Paracetamol Dosing for a 2-Year-Old Child
For a 2-year-old child, administer paracetamol 10-15 mg/kg per dose orally every 4-6 hours, not exceeding 5 doses in 24 hours or a maximum daily dose of 60-75 mg/kg/day. 1, 2
Weight-Based Dosing (Preferred Method)
- Calculate the dose based on the child's actual weight: 10-15 mg/kg per dose 1, 3
- For example, a typical 2-year-old weighing 12 kg would receive 120-180 mg per dose 1
- Administer every 4-6 hours as needed, with a minimum 4-hour interval between doses 1, 2
- Never exceed 5 doses in 24 hours or a total daily dose of 60 mg/kg/day 1, 2
Age-Based Dosing (When Weight Unknown)
According to FDA labeling, for children 2 to under 4 years of age:
- Standard dose: 160 mg (5 mL of standard suspension) every 4 hours 2
- Do not exceed 5 doses in a 24-hour period 2
Formulation and Administration
- Oral suspension is strongly preferred over rectal suppositories because oral formulations provide more rapid and consistent absorption 1, 4
- Standard concentration is typically 160 mg/5 mL (32 mg/mL) for pediatric suspensions 1
- Administer with or without food, though administration with meals may improve gastrointestinal tolerability 5
Critical Safety Considerations
The maximum daily dose should NEVER exceed 60 mg/kg/day or 5 doses in 24 hours to prevent hepatotoxicity. 1, 6 While single toxic ingestions typically require >140 mg/kg, chronic exposures exceeding 75-90 mg/kg/day for several days carry significant risk of serious liver toxicity 6, 7.
Common Prescribing Pitfalls to Avoid:
- Do not use rectal suppositories as first-line due to erratic and unpredictable absorption 1, 4
- For overweight children, calculate dose based on ideal body weight, not actual weight, to prevent inadvertent overdosing 7
- Ensure adequate time intervals between doses—rushing doses closer than 4 hours increases toxicity risk 1, 2
- Many over-the-counter dosing schedules recommend inadequate amounts; weight-based dosing is more accurate 3
Special Circumstances
- For post-vaccination fever: Can give at time of vaccination and every 4 hours for 24 hours 1
- For children with history of febrile seizures: 15 mg/kg can be given prophylactically every 4 hours, though this improves comfort but does not prevent seizure recurrence 1
- If vomiting or unable to take oral medication: Rectal administration may be considered, but expect delayed and inconsistent effect 1, 4
Monitoring
- Paracetamol provides comfort and reduces fever but there is no direct correlation between serum concentrations and clinical effect 4
- Clinical improvement in fever or pain should be evident within 30-60 minutes of oral administration 1
- If fever or pain persists beyond 3 days of appropriate dosing, medical re-evaluation is warranted 2