Paracetamol (Paediatric)

How it works

It is thought to act centrally, inhibiting prostaglandin synthesis within the central nervous system and modulating pain and temperature pathways, with little peripheral anti-inflammatory effect.

Prescribing in practice

• Paediatric dosing is weight- and age-banded and the margin between therapeutic and hepatotoxic doses is narrow, so dose and frequency must be checked against a children's formulary and carers warned not to exceed the stated daily maximum or combine with other paracetamol-containing products.
• Use caution in low body weight, malnutrition, chronic dehydration or pre-existing hepatic impairment, where toxicity can occur at lower exposures.
• Both oral and rectal formulations are available; bioavailability differs by route, so confirm the correct preparation when switching.

Monitoring

Routine monitoring is not required for short-term use, but suspected overdose mandates urgent paracetamol level measurement and assessment against the treatment nomogram.

Counselling the patient

• Use the measuring device provided and never estimate doses with kitchen spoons.
• Do not give other medicines containing paracetamol at the same time.
• Seek urgent help if more than the intended amount has been taken, even if the child seems well.

Evidence & guidelines

Paracetamol is established as first-line antipyretic and analgesic for children in NICE guidance on feverish illness in under-5s.