What is the recommended dose of paracetamol (acetaminophen) for a 3-year-old child?

Paracetamol Dosing for a 3-Year-Old Child

For a 3-year-old child, administer paracetamol 10-15 mg/kg per dose every 4-6 hours, with a maximum of 5 doses in 24 hours, not exceeding 75 mg/kg/day total. 1, 2, 3

Weight-Based Dosing (Preferred Method)

• Calculate the dose based on the child's weight: 10-15 mg/kg per dose 2, 3
• Administer every 4-6 hours as needed 1, 2
• Maximum 5 doses in 24 hours 1
• Do not exceed 75 mg/kg/day total daily dose 2, 4

The 15 mg/kg dose is significantly more effective than lower doses (≤10 mg/kg) for both fever and pain management, with efficacy comparable to NSAIDs and a safety profile similar to placebo 3. Older studies using subtherapeutic doses of ≤10 mg/kg showed inferior results, which is why the higher end of the dosing range is now preferred 3.

Age-Based Dosing (If Weight Unknown)

For children 2 to under 4 years of age:

• 5 mL (160 mg) every 4 hours 1
• Maximum 5 doses in 24 hours 1

For children 4 to under 6 years of age:

• 7.5 mL (240 mg) every 4 hours 1
• Maximum 5 doses in 24 hours 1

Administration Guidelines

• Use an appropriate measuring device such as a 3-mL or 5-mL oral syringe for accurate measurement 5
• Paracetamol can be administered with or without food 1

Critical Safety Thresholds

Avoid chronic overdosing: Exposures greater than 140 mg/kg/day for several days carry a risk of serious liver toxicity and failure 5, 4. Even doses exceeding 90-95 mg/kg/day when used repetitively can cause cumulative hepatic and renal toxicity 6.

Single acute overdose: Single ingestions of more than ten times the recommended dose are potentially hepatotoxic 4.

When Paracetamol Is Ineffective

• If paracetamol is ineffective for fever management, ibuprofen may be considered as second-line treatment 5
• Recent evidence demonstrates that paracetamol 15 mg/kg shows lower risk of adverse events compared to NSAIDs when used at repetitive doses for consecutive days 3

Common Pitfalls to Avoid

• Do not underdose: Many dosing schedules recommend inadequate amounts of paracetamol, particularly the older 10 mg/kg regimens 2, 3
• Avoid combination products: When using combination opioid-paracetamol products, exercise caution to prevent excess paracetamol dosing 5
• Do not exceed maximum daily limits: The cumulative 24-hour dose is more critical for toxicity than individual doses 4, 6