Paracetamol remains the mainstay in treating fever and mild to moderate pain in children. It is freely available over the counter and is recommended by all pediatricians as the initial, do-it-yourself management of fever > 100° F.

I, too, recommend it to my patients. However, it is possible to overdose the child if adequate care is not taken. There are two problems: one is overdosing, and the second is brand substitution. In India, unfortunately, Paracetamol is available in widely varying strengths, right from 100 mg / 5 ml to 250 mg / 5 ml (this can lead to inadvertent overdosing if one substitutes one brand for the other ml for ml. Overdosing can cause serious side effects, including severe liver damage that may even be fatal.

Please remember that Paracetamol (available in many brands in India like Crocin, Calpol, etc) should be given as follows:

Dose (in fever):

• 10-15 mg/kg body weight every 6-8 hours as and when required. However, do not exceed 75 mg/kg/day, 1 g / 6 hours, 4 g / 24 hours, or lower.

Formulation

Check the strength of Paracetamol in 5 ml (it varies with different manufacturers), do some basic math, and calculate the right dose for your child.

Some standard Paracetamol formulations available in India are as follows (there are many others)> [1]:

Syrups:

• Crocin: 240 mg / 5 cc
• Calpol: 120 mg / 5 cc
• Dolo: 156.5 mg / 5 cc

Drops:

• Crocin: 150 mg / ml
• Dolo: 100 mg / ml

1. http://apps.who.int/medicinedocs/documents/s19190en/s19190en.pdf