
- Chronic overdosing exceeding 140 mg/kg/day for several days carries risk of serious liver toxicity 1
- Studies show that 43% of children may receive supratherapeutic doses (>15 mg/kg/dose) when administered by caregivers 6
- Risk of incorrect dosing increases with the child's age 6
- Parents should be educated on proper weight-based dosing and provided with clear instructions 6
Clinical Pearls
- Paracetamol is the first-line choice for treatment of both fever and pain in children 1
- For fever management, ibuprofen may be more effective than paracetamol alone, but combining both provides longer fever-free periods 7
- If using both paracetamol and ibuprofen, careful documentation of dosing times is essential to avoid accidental overdosing 7
- When treating fever associated with discomfort, paracetamol offers effective symptom relief 1
- For mild to moderate pain, paracetamol alone or in combination with another analgesic is effective 1
Remember that paracetamol dosing should be based on the child's weight whenever possible for maximum safety and efficacy. Accurate weight measurement and dose calculation are essential to prevent both underdosing and overdosing.