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Acetaminophen and children: Why dose matters

An acetaminophen overdose is serious — and it can happen easier than you might think. Here's how to protect your child, and when to seek emergency care.

By Mayo Clinic staff

Acetaminophen (Tylenol, others) has long been a standard remedy for fever and pain in children. It's effective and readily available without a prescription. In excess, however, even good things can be harmful. Here's what you need to know about acetaminophen overdoses and children.

How does an acetaminophen overdose occur?

An acetaminophen overdose can happen in the blink of an eye. Consider these scenarios:

  • You're in a hurry. You might unknowingly give your child too much acetaminophen if you don't take the time to carefully measure the medication — or if you don't realize that another caregiver has already given your child a dose of medication.
  • You combine medications. If your child has various cold symptoms, your instinct might be to combine acetaminophen with a cold remedy. This can be dangerous, however, because many cold medications already contain acetaminophen. Also keep in mind that the Food and Drug Administration (FDA) discourages use of cough and cold medicines for children younger than age 2.
  • You use the wrong formulation. You might cause an overdose if you give your child adult acetaminophen instead of a children's formulation. Even the children's versions of acetaminophen come in many different formulations, and the dose varies for each one. For example, infant drops are more concentrated than is the liquid acetaminophen typically given to toddlers. If you assume that both liquids contain the same amount of medicine, substituting infant drops for syrup could lead to an acetaminophen overdose.
  • You decide that more is better. If you're not satisfied with the performance of the recommended dose of acetaminophen, you might increase the dose or its frequency and cause an accidental overdose.
  • Your child mistakes the medication for candy or juice. Overdoses often occur when a child mistakes acetaminophen for something safe to eat or drink. Sometimes this happens when an adult leaves the bottle open or accessible after taking his or her own medication.

What are the recommended acetaminophen doses?

If you give your child acetaminophen, read the product label carefully to determine the correct dose based on your child's weight. If you don't know your child's current weight, you can use your child's age to determine the dose.

Generally, doses can be repeated every four hours, but shouldn't be given more than five times in 24 hours.

To reduce the risk of medication errors, manufacturers are in the process of changing the concentration of infant drops to match that of children's liquid. As a result, the dosing directions for infant drops will change. Be aware that there might be a time when both the current and new concentrations of infant drops are available.

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  8. Acetaminophen (paracetamol): Pediatric drug information. http://www.uptodate.com/home/index.html. Accessed April 20, 2011.
  9. Sullivan JE, et al. Fever and antipyretic use in children. Pediatrics. 2011;127:580.
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  11. Acetaminophen. Micromedex Healthcare Series. http://www.micromedex.com. Accessed March 9, 2011.
  12. Carlton L, et al. Drug doses. In: Custer JW, et al. Harriet Lane Handbook. 18th ed. Philadelphia, Pa.: Mosby Elsevier; 2008. http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-0-323-05303-7..50034-9--cesec2&isbn=978-0-323-05303-7&type=bookPage&sectionEid=4-u1.0-B978-0-323-05303-7..50034-9--cesec2&uniqId=239895152-2#4-u1.0-B978-0-323-05303-7..50034-9--cesec2. Accessed April 25, 2011.
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HO00002 June 18, 2011

© 1998-2013 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. "Mayo," "Mayo Clinic," "MayoClinic.com," "EmbodyHealth," "Enhance your life," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.

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