What is the recommended dose of paracetamol (acetaminophen) for a child weighing 19 kilograms?

Paracetamol Dosing for a 19 kg Child

For a 19 kg child, administer 190 mg of paracetamol per dose (calculated as 10 mg/kg), which can be given every 4-6 hours, with a maximum of 4 doses in 24 hours (total daily maximum: 760 mg). 1

Weight-Based Dosing Calculation

• The American Academy of Pediatrics recommends approximately 10 mg/kg per dose as the safe therapeutic range for pediatric paracetamol dosing 1
• For a 19 kg child, this equals 190 mg per dose 1
• However, evidence supports that 15 mg/kg (285 mg for a 19 kg child) may provide superior efficacy while maintaining safety 2

Dosing Frequency and Maximum Daily Limits

• Administer doses every 4-6 hours as needed for fever or pain 3
• Maximum of 4 doses in 24 hours regardless of which per-dose amount is used 3
• Total daily dose should not exceed 60 mg/kg/day (1,140 mg for a 19 kg child) 4
• The analgesic effect typically lasts approximately 6 hours 4

Clinical Considerations for Dose Selection

The choice between 10 mg/kg versus 15 mg/kg depends on symptom severity:

• For mild fever or pain: 10 mg/kg (190 mg) is adequate and represents the conservative first-line approach 1, 5
• For moderate to severe fever or pain: 15 mg/kg (285 mg) provides significantly better efficacy and is as safe as the lower dose for short-term use 2
• Recent evidence demonstrates that older studies using ≤10 mg/kg doses showed paracetamol to be less effective than NSAIDs, while 15 mg/kg doses show equivalent or superior efficacy 2

Safety Profile

• Paracetamol at recommended doses has a tolerability profile similar to placebo 2
• Single ingestions exceeding 10 times the recommended dose (>1,900 mg for a 19 kg child) are potentially hepatotoxic 5
• Chronic exposures greater than 140 mg/kg/day for several consecutive days carry risk of serious liver toxicity 5
• When used for consecutive days, paracetamol shows lower risk of adverse events compared to NSAIDs 2

Common Pitfalls to Avoid

• Carefully record all dose times to prevent accidentally exceeding the maximum recommended daily dose, as 8% of parents in clinical trials exceeded the maximum number of doses 3
• Avoid using subtherapeutic doses (<10 mg/kg), which may result in inadequate symptom relief 2
• Do not use in children with hepatic insufficiency 4

Practical Administration

• Paracetamol can be administered via oral, rectal, or intravenous routes, though oral absorption is more predictable than rectal 4
• Effervescent formulations provide more rapid absorption and onset of action compared to conventional tablets 4
• The drug can be used safely during all ages of childhood 2