Give calpol by weight or by age? High percentile toddler

[Bluebellsfortwo]

According to the package my 1.5 yo who weighs 16kg should be having 5ml of calpol which is 120mg paracetamol. However it never brings down her fever and I feel that it's ineffective, I always have to give her nurofen alongside it to notice any improvement in her fever, pain, symptoms etc.

Having looked it up, the dose by weight is 15mg per kg of body weight which would mean that she needs to be taking 240mg of paracetamol which is literally double the usual dose!

Any advice?

I had my DS in A&E when he was that age because I couldn't get his fever down. The doctor laughed at me when I told him the dose he'd had! He said "your baby is 99centile, go off weight or it won't work".

We started off raising it to 8ml to see how he went, then eventually up to 10ml next time he was ill x

I wouldn’t want to advise you to give more as I am not a HCP but I have also been told to give higher doses and my kids are skinny. Maybe pop into a pharmacy if you can?

Yes, by weight as long as you're confident with the maths.

Weight. We live overseas and were told always to go by weight. If we had a doctor’s appointment the doctor would weigh DD and calculate the dose for us.

We live overseas and our Doliprane which is like calpol goes off weight, the syringe is in kg rather than mls same goes for ibuprofen.

We went by weight in our household - but my DH is a doctor, so I knew he would have considered any risks to that. Could you contact your health visitor/GP for advice - as there is always the possibility there is something about your child that means it is not appropriate to do. (Paracetamol is potentially dangerous). Also current advice (on nhs inform) is that unless the child is distressed, there is no need to reduce the fever with medication. Fever can actually be helpful in improving the immune response.

I always ask a paeds nurse friend to calculate a dose if my DD is particularly under the weather, and that's always higher than the packet says and my kid is small. In fact they're only 1kg heavier than yours at 4 years old.

I’m a paediatric nurse. He can have 15mg/kg =240mg

Thanks for sharing your experience. I've heard from many other parents that their children are given wayyyy higher doses of paracetamol when in hospital and they do it based on weight. My little girl is the size of a much older child so it makes sense that the dose for under 2s wouldn't work for her! I don't know why I never really realised till now.

So I asked her GP once before and he was very dismissive and told me to just follow the instructions (he was rushing me out the door really). My daughter had a bacterial throat infection and wasn't eating or drinking due to the pain and became dehydrated, it was really hard to manage her pain and symptoms. I think in future I will definitely do based on her weight.

In terms of safety I have researched quite a bit and have looked at the NHS/BNF guidelines and they have a maximum amount you can give in 24 hours (also based on weight) so that is very useful as a guide. I also feel reassured to know that many other parents also do the same too.

we are overseas. The calpol equivalent syringes are in kg. Ds age 5, is also 16kg. He has 10ml.

Interesting to know that's the norm overseas. Here it's one standard dose for all under 2s! Including my 16kg daughter and my friends 8kg son who are the exact same age!

Those syringes sound really good. I wonder if they exist in the UK?

I’ve just checked and when my son was about 15-16kg our paediatrician calculated that he should get 9.3ml of Calpol (every 8 hrs) or 7.5ml nurofen (also every 8 hrs). We still go by this dosage as his weight hasn’t changed much. The standard dose would never really bring his fever down.

It may be worth talking to her GP - in anaesthetics we tend to use an 'adjusted weight' for drugs like paracetamol for children who are overweight, but you need a bit more info than age & weight to work that out.

I have got the BNF up and calculated antihistamine doses this way, but I would be more hesitant with paracetamol because I don't know enough about liver function by age (versus weight). Definitely one where I would want the GP/pharmacist etc to ok. But very interesting to see that it's done by weight in other countries suggesting I am too cautious?!

It’s not just single dosage but also safe amount over 24 hours that comes into play I think. We had a prescription for paracetamol so my daughter could take it in school for a health issue, and the doctor told us that according to weight she could have 1.5 tablets, but that would exceed the safe amount over 24 hours, and as this was a regular and continuous painkiller usage, she was restricted to one tablet. She could however take a specific dose of liquid ibuprofen 3 x daily.

I am from overseas as well and paracetamol instructions on the box are by kg.
A paediatrician at A&E in UK as well once wrote me a nice chart of how to dose by kg, otherwise it’s just useless for symptoms but also is still taking medicine that isn’t not even useful.

this is exactly the problem at extremes of weight in both children and adults and is something that is increasingly needing to be factored in for prescribing some drugs. In overweight/obesity not all of that extra tissue is pharmacologically 'active' and so there are formulae for working out what the ideal (effective and safe) doses for some drugs might be based on different drug properties, metabolism, therapeutic vs toxic windows, how many doses are likely to be needed etc.