Change Isn't Easy

For more years the primary brand of Acetaminophen has been Tylenol©. Along with Tylenol there are many equivalent brands AND the majority of them have droppers with lines designating the number of milliliters (ml.) of medication to be dispensed to your child. About ten years ago, the only guidelines for Acetaminophens were age related. The problems with age versus weight were addressed and pound parameters were added. As physicians, we recommended not using the age dosages and instead use the weight related information. The weight versus age recommendations were and still are for a broad range of infants and children ranging from the 10th to the 90th percentile of weights for the same age groups.

A number of overdoses occurred in infants and children in families who mistakenly believed that the infant acetaminophen drops were the same concentration as the children’s elixer. Hospitalizations and deaths occurred due to this misconception. The infant acetaminophen drops which have been available for years were actually three times stronger than the oral suspension. The American Academy of Pediatrics and other organizations worked diligently to get this difference in dosages changed. Some manufacturers switched to medication spoons and syringes to show that the products were different. This didn’t reduce the numbers of emergency room visits and hospital admissions.

Finally all the manufacturers of Acetaminophen for infants and children up to 3 years of age have agreed to have the same dosing syringes and the same concentrations per teaspoon in all their products. No more separate infant or children acetaminophen medications will exist.*This applies only to single drug Acetaminophen and not to multiple drug products containing acetaminophen as one of the ingredients. By the end of March 2012, all the over the counter acetaminophen products should contain a newly marked enclosed syringe and no dropper.

The new mandated strength of acetaminophen in every bottle will be 160 milligrams (mg) per 5 milliliters (ml). Five milliliters equals one teaspoon (not a tablespoon). The weight and age groupings will remain unchanged while the milliliters recommended will have changed. As an important reminder ONLY use the dosing syringe that comes with the product you buy.


            Weight            (pounds=lbs)                        Age (months=mos)                                    Dose (Milliliters=ml)

6-11 lbs                                                0-3 mos                                                            1.25 ml

12-17 lbs                                              4-11 mos                                                          2.5 ml

18-23 lbs                                             12-23 mos                                                        3.75 ml

24-35 lbs                                             24-36 mos                                                        5.0 ml


It’s pretty easy to see why doctors and nurses prefer looking at the weight versus month information. There are very few term babies who only weigh 23 pounds at 23 months so all dosage recommendations should be verified with your health care provider.

My suggestion until the changeover is complete is to find the new Acetaminophen Oral Suspension with the new syringe, then dispose of all the old preparations that you may have and be sure to spread the word to your child care provider as well as you loved ones.

By Bruce Gach, M.D. 

Bruce is the managing partner of Livermore-Pleasanton-San Ramon Pediatrics Group. He is a Board Certified practicing pediatrician with over 30 years of experience caring for children. He has served on numerous committees dealing with child health and development.