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

Pediatric Tylenol (Acetaminophen) Dosing

The recommended dose of acetaminophen for children is 10-15 mg/kg per dose, given every 4-6 hours, with a maximum daily dose of 60 mg/kg per day (not to exceed 5 doses in 24 hours). 1

Standard Dosing by Weight

• Give 10-15 mg/kg per dose every 4-6 hours as the standard approach 1
• The maximum daily dose should never exceed 60 mg/kg per day or 5 doses in 24 hours to prevent toxicity 1
• Weight-based dosing is more accurate than age-based dosing and keeps each dose within the safe therapeutic range 2

Age-Specific Considerations

• For infants under 3 months: Acetaminophen is the only recommended analgesic, with a dose of 15 mg/kg if weight is less than 10 kg 1
• For infants 3-6 months: Continue with 10-15 mg/kg per dose every 4-6 hours 1
• For children over 40 kg: Use adult dosing 1

Route of Administration

• Oral syrup is preferred over rectal suppositories because it is absorbed more rapidly and provides a more consistent response 1
• Rectal administration should be used cautiously due to erratic absorption, which can lead to inadequate analgesia in some children or risk of accumulation with repeated dosing 1
• Consider rectal route only for children actively vomiting or in perioperative situations where oral intake is restricted 1

Special Clinical Situations

• Post-vaccination fever: Give acetaminophen at the time of vaccination and every 4 hours for 24 hours 1
• Children with history of febrile seizures: Prophylactic acetaminophen at 15 mg/kg can be given every 4 hours for 24 hours to reduce fever risk, though it does not prevent febrile seizures themselves 1
• Severe pain: Acetaminophen alone should not be used for severe pain—consider it only for mild-to-moderate pain or as an adjunct to other analgesics 1

Common Pitfalls to Avoid

• Do not exceed the maximum daily dose of 60 mg/kg per day, as exposures greater than 140 mg/kg/day for several days carry risk of serious hepatotoxicity 3
• Avoid using rectal formulations as first-line due to unpredictable absorption patterns 1
• Do not rely on acetaminophen to prevent febrile seizures—it improves comfort but does not prevent seizure recurrence 1

Alternating with Ibuprofen (if needed)

• When alternating medications, give acetaminophen every 4-6 hours and ibuprofen every 6-8 hours, staggering the timing so medications are given every 3-4 hours if both are needed 1
• Note that ibuprofen is generally not recommended for infants under 6 months 1