Earlier this year, the FDA recommended the discontinuation of infant acetaminophen drops. The goal was to minimize confusion by only making acetaminophen (aka Tylenol) in one universal liquid strength for both babies and older children. However, because the FDA provided a recommendation and not a mandate, there are currently two different liquid acetaminophen preparations on the shelves marketed for babies. And another liquid marketed for older children. Ultimately, it may be more confusing than ever. Thank goodness I just got a little help from my friends…
The pharmacists at Seattle Children’s Hospital created the below handouts designed to clarify dosing for infant and children’s over-the-counter (OTC) fever reducers/pain relievers. Print them out and put it in your medicine cabinet. Review it with Grandma or the sitter or your partner. And remember, the most important way to avoid a dosing error is to keep the original dosing device with the actual OTC medication. Resist the urge to grab a kitchen spoon!
Check out a video I made last year about common OTC medication dosing problems. The numbers will surprise you (hint: nearly all pediatric OTC meds in the US had inconsistencies, superfluous, or confusing dosing instructions). Dosing medications for our children can be more complicated than we’d like. So let me know what else you want to know about dosing acetaminophen or ibuprofen.
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Dave Hoffman says
I’m guessing that you’re tiring of explaining the change 10 times a day like I am! The frustrating thing is that there’s been such a long delay in the “new” Infant (brand name) Tylenol showing up on the shelves, so both strengths are currently out there.
Do you recommend that ibuprofen should not be given to babies under 6 months? If so, you might want to have that added to the handout.
anna ash says
this is great but I wanted to print to put on the fridge at home but when I do, it’s only text, which isn’t helpful! Can this be fixed???
Wendy Sue Swanson, MD says
Anna, it was fixed. Is it working for you now??
Danyelle Repsher says
Is this chart still up to date. When I click on it, it is no longer available.
Stacey Ulacia says
The charts are up to date. Here are links to downloadable versions. You have to click the blue “View and Print” text near the bottom right of each page.
Acetaminophen (Tylenol) Dosage Table: https://patient-education.childrens.sea.kids/Details.aspx?Id=7471
Ibuprofen (Motrin) Dosage Table: https://patient-education.childrens.sea.kids/Details.aspx?Id=7470
Kimberly Baumstark says
I agree about adding the information about ibuprofen not being recommended for infants under 6 months of age. Also, I always wonder with charts like the one above, which is the more important guide: weigh or age? I have a 25 lb 17 month old.
Thanks for posting this! As confusing as this can be and as important as it is to get it right, we can use all the help we can get.
Wendy Sue Swanson, MD says
Thanks. I don’t recommend ibuprofen (Advil or Motrin) prior to 6 months of age. I still recommend Acetaminophen (Tylenol) over Ibuprofen, but there isn’t a lot of data to support that. Theoretically, ibuprofen caries risks like stomach upset and kidney damage–and although rare, the risks do not come with acetaminophen. So I recommend using acetaminophen first.
Claire says
Thanks – this is so very helpful as we are always looking for just such a chart when one of the kids feels bad!
Courtney says
While you’re on the topic of these drugs:
Is it okay to alternate doses of acetaminophen and ibuprofen, if a child needs more medicine before the next dosing time? Does the answer change for fever versus pain relief? Thanks!
Wendy Sue Swanson, MD says
Courtney,
You bring up a great point. I may author a separate post on this! There is NO DATA to support that alternating the use of tylenol and ibuprofen improves fever response or discomfort in children. Further—it can get very confusing due to different dosages from each medicine and different intervals. Although it is safe to use acetaminophen concurrent with ibuprofen, I don’t necessarily recommend it as it may not be necessary.
My recommendation is to start with acetaminophen. If after 1-2 hours, your child isn’t improving or feeling better, it is okay to give a dose of ibuprofen. If that works far better, than you can continue to use the ibuprofen. But I would recommend waiting another 6 hours before giving any fever reducer/pain reliever to avoid confusion. You don’t need both fever reducers at once. As you see on the chart, acetaminophen is dosed every 4 hours (with no more than 5 doses in a 24 hour period), and ibuprofen can be dosed every 6 hours. SEE THE CONFUSION?
