What is the recommended paracetamol (acetaminophen) dose for a typically healthy 2‑year‑old child?

Paracetamol Dosing for a 2-Year-Old Child

For a typically healthy 2-year-old child, give paracetamol 10–15 mg/kg per dose every 4–6 hours, with a maximum daily dose of 60 mg/kg/day (not exceeding 5 doses in 24 hours). 1

Standard Dosing Protocol

• Single dose: 10–15 mg/kg per dose 1, 2
• Dosing interval: Every 4–6 hours 1
• Maximum daily dose: 60 mg/kg/day 1
• Maximum number of doses: Do not exceed 5 doses in 24 hours 1

For a typical 2-year-old weighing approximately 12 kg, this translates to 120–180 mg per dose (most commonly 150 mg), given every 4–6 hours as needed.

Practical Administration

• Oral syrup is preferred because it is absorbed more rapidly and provides a more consistent response compared to rectal suppositories 1
• The standard oral suspension concentration is 160 mg/5 mL (32 mg/mL), so for a 12 kg child receiving 150 mg, administer approximately 4.7 mL (round to 5 mL for practical dosing) 2

Loading Dose Strategy (When Rapid Effect Needed)

If more aggressive fever or pain control is required initially:

• Loading dose: 25 mg/kg as a single dose 3, 4
• Maintenance dose: 12.5 mg/kg every 6 hours thereafter 3, 4

This regimen achieves therapeutic plasma concentrations (4–18 mg/L) more rapidly and maintains them consistently 3. However, the simpler 10–15 mg/kg every 4–6 hours regimen is adequate for most situations 1.

Critical Safety Considerations

Never exceed 60 mg/kg/day or 5 doses in 24 hours to prevent hepatotoxicity 1. Single ingestions exceeding 140 mg/kg/day for several consecutive days carry significant risk of serious liver toxicity 5.

Dose Reduction Required in High-Risk Situations

Reduce the dose to 10 mg/kg (lower end of range) in children with:

• Chronic malnutrition or fasting >8 hours without adequate caloric intake 1
• Medications inducing cytochrome P450 enzymes (e.g., isoniazid), which increase production of the toxic NAPQI metabolite 1
• Pre-existing liver disease, though paracetamol remains safer than NSAIDs in this population 1

Common Pitfalls to Avoid

• Underdosing: Many commercially available dosing charts recommend inadequate amounts based on age alone rather than weight 2. Always calculate the dose based on the child's actual weight.
• Accidental overdose when alternating with ibuprofen: If using both medications, carefully record all dose times to avoid exceeding the maximum recommended dose of either drug 6. Parents should maintain a written log.
• Relying on rectal formulations: Rectal paracetamol has erratic absorption, meaning some children receive inadequate analgesia while others risk accumulation with repeated dosing 1. Reserve rectal administration only for children who are actively vomiting or in perioperative situations where oral intake is restricted 1.

Duration of Effect and Re-dosing

• A dose of 10–15 mg/kg maintains temperature reduction of approximately 1.5°C below baseline for about 6 hours 3
• The half-life is 1–3.5 hours in children 3
• Re-dose every 4–6 hours as needed, but not more frequently than every 4 hours 1

When to Consider Ibuprofen Instead

If fever or pain control is inadequate with paracetamol alone, ibuprofen 10 mg/kg every 6–8 hours may be more effective as a first-line agent 1, 6. However, ibuprofen is generally not recommended for infants under 6 months 1. For children over 6 months, ibuprofen may provide an additional 2.5 hours without fever over 24 hours compared to paracetamol alone 6.