Paracetamol Dosing for an 11-Year-Old Child Weighing 23 kg
For an 11-year-old child weighing 23 kg, administer paracetamol 10-15 mL (325-480 mg) every 4-6 hours, not exceeding 5 doses in 24 hours, based on the weight-based calculation of 10-15 mg/kg per dose with a maximum daily dose of 60 mg/kg (1380 mg/day for this child). 1, 2
Weight-Based Dosing Calculation
- The standard pediatric dose is 10-15 mg/kg per dose, given every 4-6 hours 1, 3, 4
- For a 23 kg child, this translates to:
- Minimum dose: 230 mg (10 mg/kg × 23 kg)
- Maximum dose: 345 mg (15 mg/kg × 23 kg) 1
- The maximum daily dose must not exceed 60 mg/kg/day, which equals 1380 mg/day for this 23 kg child 1, 5, 4
Practical Dosing Using Available Formulations
According to FDA labeling for oral liquid paracetamol formulations 2:
- For children 6 to under 12 years of age: 10.15 mL (325 mg) every 4 hours 2
- This dose falls within the recommended 10-15 mg/kg range (14 mg/kg for a 23 kg child) 1, 2
- Do not exceed 5 doses in a 24-hour period 2
Dosing Interval Considerations
- Administer every 4-6 hours as needed for fever or pain 1, 3
- The 4-hour interval is preferred in the UK, while some guidelines allow up to 6 hours between doses 5, 4
- Never give more than 5 doses in 24 hours to avoid exceeding the maximum daily dose 1, 2
Route of Administration
- Oral syrup formulation is strongly preferred as it is absorbed more rapidly and provides more consistent response compared to rectal suppositories 1, 4
- Rectal administration should be avoided due to erratic absorption, which may result in inadequate analgesia or risk of accumulation with repeated dosing 1, 4
Critical Safety Warnings
- The maximum daily dose of 60 mg/kg/day (1380 mg for this child) must never be exceeded 1, 5
- Chronic overdosing with exposures greater than 90-140 mg/kg/day for several days carries risk of serious hepatotoxicity 5, 6
- Parents should carefully record all dose times to avoid accidentally exceeding the maximum recommended dose, particularly if alternating with other medications 7
Common Prescribing Pitfalls
Studies show that 17% of paracetamol prescriptions exceed safe dosing limits, particularly in younger children 6. To avoid this:
- Always calculate the dose based on the child's current weight rather than relying solely on age-based recommendations 3, 6
- Be aware that many dosing schedules recommend inadequate amounts of paracetamol, so weight-based calculation is essential 3
- Provide parents with clear written instructions including the exact volume to administer and maximum number of doses per day 7