What is the recommended dosage of paracetamol (acetaminophen) for a child?

Paracetamol Dosing in Children

The recommended dose of paracetamol (acetaminophen) for children is 10-15 mg/kg per dose, given every 4-6 hours, with a maximum daily dose of 60 mg/kg per day. 1

Standard Dosing by Age and Weight

Weight-based dosing is the most accurate approach and should be used whenever possible rather than age-based approximations. 1, 2

Oral Dosing Guidelines:

• Children ≥12 years: 650 mg every 4-6 hours (maximum 6 doses/24 hours) 3
• Children 6 to <12 years: 325 mg every 4 hours (maximum 5 doses/24 hours) 3
• Children 4 to <6 years: 240 mg every 4 hours (maximum 5 doses/24 hours) 3
• Children 2 to <4 years: 160 mg every 4 hours (maximum 5 doses/24 hours) 3
• Children <2 years: Consult a physician 3

Weight-Based Dosing (Preferred Method):

• Standard dose: 10-15 mg/kg per dose 1, 2
• Dosing interval: Every 4-6 hours 1
• Maximum daily dose: 60 mg/kg/day (not to exceed 5 doses in 24 hours) 1, 4

Special Populations

Infants Under 3 Months:

• Dose: 15 mg/kg if weight is less than 10 kg 1
• Paracetamol is the only recommended analgesic in this age group 1
• Use with caution and medical supervision 3

Neonates and Very Young Infants:

• Limited safety data exists for infants under 1 month 5
• For neonates, 30 mg/kg/day achieves effective therapeutic concentrations, though further studies are needed 5
• Infants 1-3 months: 60-65 mg/kg/day is suggested by literature, though pharmacokinetic data may favor higher doses 5

Route of Administration Considerations

Oral vs. Rectal:

• Oral syrup is preferred because it is absorbed more rapidly and provides more consistent response compared to suppositories 1
• Rectal administration should be used cautiously due to erratic absorption 1
• Rectal route may be considered for children actively vomiting or in perioperative situations where oral intake is restricted 1

Measuring Devices:

• Use appropriate measuring devices such as a 3-mL or 5-mL oral syringe for accurate measurement in infants and young children 6

Critical Safety Warnings

Maximum Dose Limits:

• Never exceed 60 mg/kg per day or 5 doses in 24 hours 1
• Single ingestions of more than ten times the recommended dose are potentially toxic 7
• Chronic overdosing risk: Exposures greater than 140 mg/kg/day for several days carry risk of serious toxicity 7
• Daily doses should not exceed 90 mg/kg/day to avoid cumulative hepatic and renal toxicity 5

Common Pitfalls to Avoid:

• Do not extrapolate adult dosing to children—always use weight-based calculations 1
• Avoid combination products that may contain paracetamol, leading to inadvertent overdose 1
• Many traditional dosing schedules recommend inadequate amounts of paracetamol 2
• In children under 25 kg, be particularly careful not to exceed recommended single doses 2

Clinical Context

Efficacy Considerations:

• Paracetamol is first-line treatment for fever and mild-to-moderate pain in children 7
• At therapeutic concentrations, pharmacokinetics are linear and constant with repeated administration 4
• No direct correlation exists between serum concentrations and analgesic/antipyretic effect 4
• For severe pain, paracetamol offers significant additive analgesic effect to opiates 7

When Paracetamol May Be Insufficient:

• Ibuprofen may be considered as second-line treatment if paracetamol is ineffective for fever management 6
• For postoperative pain after minor surgery, traditional doses (20 mg/kg) may not achieve sufficient immediate analgesia 8
• Some sources suggest higher initial doses (40 mg/kg) for effective postoperative pain control, though this carries certain risks and should be used cautiously 8

Special Clinical Situations:

• Post-vaccination fever: Can be given at time of vaccination and every 4 hours for 24 hours 1
• Febrile seizure history: 15 mg/kg can be given prophylactically every 4 hours for 24 hours, though this improves comfort but does not prevent febrile seizures 1
• Stable neurologic conditions: Paracetamol is generally safe and preferred over NSAIDs 1