Paracetamol Dosing for a 15 kg, 2-Year-Old Child
For a 2-year-old child weighing 15 kg, administer 10 mL of paracetamol syrup (120 mg/5 mL) every 4–6 hours, which delivers 240 mg per dose (16 mg/kg), not exceeding 5 doses in 24 hours. 1
Dose Calculation
- Standard weight-based dosing is 10–15 mg/kg per dose every 4–6 hours 1, 2
- For a 15 kg child, this translates to 150–225 mg per dose 1
- Using the 120 mg/5 mL syrup concentration:
- Minimum dose (10 mg/kg): 150 mg = 6.25 mL
- Optimal dose (15 mg/kg): 225 mg = 9.4 mL (round to 10 mL for practical administration)
- Middle-range dose (16 mg/kg): 240 mg = 10 mL 1
Dosing Interval and Maximum Daily Dose
- Administer every 4–6 hours as needed for fever or pain 1, 3
- Maximum 5 doses in 24 hours 3
- Maximum daily dose: 60 mg/kg/day (900 mg for this 15 kg child) 1, 2
- At 240 mg per dose × 5 doses = 1200 mg/day, which exceeds the safe limit—therefore limit to 4 doses per day (960 mg) if using 10 mL per dose, or use the lower 7.5 mL dose (180 mg) for 5 doses (900 mg total) 1
Practical Dosing Strategy
The safest approach is to give 7.5 mL (180 mg = 12 mg/kg) every 4–6 hours, up to 5 doses per 24 hours, totaling 900 mg/day (60 mg/kg/day). 1, 3
- This stays within the maximum daily limit while providing effective analgesia and antipyresis 2
- Recent evidence demonstrates that 15 mg/kg dosing is significantly more effective than lower doses (≤10 mg/kg) and is as effective as NSAIDs while maintaining excellent tolerability 2
Age-Based FDA Guidance Cross-Check
- The FDA label for children 2 to under 4 years recommends 5 mL (160 mg) every 4 hours, not exceeding 5 doses in 24 hours 3
- However, this is a fixed age-based dose that does not account for weight variation within the age range 3
- Weight-based dosing is more accurate and is the preferred approach recommended by the American Academy of Pediatrics 1, 4
Key Safety Considerations
- Counsel parents to avoid all other paracetamol-containing products (e.g., cold/flu remedies) to prevent inadvertent overdose 5
- Never exceed 60 mg/kg/day or 5 doses in 24 hours 1
- Oral syrup is absorbed more rapidly and consistently than rectal suppositories 1
- For children with malnutrition, fasting >8 hours, or on enzyme-inducing medications (e.g., isoniazid), reduce dose to 10 mg/kg to minimize hepatotoxicity risk 1
Clinical Pitfalls to Avoid
- Subtherapeutic dosing (<10 mg/kg) is less effective than NSAIDs and should be avoided 2
- Chronic overdosing (>140 mg/kg/day for several days) carries serious hepatotoxicity risk 6
- Do not use paracetamol routinely for uncomplicated reflux or irritability in infants—reserve for documented fever or pain 7