Acetaminophen: Watch dosage for children

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Acetaminophen: Watch dosage for children

By Mayo Clinic staff

Acetaminophen (Tylenol, others) has long been the standard remedy for fever

and pain in children. You can give acetaminophen drops to feverish newborns.

You can buy acetaminophen at the grocery store without a prescription. But

even good things, in excess, can harm you. That maxim is particularly

appropriate when it comes to acetaminophen and children.

Acetaminophen: A popular drug

Acetaminophen is the most widely used pain reliever and fever reducer in the

United States, and it's readily available in most parts of the world. It

became a staple of the home medicine cabinet in the late 1970s and early

1980s, when the connection between aspirin and Reye's syndrome — a rare but

potentially fatal childhood disease that affects the blood, liver and brain

— gained wide publicity. Doctors now strongly advise against giving children

aspirin when they have a viral illness such as chickenpox or respiratory

influenza.

Reye's syndrome

Overdose is common

Partly because it is so easy to obtain, acetaminophen causes more overdoses

and overdose deaths than any other drug in the United States. It's

frequently the drug of choice for adolescent suicide attempts. Other

overdoses occur simply because people underestimate or are unaware of

acetaminophen's toxicity.

Acetaminophen can damage the livers of both adults and children. People who

habitually drink excessive amounts of alcohol have a higher risk of liver

damage from acetaminophen.

Dangers of liver damage

You can't live without a liver. It produces the bile that helps you digest

your food. It manufactures the clotting factors that stop the bleeding when

you cut your finger. It stores energy and iron reserves. And it breaks down

or removes many chemicals and drugs that enter your bloodstream.

Too much acetaminophen overloads the liver's ability to process the drug

safely. Its toxic byproducts injure the liver, and kidney failure also can

occur. A severe acetaminophen overdose can be fatal. Luckily, there is an

antidote — called N-acetylcysteine (NAC) — but it must be administered

within eight to 10 hours after an overdose has been ingested.

How overdoses occur

Serious cases of acetaminophen overdose occur when parents unwittingly give

a child too much of the medicine. The symptoms of overdose — nausea,

vomiting, stomachache — can be caused by so many common illnesses, it's

often not apparent that the child needs emergency medical treatment.

Parents can make a variety of mistakes in the amount of acetaminophen they

give their children. Some aren't satisfied with the performance of the

recommended dosage of acetaminophen, and decide more will be better. Others

may mistakenly give adult tablets instead of the children's formulation.

Even the children's versions of acetaminophen come in many different

formulations, and the dosage varies for each one. For example, the infant

drop formulation is three times as concentrated as the elixir or syrup

typically given to toddlers.

It's easy to see how a busy parent might assume that both liquids contain

the same amount of medicine. But substituting infant drops for syrup could

result in a dose of acetaminophen three times what it should be.

Many cold remedies already contain acetaminophen, so parents may

accidentally cause an overdose by giving acetaminophen in addition to these

preparations.

Dangerous exploration

Overdoses also can occur when children, particularly toddlers, come across

the medicine during an unauthorized exploration of a medicine cabinet or

their mother's purse. They may mistake medicine for candy or juice.

This can be especially dangerous when the medicine is adult-strength

acetaminophen. Adult tablets contain 325 milligrams (mg) or 500 mg of

acetaminophen, while children's tablets contain only 80 mg or 160 mg.

Fortunately, the most common type of exploratory ingestion involves

acetaminophen syrup. Children very rarely drink enough of this medicine to

harm their livers.

How much is too much?

Many factors, including the child's age, determine how badly a particular

dose of acetaminophen can damage the liver. For example, children under the

age of 5 seem to be less susceptible to liver damage than are older children

and adults. The amount of food in the child's stomach also is a factor.

To estimate the risk, doctors need to know how much the child weighs and how

many milligrams of acetaminophen have been ingested.

In general, doctors recommend a visit to the emergency department in cases

where a child may have ingested more than 150 mg of acetaminophen per 1

kilogram of the child's weight — or 68 mg of acetaminophen per pound of the

child's body weight. A toll-free poison control center, (800) 222-1222, also

can provide advice.

Read the label!

Acetaminophen is a safe and effective drug, when taken as recommended. Read

the label carefully and don't give your child more than the recommended

dosage. Just because a drug can be purchased without a prescription doesn't

mean it can't harm your child.

September 21, 2005

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