Paracetamol Dosing for a 6-Year-Old Child
For a 6-year-old child, give paracetamol 15 mg/kg per dose every 4-6 hours, not exceeding 60 mg/kg per day or 5 doses in 24 hours. 1
Weight-Based Dosing Algorithm
- Standard dose: 15 mg/kg per dose is the optimal therapeutic dose for both fever and pain management in children 1, 2
- Dosing interval: Administer every 4-6 hours as needed 1
- Maximum daily dose: Never exceed 60 mg/kg per day 1, 3
- Maximum number of doses: Do not give more than 5 doses in 24 hours 1
Practical Example for a Typical 6-Year-Old
- A 6-year-old typically weighs approximately 20 kg 1
- Single dose: 15 mg/kg × 20 kg = 300 mg per dose 2
- Maximum daily: 60 mg/kg × 20 kg = 1,200 mg per day 1
- This translates to 300 mg every 4-6 hours, up to 4-5 times daily 1, 4
Why 15 mg/kg Is Superior to Lower Doses
- Older studies using subtherapeutic doses of ≤10 mg/kg showed paracetamol was less effective than NSAIDs 2
- Recent evidence demonstrates that 15 mg/kg is significantly more effective than placebo and at least as effective as NSAIDs for both fever and pain 2
- The 10 mg/kg dose (used in some countries like the UK) is often inadequate for optimal efficacy 3, 5
Route of Administration
- Oral syrup is preferred: It provides more rapid and consistent absorption compared to rectal suppositories 1
- Rectal administration: Use cautiously due to erratic absorption; reserve for children who are actively vomiting or in perioperative situations where oral intake is restricted 1
Safety Considerations
- Paracetamol has a tolerability profile similar to placebo when used at recommended doses 2
- Toxicity threshold: Single ingestions exceeding 140 mg/kg/day for several consecutive days carry risk of serious hepatotoxicity 3
- Unlike NSAIDs, paracetamol is safe for children of all ages and has lower risk of adverse events with repetitive dosing 2
Common Pitfalls to Avoid
- Underdosing: Many dosing schedules recommend inadequate amounts (10 mg/kg), leading to suboptimal pain and fever control 5, 6
- Exceeding maximum daily dose: Always calculate total daily dose to ensure it stays below 60 mg/kg/day 1
- Using rectal route as first-line: Suppositories have slow and irregular absorption; use oral route whenever possible 4
Special Clinical Scenarios
- Febrile seizure history: Paracetamol at 15 mg/kg can be given prophylactically to reduce fever, though it does not prevent seizure recurrence 1, 7
- Post-vaccination fever: Can give at time of vaccination and every 4 hours for 24 hours 1
- Alternating with ibuprofen: If both medications are needed, stagger timing so medications are given every 3-4 hours (paracetamol every 4-6 hours, ibuprofen every 6-8 hours) 1