Wanda says
My 2 1/2 yr old grandson, wt. 31 lbs., has flu. His mama says dr told her it’s ok to give Tylenol every four hours and then ibuprofen four hours later then back to Tylenol and etc. the discharge instructions do not include that. Only says Tylenol CAN be given every four hours, and ibuprofen should not be taken but 4 x a day or every six hours. For the first 24 hours. She says for three days. I am the one giving the meds. Should I do just what dr instructed and ignore my daughter? His fever does jump up very high but 5 mls of this then four hours later 5 mls that! Help
Awesome Mom says
I was told to go by weight over age by my ped. Thanks for posting this. It is always a bit scary to give OTC medications because of the confusing information out there.
Jen says
our ped gave us a version of this 9 years ago when we had our daughter. I have kept it tucked away in the medicine cabinet. Very handy to have. I finally just stopped using the infant drops and just use the correct dosage for age and weight of the regular stuff. with three kids it cuts down on the number of bottles of meds in the house. We have found with the stubborn fevers the advil is better and relieving discomfort in our kids. when it’s really bad we have to layer a bit with tylenol but we keep a chart of last dosage of each and when the next is due and how many they have had in 24 hours. it’s confusing if you don’t write it all down.
Kate says
Hi, Wendy — this article was very timely and a helpful resource for us when dealing with a teething toddler. Thank you! I have an unrelated question but I’m not sure how else to reach out to you. I would love to subscribe to your blog, but every time I try (e.g., in Google Reader), only the comments on your posts show up in the feed — not the posts themselves. I don’t have this problem with other Seattle Children’s blogs (e.g., The Autism Blog). Is there anything you can do to help? I want to make sure I don’t miss your posts! Thanks!
Viki says
My son was very intolerance of corn, so the corn syrup and corn starch in suspensions would give him diarrhea or make him vomit. I mentioned this to the pharmacist at children’s one day and she said: do you have a pill cutter? Give him half a tab of regular strength ibuprofen instead of the suspension. A DUH! and A-HA! moment. The suspension really obscures the dose. It’s so much easier to dose the children’s medicine the same as ours. Now I ask for all their rx’s in pill form in correct dose or dose I can easily cut and grind it with apple sauce. Easy peasey. How about we do away with suspensions after age 2?
BTW, tylenol 325mg and 500mg don’t easily cut down to the exact dose above. You end up a bit under going this route. But tylenol makes a “melt away” pill for ages 2-6 if you want a precise dose in pill form.
JR says
So would a nearly 16 year old boy about 130 be given adult doses of OTC medications such as cough syrup, acetominophen?
Jeannie says
For the past two days my 1-yr-old daughter has been having a low-grade fever. I didn’t give her anything because I was hoping she’d fight off the bugs on her own. This afternoon however she was extraordinarily fussy, so I decided to give her some acetaminophen. But how much??? Then I remembered that I had saved your handy chart on my computer. Looked it up, 1.2 mL, easy as pie. Thank you very very much for providing this for all of us!!!
Meagan says
I was wondering the same thing about weight/age. Normally I would assume weight, I think that’s what I’ve usually heard, but I have a big baby, so I’d be inclined to go with age just to be safe? My 5 and a half month baby is almost 20 lbs!
Julie says
I am a nurse and we have a 9/0 patient who weighs in at 256 lbs. Her mother argues with me that she should be give a larger dosage due to her weight not her age. I am concerned about over medicating her?
Wendy Sue Swanson, MD says
Medications are dosed based on weight (over age). However there are maximum doses as well. I would dose her based on weight but ensure that it is not over the maximum or adult dose.
BookMama says
Another question about dosing by weight. If a child is obviously of age for children’s medications, but heavier than the highest weight on your chart, how would one determine dosage? My 10YO son is 80 lbs. So, does he get 15 ml of the children’s solution? Or is there another way to determine dosage? (Surely the child in the previous example shouldn’t be getting 40-50 ml, should she?)
