Paracetamol Overdose in Infants and Children

Paracetamol (also known as acetaminophen) is one of the most commonly used over-the-counter (OTC) medications for pain relief and fever reduction in children. While it is generally safe when administered correctly, an overdose can have severe consequences, including liver damage or failure. 

Paracetamol overdose occurs when a child consumes more than the recommended dose of the medication, leading to toxic effects on the liver. The liver metabolizes paracetamol into harmless substances, but excessive amounts produce toxic metabolites that can cause severe liver damage.

• Incorrect dosing: Parents may accidentally give too much, thinking it will work faster.

• Multiple medications: Some cold and flu syrups contain paracetamol, increasing the risk of overdose if given alongside a direct paracetamol dose.

• Accidental ingestion: Curious toddlers may access medicine bottles left within reach.

The symptoms of overdose occur in four stages:

1. First 24 Hours: Nausea, vomiting, lethargy, loss of appetite, and mild abdominal pain.

2. 24-72 Hours: Worsening abdominal pain, jaundice, dark urine, and signs of liver dysfunction.

3. 72-96 Hours: Severe toxicity leading to liver failure, confusion, coma, or even death.

4. Recovery Phase: If treated in time, the liver may start to recover over several weeks.

If a child exhibits any of these symptoms after consuming paracetamol, seek immediate medical attention.

Understanding Young’s Formula

Young’s formula is a calculation used to determine the appropriate medication dose for children based on their age:

However, pediatricians usually follow a weight-based dosing method for accuracy.

Pediatricians prescribe paracetamol based on the child’s weight, not just their age.

• For infants (below 1 year): 10-15 mg per kg of body weight every 6 hours.

• For toddlers (1-5 years): 120 mg per dose, maximum 4 doses per day.

• For older children (6-12 years): 250-500 mg per dose, not exceeding 4 doses per day.

Over 4,000 mg in 24 hours can be fatal. If uncertain, always consult a doctor before administering medication.

1. Always measure doses correctly. Use a proper measuring syringe or spoon, not household teaspoons.

2. Read labels carefully. Avoid giving multiple medicines containing paracetamol at the same time.

3. Follow weight-based dosing. Do not estimate based on age alone.

4. Store medicine safely. Keep paracetamol and all medicines out of children’s reach.

5. Track doses. Note down when you gave the last dose to prevent accidental extra dosing.

Mistakes can happen, especially when dealing with a sick child. If you realize that you gave too much paracetamol, follow these steps immediately:

1. Do Not Panic: Staying calm will help you take quick and rational actions.

2. Check the Amount Given: If the extra dose is small, observe for any symptoms. If it’s significantly higher, seek medical help immediately.

3. Call a Doctor or Poison Control: Medical professionals can guide you on whether immediate intervention is needed.

4. Do Not Induce Vomiting: Unlike other poisonings, vomiting is not recommended for paracetamol overdose.

5. Go to the Hospital if Necessary: Doctors may administer activated charcoal (if within 1 hour of ingestion) or N-acetylcysteine (NAC), an antidote that helps prevent liver damage.

Paracetamol toxicity can be serious, but early medical intervention can prevent permanent liver damage.

While paracetamol overdose primarily affects the liver, aspirin poisoning leads to metabolic imbalances, affecting the brain and lungs. Both require immediate medical attention. You can also read our detailed article on Aspirin Poisoning in Kids to understand its symptoms and treatment.

Paracetamol is an essential medicine in pediatric care, but careful dosing is crucial to avoid dangerous side effects. Always measure accurately, store medicines safely, and seek medical help if an overdose occurs.