Paracetamol Dosing for an 18-Month-Old Child
For an 18-month-old child, administer paracetamol at 10-15 mg/kg per dose every 4-6 hours, with a maximum of 5 doses in 24 hours and a total daily dose not exceeding 60 mg/kg. 1, 2, 3
Weight-Based Dosing Calculation
- The optimal therapeutic dose is 15 mg/kg per dose, which provides superior efficacy compared to lower doses while maintaining an excellent safety profile 3
- For a typical 18-month-old weighing approximately 11 kg, this translates to 165 mg per dose (using 15 mg/kg) 1
- The acceptable dosing range is 10-15 mg/kg, meaning 110-165 mg per dose for an 11 kg child 1, 4
- Doses should be administered every 4-6 hours as needed, not exceeding 5 doses in 24 hours 2, 5
Maximum Daily Dose Limits
- The maximum daily dose is 60 mg/kg (660 mg for an 11 kg child) 1, 5
- This limit must not be exceeded, as chronic overdosing above 140 mg/kg/day for several days carries risk of serious hepatotoxicity 5
- Single ingestions exceeding ten times the recommended dose are potentially toxic 5
Critical Dosing Considerations
Why 15 mg/kg is Preferred Over 10 mg/kg
- Recent evidence demonstrates that 15 mg/kg is significantly more effective than placebo and at least as effective as NSAIDs for fever and pain management 3
- Older studies using subtherapeutic doses of ≤10 mg/kg showed paracetamol to be less effective than NSAIDs, but this was due to inadequate dosing 3
- The 15 mg/kg dose has a tolerability profile similar to placebo when used short-term 3
Age-Based Dosing Pitfall
- Age-based dosing from the FDA label states "2 to under 4 years: 5 mL (160 mg) every 4 hours" 2
- However, this age-based approach can lead to inappropriate dosing for underweight or overweight children 6
- Weight-based dosing is strongly preferred to avoid underdosing in larger children or overdosing in smaller children 6
Practical Administration
- Paracetamol can be given without regard to meals, though administration with food may improve gastrointestinal tolerability 7
- Parents must be counseled to avoid all other products containing paracetamol, including over-the-counter cold remedies, to prevent inadvertent overdose 1
- The oral suspension concentration is typically 160 mg/5 mL in the United States 2
Safety Profile
- Paracetamol is the first-line choice for fever and pain in children of all ages, including those under 3 months 3, 5
- When used at recommended doses, it has few side effects and is remarkably well tolerated 5
- Unlike NSAIDs, paracetamol shows lower risk of adverse events when used at repetitive doses for consecutive days 3