(Good to know that weight trumps age, though. I’d always gone with whichever meant less medication.)
Wendy Sue Swanson, MD says
BookMama, as I stated above, you use weight but then there is an upper-end cutoff for doses. Consider adult doses as cut-offs.
Your child at 80 lbs can have 15mL (3 teaspoons) for a total of 480mg of acetaminophen. This is under the upper-end dose for him, by weight. By weight he can have up to 540mg at each dose. So because by weight your child can tolerate it, you may want to use a tablet form as there are 500mg capsules of acetaminophen available. Far easier than 3 teaspoons I suspect!
(FYI I calculated his upper-end dose based on milligram per kilogram specific dosing)
Ruth says
If the dosage on the bottle is different from that in your chart, I assume we should follow that? I have some children’s ibuprofen suspension, and on the bottle it says 6ml for a child 24lb+. Your chart says 5ml. Thanks for all the info!!
BookMama says
Far easier and far cheaper, too! 😉
Thanks for the reply. It can be confusing when kids are at this kind of in-between state, and I appreciate the clarification. It hadn’t really occurred to me that he could have a regular \adult\ tablet, but it makes sense.
Lcb says
Be careful splitting- pills must be scored to make sure the active infredient is distrubuted evenly. If it isn’t scored, all the medicine may be in one half and none, just filler, in the rest.
Brittany says
Hey. My daughter is is almost 3. She’s had a fever since yesterday. She had children’s tylenol every 4 hrs ending at 9pm last night. She had about 5 doses. Its now 930am is it ok to give her another dose?
eE6wifey says
My son is 10 yrs old 161 pounds is a 500mg pill enough for his fever?
Wendy Sue Swanson, MD, MBE says
Depends what medicine you are using, of course. Consult with your son’s pediatric clinic nurse for dosing as needed.
Typically acetaminophen is dosed no more than 15mg for every kilogram every 4 hours.
Typically ibuprofen is dosed no more than 10mg for every kilogram every 6-8 hours.
Julie says
My baby vomits after taking meds… Can I give her a lesser dose than recommended?? I.r. My baby is 16.8 lbs which means 2.5ml of Tylenol, can I give her 1ml instead??
Karen Frei says
this is still America. I wish we used teaspoons.
Wendy Sue Swanson, MD, MBE says
Well yes, it is (!), but teaspoons simply aren’t as accurate as measuring in milliliters (mL) or cubic centimeters (cc). Also, because some docs and nurses talk about doses in teaspoons in the office or on the phone and then the packaging or bottle comes labeled in mL it can readily confuse.
Tonya says
Wendy, Thank you for this. Although I do completely agree with your opinion on rotating acetaminophen and IBU. My almost four years old has been suffering from strep like symptoms for four weeks now, not eating, barely drinking and her throat just stopped bleeding the last day or too. For her, the IBU is the prominent one, I can practically see it work. (She wakes crying, hard swallowing and gagging within 10 minutes she goes from that to sound asleep. ) Obviously, there is something greater going on. However for pain/fever managing in times when she just had the IBU an hour or 30 minutes ago, and now a fever has spiked is it safe to dose acetaminophen then? How close in between can you go? I am aware that since we have been using both medications for so long her system has started to become immune. However, I have no other options, I am getting no where with her doctors who just think its a “bug”.
Kelly says
My sister inl-law has been giving her baby Tylenol evry 4 hrs if needed or not. She recently started adding Advil to the mix. This has been going on for month and I was hoping you could share way this is not such a good thing. My daughter is about to give birth and although I don’t believe she would do this I would like her to see way she shouldn’t. Sister in-law has an alarm set so she won’t miss a dose. So very sad I can’t do anything to stop it
Syd says
My child is 19months old but he weighs 25 lbs and I got some Tylenol but it says children under 2 ask a doctor and children that are 2-3 yrs should have 5ml so I am confused…
Stacey Ulacia says
Always dose based on your child’s age. If your child weighs 25 pounds, provide the dose for a child who is 25 pounds!