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Acetaminophen (Tylenol, others) has long been a standard remedy for fever and pain in children. It's effective and readily available without a prescription. In excess, however, even good things can be harmful. Here's what you need to know about acetaminophen overdoses and children.

An acetaminophen overdose is serious, and it can occur all too easily. Consider these scenarios:

• You're in a hurry. You might unwittingly give your child too much acetaminophen if you don't take the time to carefully measure the medication — or if you don't realize that another caregiver has already given your child a dose of medication.
• You combine medications. If your child has various cold symptoms, you might combine acetaminophen with a cold remedy. But this can be dangerous because many cold medications already contain acetaminophen.
• You use the wrong formulation. You might cause an overdose if you give your child adult acetaminophen tablets instead of the children's formulation. Even the children's versions of acetaminophen come in many different formulations, and the dosage varies for each one. For example, infant drops are more concentrated than is the liquid acetaminophen typically given to toddlers. If you assume that both liquids contain the same amount of medicine, substituting infant drops for syrup could lead to an acetaminophen overdose.
• You decide that more is better. If you're not satisfied with the performance of the recommended dosage of acetaminophen, you might increase the dosage and cause an accidental overdose.
• Your child mistakes the medication for candy or juice. Overdoses often occur when a child mistakes acetaminophen for something safe to eat or drink. Sometimes this happens when an adult leaves the bottle open or accessible after taking his or her own medication.

If you give your child acetaminophen, read the product label carefully to determine the correct dosage based on your child's age and weight. Too much acetaminophen overloads the liver's ability to process the drug safely. An acetaminophen overdose can lead to life-threatening liver problems.

How much acetaminophen is too much varies depending on the child's age and weight. Consider these guidelines from the American Association of Poison Control Centers:

• Age 5 and younger. Seek emergency care if your child age 5 or younger swallows 91 milligrams (mg) of acetaminophen per pound of his or her weight (200 mg per kilogram, or kg) in 24 hours.
• Age 6 and older. Seek emergency care if your child age 6 or older swallows 91 mg of acetaminophen per pound of his or her weight (200 mg per kg) or at least 10,000 mg of acetaminophen — whichever is less.

*80 mg per 0.8 mL, which equals one dropperful
**160 mg per 5 mL, which equals 1 tsp.

Note: This table is a general guide only, not a substitute for a consultation with a trained poison specialist. If you're concerned about an acetaminophen overdose, contact your local poison control center at 800-222-1222 or seek emergency care.

If your child ingests more than the recommended amount of acetaminophen but not enough to cause a toxic reaction, medical care isn't likely necessary. Be cautious, however. If you're concerned about a possible acetaminophen overdose or notice early signs or symptoms of an overdose — nausea, vomiting, lethargy and abdominal pain within 24 hours — call your local poison control center at 800-222-1222 or seek emergency care.

In the hospital, a child with an acetaminophen overdose may be given activated charcoal to decrease absorption of the acetaminophen. Activated charcoal is usually given as a black liquid drink, but it can be given through a tube inserted through the mouth or nose and into the stomach if necessary. If the overdose is severe, the child may need an antidote to reverse the effects of the acetaminophen. The antidote should be given within eight to 10 hours after the acetaminophen is swallowed.

Left untreated, a serious acetaminophen overdose may be fatal within a few days. Careful use of acetaminophen and prompt treatment in case of an overdose can help prevent a tragedy.