What is the recommended dose of Tylenol (acetaminophen) for pediatric patients?

Pediatric Acetaminophen (Tylenol) Dosing

The recommended dose of acetaminophen for children is 10-15 mg/kg per dose, given every 4-6 hours, with a maximum of 60 mg/kg per day or 5 doses in 24 hours. 1

Standard Dosing by Weight

• Single dose: 10-15 mg/kg administered every 4-6 hours 1, 2, 3
• Maximum daily dose: Never exceed 60 mg/kg per day 1
• Maximum frequency: No more than 5 doses in 24 hours 1
• Dosing interval: Maintain at least 4 hours between doses 1

Age-Specific Considerations

Infants Under 3 Months

• Acetaminophen is the only recommended analgesic for this age group 1
• Dose: 15 mg/kg if weight is less than 10 kg 1

Infants 3-6 Months

• Continue with standard 10-15 mg/kg dosing 1
• Acetaminophen remains preferred over ibuprofen in this age range 1

Children Over 6 Months

• Standard 10-15 mg/kg dosing applies 1, 3
• May consider alternating with ibuprofen if needed (see below) 1

Route of Administration

Oral Formulation (Preferred)

• Oral syrup is absorbed more rapidly and provides more consistent response compared to suppositories 1
• Onset of temperature reduction occurs rapidly, with maximum effect at approximately 3 hours 3

Rectal Formulation (Use Cautiously)

• Rectal acetaminophen should be used cautiously due to erratic absorption 1
• Some children may receive inadequate analgesia while others risk accumulation with repeated dosing 1
• Consider rectal route only when: child is actively vomiting, or in perioperative situations where oral intake is restricted 1

Alternating with Ibuprofen

When both medications are needed:

• Give acetaminophen every 4-6 hours 1
• Give ibuprofen every 6-8 hours 1
• Stagger timing so medications are given every 3-4 hours if both are required 1

Special Clinical Situations

Post-Vaccination Fever

• Acetaminophen can be given at the time of vaccination and every 4 hours for 24 hours 1
• This prevents vaccine-related fever discomfort 1

Children with History of Febrile Seizures

• Acetaminophen at 15 mg/kg can be given prophylactically to reduce fever risk 1
• However, acetaminophen will improve comfort but does not prevent febrile seizures, as demonstrated in multiple randomized controlled trials 1

Pain Management

• Acetaminophen alone should be considered only for mild-to-moderate pain or as an adjunct 1
• For severe pain, acetaminophen alone is inadequate 1

Critical Safety Points

• Never exceed 60 mg/kg per day to avoid hepatotoxicity 1
• Never give more than 5 doses in 24 hours 1
• Potential adverse effects of overdose include liver and kidney failure 4
• Monitor for adequate dosing: studies show 27% of children receive underdoses (<10 mg/kg) and 12% receive overdoses (≥20 mg/kg) due to parental administration errors 5

Practical Dosing Guidance

The 10-15 mg/kg range provides flexibility:

• Use 10 mg/kg for routine fever management 2, 3
• Use 15 mg/kg for higher fever or when more robust antipyretic effect is needed 1, 6
• Clinical studies demonstrate that 20 mg/kg as a single dose is more effective than 10 mg/kg, while 5 mg/kg has little antipyretic effect 6