Is Acetaminophen Safe for Children?

Acetaminophen is a commonly used medication for managing pain and fever. Luckily for parents, it works really well in children and is generally safe to use! I consider acetaminophen a staple in any family's medicine cabinet. It's always good to have on hand, especially for those middle-of-the-night illnesses that inevitably pop up throughout the cold and flu season. 

Understanding how to use this medication safely is important for parents. This guide provides essential information to help you use acetaminophen effectively for your child.

Understanding Acetaminophen

Acetaminophen, commonly known as Tylenol®, is an analgesic (pain reliever) and antipyretic (fever reducer) medication. It is available on its own or in a variety of combination products. It comes in various forms, including liquid suspensions, chewable tablets, and suppositories, making it suitable for children of different ages. 

When to Use Acetaminophen

Acetaminophen is appropriate for:

• Mild to moderate pain (such as headaches, sore throats, teething pain, or minor injuries)
• Fever reduction

One tidbit: not all fevers require medication. Fever is often the body's normal response to fighting infection. Speak to your child's medical provider for guidance, but generally speaking, if your child has a low-grade fever and is comfortable, monitoring them without medication may be acceptable. 

What Types of Acetaminophen are Available?

The liquid products come in various flavors and colors, including dye-free and sugar-free options. Even the most discerning of toddlers should accept this medication with minimal fuss! 

The chewable tablets are excellent for children who won't take the liquid or for caregivers who cannot accurately draw up the correct volume of liquid. Chewable tablets come in different strengths, so read the dosage label carefully. 

How is Acetaminophen Dosed in Kids?

Correct dosage is critical when using acetaminophen in children. It is a safe medication, but it can have severe consequences if patients receive too much. Here are key points to remember:

• The appropriate dose is based on your child's weight, not age.
• Follow the dosing recommendation on the package. 
  • Consult your pediatrician for further guidance on dose, but be sure to cross-reference the package. 
  • Tablets, chewable tablets, and liquids come in different strengths, so it's important to know how many milligrams, or "mg," your child needs and how that corresponds to the product in your hand. 
• Always use the measuring device provided with the medication.
  • An oral syringe or cup with markings in milliliters or "mL" is appropriate. 
  • Do not use household measuring devices.
  • Do not estimate or guess the correct volume. 
• Check the concentration of liquid medication and the strength of tablets or chewable tablets, as formulations may differ. 
• Never exceed the recommended dose or frequency of administration.

How Often is Acetaminophen Given?

Acetaminophen can be given every 4 to 6 hours as needed but should not be administered more than 5 times in 24 hours. When my kids are sick, I find it helpful to keep notes of when they receive acetaminophen so I don't accidentally give them too much. 

Sometimes, a healthcare provider may recommend giving acetaminophen "around the clock" or on a scheduled basis. Work with your child's doctor to ensure you give the correct dose and stay within the maximum amount recommended for your child in each 24-hour period. Remember, the maximum individual and daily doses of acetaminophen for children are based on weight. 

Potential Side Effects

While generally safe when used as directed, acetaminophen can cause side effects in some children, including:

• Nausea or stomach pain
• Loss of appetite
• Rash or allergic reactions (rarely)

If you notice unusual symptoms, discontinue use and contact your healthcare provider.

Avoiding Acetaminophen Overdose

Acetaminophen overdose can cause severe liver damage. In fact, the FDA has taken several measures over recent years to improve labeling and regulate the various strengths that manufacturers can produce. 

Liver damage and other serious side effects can occur after a single large overdose or after several days of administering too much. To prevent accidental overdose:

• Read labels carefully, as acetaminophen is an ingredient in many combination medications. For kids, I recommend avoiding combination cold and flu products that contain multiple ingredients in most cases. While not technically "wrong," I find it very easy for sleep-deprived parents to accidentally give their children acetaminophen and then give them a cough medicine that ALSO contains acetaminophen. 
• Keep a log of all medications given to your child. Write down the times that your child received acetaminophen to help keep better track.
• Store medications out of children's reach. Consider a childproof box on a high shelf. 
• Never give adult formulations to children unless instructed by a healthcare provider. 

Other Things to Know

For Infants

For babies under 3 months with a fever, do not self-treat a fever or pain. Contact your healthcare provider immediately.

For Children with Certain Health Conditions

Consult with your healthcare provider before using acetaminophen if your child has liver disease, is malnourished, or is taking other medications. Acetaminophen is a safe medication but is metabolized by the liver, and care must be taken in children with specific healthcare concerns. 

For Caregivers 

• Store all medication out of reach of children. 
• Check expiration dates. 
• Keep oral syringes on hand for accurate measuring of liquids.
  • Pro tip: if you run out, consider asking your local pharmacist for oral syringes. Pharmacists are often happy to give them out free of charge :) 
• If another caregiver, such as Grandma or the babysitter, will be watching your child, leave precise written instructions to help prevent overdose. 

When to Seek Medical Attention

Seek medical attention if:

• Your child's fever persists for more than 3 days.
• Pain continues for more than 5 days.
• Your child's fever is very high (different doctors may have different guidance on what is considered very high, so consult your office with concerns). 
• Symptoms worsen, or new symptoms appear.
• You suspect an overdose has occurred.

Conclusion

When used correctly, acetaminophen can safely manage pain and fever in children. It can be a wonder drug on those yucky, don't feel good days. If your child can get by without medication, great! But if they are so uncomfortable they're unable to eat, sleep, or drink, acetaminophen may be a great option to help reduce fever or pain. 

Always follow dosing instructions carefully and consult your healthcare provider with any questions or concerns.

This guide and others at KidsMedGuide.com provide general information and are not a substitute for professional medical advice. Always consult with your pediatrician for medical advice or personalized recommendations. 

References:

1. U.S. National Library of Medicine. (2023). DailyMed - ACETAMINOPHEN. https://www.dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0c659735-9810-912a-e063-6294a90a9051
2. U.S. National Library of Medicine. (2023). Acetaminophen. MedlinePlus. https://medlineplus.gov/druginfo/meds/a681004.html
3. American Academy of Pediatrics. (2023). Medications Used to Treat Fever. HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/fever/Pages/Medications-Used-to-Treat-Fever.aspx
4. U.S. Food and Drug Administration. (n.d.). Acetaminophen. https://www.fda.gov/drugs/information-drug-class/acetaminophen

This article has been reviewed by Andrea Morrissey, PharmD, Board Certified Pediatric Pharmacy Specialist, and Chief Content Officer of Kids Med Guide. The content is for educational and entertainment purposes only and does not replace professional medical advice. Always consult your healthcare provider for medical guidance, and call 911 in an emergency.

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