Pediatric Paracetamol Dose

Pediatric paracetamol (acetaminophen) dosing

In children, paracetamol is dosed by body weight. The usual range is 10–15 mg/kg per dose, repeated every 4–6 hours when needed. The daily maximum is 75 mg/kg/day for children aged ≥2 years and 60 mg/kg/day below 2 years, and it should never go past 4 g/day in adolescents. The Brazilian presentations you will run into are drops 200 mg/mL (1 drop ≈ 10 mg), plus oral suspension 100 mg/mL and 32 mg/mL. Take a worked example: a 15 kg child at 12.5 mg/kg needs 187.5 mg per dose, which works out to about 19 drops (200 mg/mL) or 1.9 mL of the 100 mg/mL suspension. The daily ceiling here is 75 × 15 = 1125 mg/day.

Clinical context

It is the first-line antipyretic and analgesic in pediatrics, covering fever, post-vaccination discomfort and mild-to-moderate pain. When a child is dehydrated or carries a bleeding risk, it tends to be chosen ahead of ibuprofen. Stick to the ANVISA package insert and the recommendations of the Brazilian Society of Pediatrics (SBP). One thing worth double-checking every time is the concentration printed on the specific brand, since mixing up 100 mg/mL with 200 mg/mL doubles the dose. In accidental overdose the main danger is hepatotoxicity.

FAQ

Drops or suspension? Drops (200 mg/mL) keep the volume small, which helps with younger kids. The oral suspension (100 mg/mL or 32 mg/mL) works better at larger weights and leaves less room for measuring mistakes.

Can I give paracetamol every 4 hours? Yes. Just keep the total daily dose under the maximum and make sure the child stays properly hydrated.

What if the fever does not improve? Check again after 30–60 minutes, and resist the urge to double the dose. If the fever hangs on, or you notice lethargy or signs of dehydration, get medical attention.