Pediatric Paracetamol (Acetaminophen) Dosing Guidelines
The recommended pediatric dosage of paracetamol (acetaminophen) is 10-15 mg/kg every 4-6 hours, not to exceed 5 doses in a 24-hour period for children under 12 years of age. 1, 2
Age-Based Dosing Recommendations
- Adults and children 12 years and older: 650 mg every 4-6 hours, not to exceed 6 doses in 24 hours 1
- Children 6 to under 12 years: 325 mg every 4 hours, not to exceed 5 doses in 24 hours 1
- Children 4 to under 6 years: 240 mg every 4 hours, not to exceed 5 doses in 24 hours 1
- Children 2 to under 4 years: 160 mg every 4 hours, not to exceed 5 doses in 24 hours 1
- Children under 2 years: Consult a doctor for appropriate dosing 1
Weight-Based Dosing Considerations
- The optimal single dose range is 10-15 mg/kg administered at 4-hour intervals 2, 3
- Maximum daily dose should not exceed 60-75 mg/kg/day to avoid potential hepatotoxicity 2
- For more precise dosing in young children, weight-based calculations are preferred over age-based recommendations 3
Safety Considerations and Precautions
- Overdose warning: Single ingestions of more than 10 times the recommended dose (>100-150 mg/kg) are potentially toxic and can cause hepatotoxicity 2
- Chronic overdosing at doses greater than 140 mg/kg/day for several days carries risk of serious toxicity 2
- For children with hepatic impairment, doses should be reduced and intervals extended to minimize the risk of hepatotoxicity 4
- Standard dosing can generally be used in children with renal impairment, but monitoring is recommended in severe cases 4
Common Pitfalls in Paracetamol Dosing
- Underdosing is common in clinical practice, which may result in inadequate pain or fever control 3
- Some practitioners are uncertain about safe dosing regimens, particularly in younger age groups (under 3 months), leading to potential dosing errors 5
- Using household measuring devices rather than the provided dosing cup/syringe can lead to inaccurate dosing 2
- Failing to account for paracetamol in combination products (cold medicines, etc.) can lead to unintentional overdosing 2
Special Populations
- Neonates and infants under 3 months: Limited data exists, but approximately 10-15 mg/kg every 6-8 hours is generally considered safe; consult a physician before administration 5
- Infants 1-3 months: 60-65 mg/kg/day divided into 4-6 doses has been suggested in the literature 5
While paracetamol is widely used for both acute and chronic pain in children, it's worth noting that there is limited evidence from randomized controlled trials specifically for chronic non-cancer pain in pediatric populations 6.