Carers and pharmacists confused about paracetamol doses for overweight kids

August 20, 2012, British Medical Journal

The correct therapeutic dose is important for this commonly used painkiller, say the authors, because it is potentially fatal to give too high a dose; and too low a dose may result in more serious illness.

The authors surveyed 45 carers and 28 to find out what dose of paracetamol they thought would be appropriate for an eight year old child, weighing 25, 32, or 50 kg.

They also observed the doses given to 86 children, one in three of whom was overweight/obese, in the department of a specialist children's hospital.

The recommended paracetamol dose for children ranges between 15 and 20 mg/kg every 4 to 6 hours, up to a maximum of 60 mg/kg per day - extended to 90 mg/kg per day if under .

But these doses are for children who are average/normal weight for their age. Current expert opinion suggests that doses should be reduced in children who are more than 120% above their ideal , but it is unclear whether children should be dosed according to their actual, rather than their ideal, body weight, say the authors.

The showed that while most carers and pharmacists knew the correct dose for a normal weight child, their responses varied widely as the hypothetical child's weight increased.

By the time they were faced with the third scenario of the 50 kg child, the pharmacists recommended a twofold variation in dose; and one in four carers did not even answer the question.

When the doses were corrected according to actual and weight, for scenarios 1 and 2, all the recommended doses fell within the safe range of 10 and 20 mg/kg. But when it came to the heaviest child in scenario 3, one in three carers (36%) and one in four (24%) pharmacists underdosed when corrected for actual body weight.

And when corrected for ideal body weight, almost two out of three carers and three out of four pharmacists would have given the child a dose above 20 mg/kg.

Among the children, few children were given doses above 20 mg/kg when corrected for a child's actual body weight. But the further a child was above their ideal body weight, the higher was the dose of given, which goes against the recommendation to taper down the dose in overweight children.

"Simple evidence based dosing guidelines must be developed and communicated to practitioners to reduce the potential for confusion, which may lead to adverse consequences for these children," conclude the authors. This is extremely important they add, as "childhood obesity will almost certainly continue to be an issue for many years to come."

Explore further: Adalimumab is a promising therapy for children with Crohn's disease

More information: www.ejhp.bmj.com/lookup/doi/10 … ejhpharm-2011-000031

Related Stories

Adalimumab is a promising therapy for children with Crohn's disease

August 6, 2012
Adalimumab (an anti-tumor necrosis factor [TNF] antibody) is effective in maintaining remission in certain pediatric patients with Crohn's disease, according to a new study in Gastroenterology, the official journal of the ...

Scottish data highlight dangerous practice in pediatric paracetamol prescribing

May 19, 2011
Many of the prescriptions issued by GPs for paracetamol either give less than recommended doses to older children or exceed recommended doses in young children. Under-dosing may result in insufficient pain relief and over-dosing ...

Recommended for you

Rise in preterm births linked to clinical intervention

January 18, 2018
Research at the University of Adelaide shows preterm births in South Australia have increased by 40 percent over 28 years and early intervention by medical professionals has resulted in the majority of the increase.

New report calls into question effectiveness of pregnancy anti-nausea drug

January 17, 2018
Previously unpublished information from the clinical trial that the U.S. Food and Drug Administration relied on to approve the most commonly prescribed medicine for nausea in pregnancy indicates the drug is not effective, ...

New study finds 'baby brain' is real, but the cause remains mysterious

January 15, 2018
So-called "baby brain" refers to increased forgetfulness, inattention, and mental "fogginess" reported by four out of five pregnant women. These changes in brain function during pregnancy have long been recognised in midwifery ...

Sleep quality improves with help of incontinence drug

January 12, 2018
A drug used to curtail episodes of urinary incontinence in women also improves quality of sleep, a researcher at the Stanford University School of Medicine reports.

Frozen embryos result in just as many live births in IVF

January 10, 2018
Freezing and subsequent transfer of embryos gives infertile couples just as much of a chance of having a child as using fresh embryos for in vitro fertilization (IVF), research from Ho Chi Minh City, Vietnam, and Adelaide, ...

Study suggests air pollution breathed in the months before and after conception increases chance of birth defects

January 8, 2018
A team of researchers with the University of Cincinnati and Cincinnati Children's Hospital has found evidence that indicates that pre-and post-pregnant women living in an area with air pollution are at an increased risk of ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.