Acetaminophen (Tylenol) Dosing for Children
The recommended dose of acetaminophen for children is 10-15 mg/kg per dose, administered every 4-6 hours, with a maximum daily dose not exceeding 60 mg/kg per day or 5 doses in 24 hours. 1
Standard Dosing Guidelines
Weight-based dosing is the most accurate approach and should be used whenever possible to ensure appropriate therapeutic levels while avoiding toxicity 1, 2:
- Single dose: 10-15 mg/kg per dose 1, 3
- Dosing interval: Every 4-6 hours 1, 3
- Maximum daily dose: 60 mg/kg per day 1
- Maximum number of doses: 5 doses in 24 hours 1
Age-Specific Considerations
Infants Under 3 Months
- Acetaminophen is the only recommended analgesic in this age group 1
- Use 15 mg/kg per dose if weight is less than 10 kg 1
Infants Under 6 Months
- Acetaminophen remains the preferred antipyretic/analgesic 1
- Ibuprofen is generally not recommended in this age group 1
Formulation Considerations
Oral suspension is preferred over rectal suppositories because it provides more rapid absorption and more consistent therapeutic response 1, 4. While suppositories can be used, they may result in more variable drug levels and less predictable fever reduction 4.
Clinical Scenarios
Post-Vaccination Fever
For children with specific risk factors (history of seizures or family history of convulsions), acetaminophen can be given prophylactically 5:
Febrile Seizure History
Children with a history of febrile seizures may receive acetaminophen at 15 mg/kg prophylactically to reduce fever risk 1
Critical Safety Parameters
Never exceed these maximum limits to prevent hepatotoxicity 1, 6:
- 60 mg/kg per day total dose 1
- 5 doses in any 24-hour period 1
- Chronic exposures greater than 140 mg/kg/day for several days carry risk of serious liver toxicity 6
Toxicity Threshold
Single ingestions of more than ten times the recommended dose are potentially hepatotoxic and require immediate medical evaluation 6.
Alternating with Ibuprofen (if applicable)
If both medications are needed 1:
- Give acetaminophen every 4-6 hours
- Give ibuprofen every 6-8 hours
- Stagger timing so medications are administered every 3-4 hours
Common Pitfalls to Avoid
- Do not use age-based dosing alone when weight is known—weight-based dosing is more accurate 3, 2
- Do not combine multiple acetaminophen-containing products (many cold/flu medications contain acetaminophen) 6
- Do not exceed maximum daily dose even if fever persists—seek medical evaluation instead 1
- Avoid concurrent use with topical lidocaine-prilocaine cream in infants <12 months due to methemoglobinemia risk 5
Efficacy Expectations
The 10-15 mg/kg dose produces 4, 2:
- Rapid onset of temperature reduction
- Maximum temperature decrease approximately 3 hours after administration
- Temperature maintained approximately 1.5°C below baseline for up to 6 hours