What is the recommended dosage of acetaminophen (Tylenol) and ibuprofen for a 2-year-old child with fever?

Acetaminophen and Ibuprofen Dosing for a 2-Year-Old with Fever

For a 2-year-old child with fever, give acetaminophen 10-15 mg/kg every 4-6 hours (maximum 5 doses per 24 hours) OR ibuprofen 5-10 mg/kg every 6-8 hours (maximum 3-4 doses per 24 hours), with ibuprofen providing longer duration of fever control. 1, 2

Weight-Based Dosing (Preferred Method)

Acetaminophen Dosing

• Dose: 10-15 mg/kg per dose 3
• Frequency: Every 4-6 hours 1, 3
• Maximum: 5 doses in 24 hours 1
• For a typical 2-year-old weighing 12-13 kg (26-29 lbs), this translates to approximately 120-195 mg per dose 3

Ibuprofen Dosing

• Dose: 5-10 mg/kg per dose 2
• Frequency: Every 6-8 hours 1, 4
• Maximum: 3-4 doses in 24 hours 1
• For a typical 2-year-old weighing 12-13 kg, this translates to approximately 60-130 mg per dose 2

Comparative Effectiveness

Ibuprofen demonstrates superior antipyretic efficacy compared to acetaminophen at standard doses. 2

• Ibuprofen (5-10 mg/kg) reduces temperature more effectively than acetaminophen (10-15 mg/kg) at 2,4, and 6 hours post-administration 2
• The longer duration of action (6-8 hours vs 4-6 hours) makes ibuprofen more convenient and reduces dosing frequency 4
• Both medications show comparable safety profiles when used at recommended doses 1, 2

Safety Considerations

Critical Dosing Precautions

• Never exceed maximum recommended doses: Acetaminophen toxicity occurs at lower overdose levels and is more severe than ibuprofen overdose 4
• Parents should carefully record all dose times to prevent accidental overdosing 5
• Use weight-based dosing rather than age-based dosing when possible for accuracy 3

Combination Therapy

• Combining acetaminophen and ibuprofen provides an additional 2.5-4.4 hours without fever over 24 hours compared to either agent alone 5
• However, combination therapy increases complexity and risk of exceeding maximum doses (8-11% of children exceeded recommended doses in studies) 5
• If using both medications, maintain detailed written records of all doses and timing 5

Clinical Approach Algorithm

1. First-line choice: Start with ibuprofen 5-10 mg/kg every 6-8 hours for superior antipyretic effect and longer duration 4, 2

2. Alternative: Use acetaminophen 10-15 mg/kg every 4-6 hours if ibuprofen is contraindicated or not tolerated 1

3. Consider combination therapy only if:

   • Single-agent therapy provides inadequate fever control 5
   • Parents can reliably track dosing times for both medications 5
   • The benefit of additional 2.5 hours without fever justifies the increased complexity 5

Important Clinical Context

The primary goal is improving the child's overall comfort, not normalizing temperature. 1

• Fever itself does not worsen illness course or cause neurologic complications 1
• Focus on the child's activity level, fluid intake, and signs of serious illness rather than the specific temperature number 1
• Most febrile children return to normal within 48 hours to 5 days 5