Paracetamol dose for children: a complete guide

The short answer: 15 mg/kg per dose, every 4–6 hours, max 4 doses per 24 hours

Paracetamol (acetaminophen) is the first-line antipyretic and mild analgesic for children from about 2 months of age. Dosing is by weight (not age), with a standard dose of 15 mg per kilogram every 4–6 hours, not to exceed 60 mg/kg/day (adult maximum 4,000 mg/day for healthy teenagers).

Is paracetamol approved for children?

Yes — paracetamol is approved and routinely used:

• Under 2 months: only with pediatrician guidance (fever in a young infant always needs medical review)
• 2–12 months: safe at weight-based doses
• Children (1–11 years): safe and first-line
• Adolescents (12+): adult-style dosing (500–1000 mg per dose)

Dosing by weight

For the common 120 mg/5 mL pediatric suspension:

| Weight (kg) | Dose (mg) | mL of 120 mg/5 mL | Frequency | |---|---|---|---| | 4–6 kg | 60–90 mg | 2.5–3.75 mL | every 4–6 h | | 6–8 kg | 90–120 mg | 3.75–5 mL | every 4–6 h | | 8–10 kg | 120–150 mg | 5–6.25 mL | every 4–6 h | | 10–15 kg | 150–240 mg | 6.25–10 mL | every 4–6 h | | 15–25 kg | 240–375 mg | 10–15.5 mL | every 4–6 h | | 25–40 kg | 375–600 mg | 15.5–25 mL | every 4–6 h | | >40 kg | 500–1000 mg | adult dose | every 4–6 h |

Maximum 4 doses in 24 hours. Do not exceed 60 mg/kg/day; for most children that translates to 4 doses at 15 mg/kg.

Formulations for children

• Infant drops (usually 100 mg/mL or 80 mg/mL) — for infants under 12 months; use the syringe provided
• Pediatric suspension (120 mg/5 mL or 160 mg/5 mL) — for children 1–11 years; use a medical dosing syringe, not a kitchen spoon
• Chewable tablets (80 or 160 mg) — age 2+ who can chew reliably
• Suppositories (125 or 250 mg) — for vomiting children or those refusing oral drug
• Adult tablets (500 mg) — only for adolescents reliably able to swallow

Warnings specific to pediatrics

• Dosing errors are the most common cause of pediatric paracetamol toxicity. Use a medical syringe, not a teaspoon.
• Concentration confusion: infant drops (100 mg/mL) are much more concentrated than pediatric suspension (120 mg/5 mL). Always double-check the label.
• Do not combine with other paracetamol-containing cold/flu medications — accidental double-dosing is the #2 cause of overdose.
• Fever in infants under 3 months is a medical emergency — see a doctor before giving antipyretics.
• Signs of overdose: nausea, vomiting, right upper abdominal pain hours later. Liver toxicity peaks at 48–72 hours; contact poison control immediately if overdose is suspected.

Clinical sources

• American Academy of Pediatrics — "Fever and Antipyretic Use in Children" clinical report (Pediatrics 2011, updated 2022).
• NICE CG160 "Fever in under 5s: assessment and initial management."
• BNF for Children (BNFc) — acetaminophen monograph.
• FDA Pediatric Drug Information — acetaminophen.

Bottom line

Paracetamol 15 mg/kg every 4–6 hours (maximum 4 doses/day) is safe and first-line for fever and mild pain in children over 2 months. Use a proper medical dosing syringe, avoid combining with cold/flu products, and consult your pediatrician for infants under 3 months or for persistent fevers.

Always use a medical dosing syringe — never a household teaspoon. When in doubt, call your pediatrician or pharmacist.