What is the recommended dose of acetaminophen (paracetamol) for a 3-year-old child weighing 14.5 kg?

Acetaminophen Dosing for a 3-Year-Old Weighing 14.5 kg

For a 3-year-old child weighing 14.5 kg, administer acetaminophen 145-217.5 mg per dose (calculated as 10-15 mg/kg), given every 4-6 hours as needed, with a practical dose of 160 mg per dose for ease of measurement using standard formulations. 1

Weight-Based Dose Calculation

• The standard pediatric dosing is 10-15 mg/kg per dose every 4-6 hours 1
• For this 14.5 kg child: 14.5 kg × 10-15 mg/kg = 145-217.5 mg per dose 1
• The practical recommended dose is 160 mg per dose for ease of measurement with standard syrup formulations 1

Maximum Daily Limits

• Maximum single dose: 15 mg/kg (217.5 mg for this child) 1
• Maximum daily dose: 75 mg/kg/day, which equals approximately 1,087.5 mg/day for this 14.5 kg child 1
• Maximum number of doses: 4-5 doses per 24 hours 1
• Minimum dosing interval: 4 hours between doses 1

Formulation and Administration

• Acetaminophen syrup typically comes as 120 mg/5 mL (24 mg/mL) or 160 mg/5 mL (32 mg/mL) 1
• For the 120 mg/5 mL formulation: give 6.5 mL per dose (156 mg) 1
• For the 160 mg/5 mL formulation: give 5 mL per dose (160 mg) 1
• Use an appropriate measuring device such as a 3-mL or 5-mL oral syringe for accurate measurement 2

Practical Prescribing Example

Prescription: Acetaminophen syrup 160 mg/5 mL, give 5 mL (160 mg) every 4-6 hours as needed for fever or pain, maximum 5 doses in 24 hours. 1

Critical Safety Considerations

• The maximum daily dose of 4 grams (4,000 mg) applies to adults and should never be extrapolated to children; always use weight-based dosing 3
• Exceeding 75 mg/kg/day can lead to hepatotoxicity through accumulation of the toxic metabolite NAPQI, which depletes glutathione stores and causes liver necrosis 4, 5
• Parents must be instructed to never exceed the recommended dose and to measure carefully with the provided syringe or measuring cup 1
• If fever persists despite appropriate acetaminophen dosing, ibuprofen may be considered as second-line treatment 2

Common Pitfalls to Avoid

• Avoid cumulative overdose: Many parents inadvertently give multiple acetaminophen-containing products simultaneously (e.g., cold medications plus acetaminophen), leading to accidental overdose 6, 5
• Do not use adult dosing: The 4-gram daily maximum for adults translates to approximately 57 mg/kg for a 70 kg adult, which is below the 75 mg/kg/day pediatric maximum, but adult doses should never be given to children 3
• Ensure proper measuring devices: Household teaspoons are inaccurate; always provide calibrated oral syringes 2