Paracetamol for children

What is paracetamol?

Paracetamol can be safely given to babies and children to treat different types of pain including headache, toothache and sore throat. Paracetamol is also used to treat fever but mild fever does not need to be treated unless it is causing discomfort. Read more about fever in children. 

Does my child need paracetamol?

• Paracetamol may be used if your child needs pain relief or if your child has a fever (temperature over 38.5°C) AND is miserable.
• It is not recommended to give paracetamol before or after regular vaccinations unless your child is in pain or is miserable.

Do not give paracetamol before vaccinations and only give it after vaccination if your child needs it. 

Paracetamol should start to work quite quickly. Your child should feel less pain 30 minutes to an hour after taking paracetamol. Use paracetamol only if necessary, and for the shortest amount of time to reduce fever or pain. 

Medicines that have paracetamol in them

In New Zealand, paracetamol is available as a liquid, tablet and suppository. It is also found in many other medicines you can buy from the pharmacy for colds and flu or pain. Overdose can happen if you give your child more than one paracetamol-containing medicine. Check the ingredients of cold and flu medicines before you give them to your child. If you do give your child other medicines that have paracetamol, be careful not to give them more than the recommended dose of paracetamol each day.

Note: the following products are not suitable for children younger than 12 years.   

Using paracetamol safely

Paracetamol can be safely given to babies and children but there is a limit to the amount of paracetamol that can be safely taken in a 24-hour period. Giving more than the daily limit is very harmful to the liver. 

Doses for children depend on their weight and must be calculated carefully. The maximum dose is 15 mg/kg every 4–6 hours to a maximum of 1 gram per dose, and no more than 4 doses in a 24-hour period.

How to give paracetamol to babies and children

Dose

• The dose of paracetamol is based on your child’s weight and not their age.
• The recommended dose is 15 mg/kg every 4 to 6 hours to a maximum of 1 gram per dose, and no more than 4 doses in a 24-hour period.
• As your child grows, the dose of paracetamol will need to be increased based on their weight, to ensure that they are getting the correct dose.
• The dose for each child is based on their own weight. Do not use the same dose for each child unless they are the same weight.
• If you are giving paracetamol to your child, and are unsure of how much to give, always check with your pharmacist. See the dose chart below as a guide.
• When measuring the dose, measure the right amount using an oral syringe or medicine spoon. You can get these from your pharmacy. Do not use a kitchen spoon as it will not give you the right amount. Read more: tips on how to give medicines to babies and children.

Timing

Paracetamol is given no more than 4 times a day, for example, in the morning, at about midday, late in the afternoon and at bedtime. Wait at least 4 hours before giving the next dose, for example, 8 am, midday, 4 pm and 8 pm. Do not give more than four times in 24 hours. Keep track of the timing of the doses and check when it was last given before giving it again. Before each dose, check if your child still needs it.

Strength

Paracetamol liquid

Paracetamol liquid is available in two strengths – 120mg in 5mL (lower strength) and 250mg in 5mL (higher strength).
Always check that the dose you are giving your child matches the strength of the liquid. If you are unsure, check with your doctor or pharmacist. 

• Also see Giving paracetamol safely to babies and children (Chinese) (Korean) SafeRx, Waitematā DHB, 2014 
• The following is a guide:  

• Paracetamol tablets comes as 500 mg tablets.
• Check other medicines your child is taking. Some combination medicines for colds and flu may also have paracetamol in them.
• Tablets are suitable for older children who can swallow them.
• Tablets should be swallowed with a glass of water. Your child should not chew the tablet., it has a very bitter taste.
• When giving tablets, you must work out the dose that is right for your child.

My child's dose

Know the right dose to give your child and check the strength. Use the table above to calculate your child's dose.

• Strength of paracetamol:   120 mg/5 mL  OR   250 mg/ 5 mL  OR 500 mg tablets
  
  
• My child's weight (kg):   ______________
  
  
• Dose (mL):    _________________  

How to store paracetamol?

Keep all medicines out of the reach and sight of children, in a locked or latched cupboard.

• Paracetamol does not need to be chilled: do not keep it in the fridge.
• Make sure the bottle has a child-resistant cap – ask your pharmacist.

Overdose

Paracetamol is a very popular medicine and when taken correctly works well. However, too much paracetamol is very harmful to the liver.

• If you realise you have given your child too much (including other products with paracetamol in it), call your doctor, nurse or the Poisons Centre  0800 POISON (0800 764 766) immediately. Children are most at risk so take extra care.
• Keep all paracetamol in child-proof containers, out of reach and out of sight of children.

Do NOT wait for signs of an overdose as these appear late when damage to the liver is already done.

Late signs may include nausea or vomiting, diarrhoea (runny poos), yellow skin or eyes, poor appetite and confusion or extreme sleepiness.

Learn more

Medsafe Consumer information sheets  Children's Panadol

References

1. Paracetamol New Zealand Formulary for children
2. Paracetamol dosing for children in primary care BPAC, 2018