What is the recommended dose of paracetamol (acetaminophen) for a 2-year-old child weighing 22kg?

Paracetamol Dosing for a 22kg 2-Year-Old Child

For this 22kg 2-year-old child, administer 15 mg/kg per dose (330 mg) every 4-6 hours orally, not exceeding 60-75 mg/kg/day (1320-1650 mg/day total). 1, 2

Weight-Based Dosing Calculation

• Single dose: 15 mg/kg × 22 kg = 330 mg per dose 1, 2
• Dosing interval: Every 4-6 hours as needed 1, 2
• Maximum daily dose: 60-75 mg/kg/day = 1320-1650 mg/day 1, 2
• Maximum number of doses: 4-5 doses per 24 hours 3

Dosing Range and Rationale

• The recommended single dose range is 10-15 mg/kg, with 15 mg/kg being superior to 10 mg/kg for achieving adequate antipyretic and analgesic effects 1, 4
• Doses below 10 mg/kg provide suboptimal fever reduction and pain control 4
• A dose of 15 mg/kg maintains temperature reduction of approximately 1.5°C below baseline for 6 hours 4
• Plasma concentrations of 4-18 mg/L are needed for therapeutic effect, which is reliably achieved with 15 mg/kg dosing 4

Safety Considerations

• Cumulative toxicity threshold: Avoid exceeding 90-95 mg/kg/day, as chronic overdosing above this level carries risk of hepatotoxicity 5
• Single toxic doses require ingestion of more than 10 times the recommended dose (>150 mg/kg as a single ingestion) 3
• Exposures greater than 140 mg/kg/day for several consecutive days carry risk of serious liver toxicity 3
• At the recommended 60-75 mg/kg/day dosing, paracetamol has an excellent safety profile with few side effects 3

Route-Specific Guidance

• Oral route is preferred over rectal suppositories due to more consistent and predictable absorption 4
• Rectal administration shows slow and irregular absorption patterns 2
• If using oral suspension, ensure accurate measurement with calibrated dosing devices 1

Common Pitfall to Avoid

Many dosing schedules recommend inadequate amounts of paracetamol based on outdated or overly conservative recommendations 1. The 10 mg/kg dose, while safe, is often insufficient for optimal symptom control. Using 15 mg/kg per dose provides superior efficacy while remaining well within safety margins 1, 4.