Pediatric Acetaminophen Dosing
The recommended dose of acetaminophen (Tylenol) for pediatric patients is 10-15 mg/kg per dose, administered every 4-6 hours, with a maximum of 5 doses per day or 75 mg/kg/day (not to exceed 4000 mg/day). 1, 2
Standard Dosing Protocol
Weight-based dosing is superior to age-based dosing and should be used whenever possible to ensure accurate therapeutic levels and avoid underdosing, which occurs in approximately 27% of children when parents dose at home. 3, 4
Single Dose Recommendations
- Standard dose: 10-15 mg/kg per dose 1, 2
- Optimal antipyretic effect: 15 mg/kg achieves more consistent therapeutic plasma concentrations (10-20 μg/mL) compared to 10 mg/kg 3, 2
- Loading dose strategy: 25 mg/kg as initial dose, followed by 12.5 mg/kg every 6 hours for maintenance 5
- Minimum effective dose: At least 10 mg/kg is required to maintain temperature reduction of 1.5°C below baseline for 6 hours 5
Dosing Interval
- Every 4 hours is the standard interval 1, 4
- Maximum temperature reduction occurs approximately 3 hours after administration 2
- Do not exceed 5 doses in 24 hours 4
Special Clinical Situations
Post-Vaccination Fever Prevention
- Acetaminophen can be given at the time of vaccination and every 4 hours for 24 hours, as recommended by the CDC 6
Febrile Seizure History
- Prophylactic dosing at 15 mg/kg can be given to reduce fever risk in children with a history of febrile seizures, per AAP recommendations 6
Common Pitfalls to Avoid
Age-based dosing leads to significant dosing errors: Up to 30% of children receive inadequate doses when parents use age-based recommendations rather than weight-based calculations. 3
The 10 mg/kg dose is often subtherapeutic: Pharmacokinetic modeling demonstrates that 10 mg/kg fails to reach the therapeutic plasma concentration range (10-20 μg/mL) needed for effective antipyresis, particularly in children aged 2-3 years. 3
Manufacturer's fixed-dose recommendations may be inadequate: A fixed 160 mg dose is only effective for children weighing approximately 10.9 kg, but becomes subtherapeutic for heavier children in the 2-3 year age range. 3
Route of Administration
- Oral suspension is preferred over suppositories for more consistent absorption and predictable therapeutic response 5
- Rectal administration (10-15 mg/kg) shows similar efficacy but with greater variability in response 5
Safety Profile
- Acetaminophen at recommended doses (10-15 mg/kg) is one of the safest analgesic-antipyretics in children 1
- Adverse events are typically mild gastrointestinal symptoms 2
- Overdosing (≥20 mg/kg per dose) occurred in 12% of home administrations in community studies, emphasizing the need for proper parental education 4