What are the recommended doses of acetaminophen (paracetamol) and ibuprofen for a 17kg child in a prehospital scenario for pain or fever management?

Pediatric Drug Dosing for a 17kg Child in Prehospital Setting

For a 17kg child in a prehospital scenario, administer acetaminophen 10-15 mg/kg (170-255 mg) every 4-6 hours OR ibuprofen 10 mg/kg (170 mg) every 6-8 hours for pain or fever management.

Acetaminophen (Paracetamol) Dosing

Oral Route

• Standard dose: 10-15 mg/kg every 4-6 hours 1
• For a 17kg child: 170-255 mg per dose 1
• Maximum daily dose: 60 mg/kg/day (1020 mg/day for this child) 1
• Can be given with or without food 2

Rectal Route (if oral not feasible)

• Loading dose: 20-40 mg/kg (340-680 mg for 17kg child) 1
• The higher rectal dose is necessary due to poor bioavailability from the rectal route 1
• For children <10 kg, use 15 mg/kg rectally 1

Intravenous Route (if available in prehospital setting)

• Loading dose: 15-20 mg/kg (255-340 mg for 17kg child) 1
• Maintenance: 10-15 mg/kg every 6-8 hours 1
• IV preparation is 10 mg/mL 1

Ibuprofen Dosing

Oral Route

• Standard dose: 10 mg/kg every 6-8 hours 1
• For a 17kg child: 170 mg per dose 1
• Ibuprofen demonstrates superior antipyretic efficacy compared to acetaminophen, particularly for bacterial infections 3, 4

Rectal Route

• 10 mg/kg every 8 hours 1
• For a 17kg child: 170 mg per dose 1

Intravenous Route (if available)

• 10 mg/kg every 8 hours 1
• For a 17kg child: 170 mg per dose 1

Critical Prehospital Considerations

Single-Agent Therapy Preferred

• Use either acetaminophen OR ibuprofen as single-agent therapy, not routinely alternating 5
• Alternating medications increases risk of dosing errors and overdose 5
• Meticulous dose tracking is essential if both medications are used 2

Safety Thresholds

• Acetaminophen toxicity occurs with single ingestions exceeding 150 mg/kg (2550 mg for 17kg child) 2, 6
• Chronic acetaminophen exposures >140 mg/kg/day for several days carry risk of serious hepatotoxicity 6
• For this 17kg child, stay well below 2380 mg/day (140 mg/kg/day threshold) 6

Prehospital Protocol Development

• Pain assessment and management protocols specifically for prehospital EMS providers improve pain management in the field 1
• Alternative delivery systems such as transmucosal medications could offer pain control without requiring IV access 1
• Several studies show that analgesics can be used in prehospital protocols to decrease pain scores without causing respiratory depression 1

Common Pitfalls to Avoid

Dosing Errors

• 27% of parents underdose (<10 mg/kg) and 12% overdose (≥20 mg/kg) acetaminophen 7
• Weight-based dosing is more accurate than age-based dosing for individual patients 8
• Always calculate the exact dose based on the child's weight rather than using approximate age-based dosing 8

Contraindications

• Never use aspirin in children due to risk of Reye syndrome 5
• Exercise extreme caution with acetaminophen in children with chronic alcohol use or liver disease history 3
• Ibuprofen has antiplatelet activity and rare gastrointestinal/renal toxicity 1

Reassessment

• The effect of any drug intervention should be re-evaluated based on the drug's half-life 1
• Acetaminophen half-life is 1-3.5 hours 9
• One abnormal pain/fever score should not immediately trigger dose changes 1

Pain vs Anxiety Management

• Pain medications do not mask symptoms or cloud mental status, preventing adequate assessment 1
• Small titrated doses of opiates can provide pain relief in trauma without affecting clinical examination 1
• Distraction techniques (bubble blowers, pinwheels) can reduce anxiety and pain perception during procedures 1