What is the recommended dose of paracetamol (acetaminophen) for a healthy 12-year-old child?

Paracetamol Dosing for a 12-Year-Old Child

For a 12-year-old child, administer paracetamol 650 mg (20.3 mL of liquid formulation) every 4 to 6 hours as needed, not exceeding 6 doses in 24 hours. 1

Standard Dosing Guidelines

FDA-Approved Dosing

• Children 12 years and older are dosed as adults: 650 mg every 4-6 hours 1
• Maximum daily dose: Not to exceed 6 doses in 24 hours (approximately 3,900 mg/day) 1
• This represents a shift from weight-based pediatric dosing to adult fixed-dose regimens at age 12 1

Weight-Based Dosing Alternative

If using weight-based calculations (for children at the lower end of the 12-year-old weight range):

• Standard pediatric dose: 10-15 mg/kg every 4 hours 2, 3, 4
• Maximum daily dose: 60 mg/kg/day 2, 5
• For optimal efficacy, 15 mg/kg per dose is preferred over 10 mg/kg, as lower doses have shown inferior efficacy compared to NSAIDs 4

Clinical Considerations

Efficacy Optimization

• 15 mg/kg dosing demonstrates significantly better efficacy than placebo and equivalent efficacy to NSAIDs for fever and pain management 4
• Older studies using subtherapeutic doses of ≤10 mg/kg showed paracetamol to be less effective than NSAIDs, but this was due to inadequate dosing 4
• The analgesic effect typically lasts 4-6 hours, supporting the dosing interval 5

Safety Profile

• Paracetamol has a tolerability profile similar to placebo when used at recommended doses 4
• Single toxic dose threshold: Ingestions exceeding 10 times the recommended dose (>150 mg/kg) are potentially hepatotoxic 2
• Chronic overdose risk: Exposures greater than 140 mg/kg/day for several consecutive days carry risk of serious hepatotoxicity 2
• Unlike NSAIDs, paracetamol shows lower risk of adverse events with repetitive dosing over consecutive days 4

Common Pitfalls to Avoid

Dosing Errors

• Do not use inadequate doses: Many older dosing schedules recommend insufficient amounts (≤10 mg/kg), which compromise efficacy 3, 4
• Avoid exceeding maximum daily dose: The 4g/day adult maximum (or 60 mg/kg/day pediatric maximum) must not be exceeded 2, 5
• Account for combination products: Ensure the patient is not receiving paracetamol from multiple sources (e.g., cold/flu preparations) 2

Route Considerations

• Oral route preferred: Provides consistent, predictable absorption 5
• Rectal route: Shows slow and irregular absorption; less reliable than oral administration 5
• Effervescent formulations: Offer more rapid absorption and onset of action compared to conventional tablets 5