Paracetamol and children: Why dose matters for effectiveness, safety

Paracetamol (Acetaminophen) has long been a standard remedy for fever and pain in children. It’s effective and available without a prescription. Giving the correct dose is important because most medicines need to be taken in a certain amount and at certain times to be effective.

But giving children paracetamol safely can be complicated. An overdose can happen in the blink of an eye, from combined medications to using the wrong formulation and can cause stomach irritation within hours and liver damage within a few days.

An overdose of paracetamol in children is possible when the amount is taken exceeds the required dosage. Doses of drugs are dependent on the child’s actual size. In some situations, the amount prescribed is approximate based on the expected weight of the child at a particular age.

Dr Kemi Tongo, a consultant paediatrician, University College Hospital, Ibadan said that although administering the correct dose of any drug to a child based on the bodyweight might be possible at the hospital, doing so at home sometimes might be difficult.

She added, “If a child should actually take like 100mgs of a drug but because the drug comes as 120mgs in 5 mls, you have an excess of 20mgs. It is still okay since it is not something that the child will be taken so much.

“It is also difficult to tell a mother to give 3 or 4 mls of a syrup except if they will be using syringes. That is why we just use those ranges. In a situation where the child is grossly underweight and we use age to calculate the dose, the child may take too much.”

Dr Tongo, however, assured that because paracetamol has a wide safety margin, an extra of say 20mgs above that which is required might not be a problem.

However, she said a situation where the mother just gives paracetamol, maybe because the child has walked or played in the sun even, though the child is without any complaint or running a fever is dangerous and can lead to an overdose.

She declared that an overdose of paracetamol can damage the liver, including the brain and should be avoided in children.

According to her, “Paracetamol is not a drug that somebody should use for days on end. Usually, if the child has a fever, you use it and at most for a day or 2. Sometimes, I recall irresponsible advertisements, saying if a child is running a fever, give paracetamol and after 3 days consult a doctor.

“Three days is enough time for a lot of damage to have taken place. For instance, if a child has a fever and it is due to malaria and you keep given paracetamol only, in those 3 days, malaria will break down the child’s red blood cells. By the time they are landing in the hospital, the child is paperwhite. Meanwhile, the paracetamol will only suppress the fever but the cause of the fever is still there, it will come up later.

Dr Tongo said the advice may work in environments where bacterial infections and malaria are not very common and most febrile illnesses are due to viral infections since viral infections will run their course and go.

“In our environment, we have a lot of malaria and bacterial infections, you cannot take that kind of risk; you can’t approach it in that kind of manner because it is always better to quickly know what is wrong.

“But even then you are still at home and continue to give paracetamol until the child has developed complications, and then at that point, you are now so anxious and want the illness to go immediately, that is just wrong.”

It is common practice in Nigeria for mothers, especially in the local setting to give paracetamol tablets to children rather than syrups. Howbeit, she declared: “I encourage that especially since when we had “My pikin saga” when PCM syrup was adulterated. They used a diluent that was poisonous. When you look at it whether it is the tablet or the syrups, it is the same effect and also many of the paracetamol syrups do not come with measuring caps.”

Dr Tongo said the choice of paracetamol tablet will also ensure an adequate dose is given since paracetamol syrups don’t come with spoons and if you take a sample of the teaspoons in the market give different amounts of the syrup, and as such children may end up not getting the appropriate dose.

“Each quarter of a scored paracetamol tablet is equivalent to 5mls of the syrup. So to give 5mls, one will break it into 4, crush the quarter and put a small volume of water or breast milk to dilute it. It is a lot easier to get the child to take paracetamol in this form than the syrups, which feels very pungent and have a bitter after-taste. You will notice when children are taking the prepared syrups, they look like they are choking. If you have not tasted it, you wouldn’t know what these children really feel.

Giving children’s medicine safely can be complicated. Using medicines safely means knowing when they’re needed — and when they’re not. Always check with the doctor or pharmacist to be sure. Too little medicine can be ineffective and too much could be harmful. Also, different medicines have different concentrations of ingredients.