Paracetamol (Acetaminophen) Dosing for Children
The recommended dose of paracetamol for children is 10-15 mg/kg per dose, given every 4-6 hours, with a maximum daily dose of 60 mg/kg/day (not to exceed 5 doses in 24 hours). 1, 2
Standard Dosing by Weight
Weight-based dosing is more accurate than age-based dosing and should be prioritized. 1, 3
- Standard single dose: 10-15 mg/kg per dose 1, 4, 5
- Dosing interval: Every 4-6 hours 1, 2
- Maximum daily dose: 60 mg/kg/day 1, 6
- Maximum number of doses: Not to exceed 5 doses in 24 hours 2
The 15 mg/kg dose is more effective than 10 mg/kg doses and shows equivalent efficacy to NSAIDs while maintaining excellent tolerability. 5
Age-Based Dosing (When Weight Unknown)
When weight is unavailable, the FDA-approved age-based dosing can be used: 2
- Ages 2 to under 4 years: 5 mL (160 mg) every 4 hours
- Ages 4 to under 6 years: 7.5 mL (240 mg) every 4 hours
- Ages 6 to under 12 years: 10.15 mL (325 mg) every 4 hours
- Ages 12 years and over: 20.3 mL (650 mg) every 4-6 hours (not to exceed 6 doses in 24 hours)
- Under 2 years: Consult a doctor 2
Special Populations
Infants Under 3 Months
- Paracetamol is the only recommended analgesic in this age group 1
- Dose: 15 mg/kg if weight is less than 10 kg 1
- Limited evidence exists for neonates; 30 mg/kg/day achieves therapeutic concentrations, though further studies are needed 7
- For infants 1-3 months, 60-65 mg/kg/day is suggested, though pharmacokinetic data may favor higher doses 7
Post-Vaccination Fever
- Can be given at time of vaccination and every 4 hours for 24 hours 1
Children with History of Febrile Seizures
- Prophylactic dose of 15 mg/kg every 4 hours for 24 hours can reduce fever risk, though it does not prevent febrile seizures themselves 1
Route of Administration
Oral syrup is strongly preferred over rectal suppositories due to more rapid and consistent absorption. 1
Rectal Administration
- Should be used cautiously due to erratic absorption 1
- Consider only when child is actively vomiting or in perioperative situations where oral intake is restricted 1
- Risk of inadequate analgesia or accumulation with repeated dosing 1
Critical Safety Considerations
Maximum Dose Limits
- Never exceed 60 mg/kg/day or 5 doses in 24 hours 1, 2
- Single ingestions exceeding 10 times the recommended dose are potentially toxic 6
- Chronic exposures greater than 140 mg/kg/day for several days carry risk of serious hepatotoxicity 6
Common Prescribing Errors
- Many dosing schedules recommend inadequate amounts (≤10 mg/kg), which are less effective than NSAIDs 4, 5
- 17% of prescriptions may exceed 95 mg/kg/day, though actual administration is lower due to pharmacy and nursing oversight 7
- Prescriptions should clearly state: daily dose, number of divided doses, and child's weight 3
Pain Management Context
- Paracetamol is appropriate for mild-to-moderate pain 1
- Should not be used alone for severe pain; consider as adjunct only 1
- Provides significant additive analgesic effect when combined with opiates for severe pain 6
Clinical Efficacy
When dosed at 15 mg/kg, paracetamol is: 5
- Significantly more effective than placebo
- At least as effective as NSAIDs (ibuprofen, ketoprofen)
- Shows lower risk of adverse events compared to NSAIDs with repetitive dosing
- Has tolerability profile similar to placebo for short-term use