Paediatric Dental Doses (UK): Antibiotics, Analgesics and Local Anaesthetic by Age and Weight
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Published by Nosht Limited
This page is an educational reference for UK dentists who prescribe for children, and for dental therapists and hygienists who administer local anaesthetic or other medicines to children within their GDC scope of practice. It summarises the commonly used UK paediatric dental analgesics, antibiotics and local anaesthetics, with age-band doses and weight-based mg/kg figures, the main cautions, and the recognised weight-estimation formulae. It is general professional information, not patient-specific advice. You remain responsible for the dose you prescribe or administer, for confirming the child's weight, age, medical history, allergy status, medication and any safeguarding considerations, and for checking the current formulary at the point of care. Based on current BNFc and SDCEP Drug Prescribing for Dentistry (website edition, sdcepdentalprescribing.nhs.scot).
Analgesics for children (paracetamol and ibuprofen)
Paracetamol is the first-line analgesic and antipyretic; ibuprofen can be added or used as an alternative where not contraindicated. Codeine and dihydrocodeine must not be used (see the codeine warning below).
Paracetamol — weight-based reference: 15 mg/kg per dose, maximum 1000 mg per single dose, every 4–6 hours, maximum 4 doses in 24 hours, with a minimum 4-hour gap between doses.
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| Age band | Paracetamol dose (per dose) |
|---|---|
| 3–5 months | 60 mg |
| 6–23 months | 120 mg |
| 2–3 years | 180 mg |
| 4–5 years | 240 mg |
| 6–7 years | 240–250 mg |
| 8–9 years | 360–375 mg |
| 10–11 years | 480–500 mg |
| 12–15 years | 480–750 mg |
| 16+ years | 500–1000 mg |
Ibuprofen — weight-based reference: 5–10 mg/kg per dose, maximum 400 mg per single dose, every 6–8 hours. The calculator gives three doses a day (TDS) and caps each dose so the daily total stays within 30 mg/kg/day in children under 12 (SDCEP/BNFc) and 2.4 g/day in adolescents; BNFc allows 3–4 doses a day within those ceilings. Take after food. Avoid in severe / aspirin-sensitive asthma, renal impairment, active peptic ulcer disease, or dehydration.
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| Age band | Ibuprofen dose |
|---|---|
| 3–5 months | 50 mg TDS (only if > 5 kg) |
| 6–11 months | 50 mg TDS |
| 1–3 years | 100 mg TDS |
| 4–6 years | 150 mg TDS |
| 7–9 years | 200 mg TDS |
| 10–11 years | 300 mg TDS |
| 12–17 years | 300–400 mg TDS |
Antibiotics for children (dental infection)
Antibiotics are indicated for a child with a dental infection showing systemic involvement or spreading infection — they are not a substitute for removing the source (drainage, extirpation or extraction). SDCEP's drug of first choice is phenoxymethylpenicillin; amoxicillin is as effective but broader-spectrum, so SDCEP reserves it for when the four-times-daily phenoxymethylpenicillin regimen is likely to be hard to follow. For penicillin allergy, SDCEP recommends metronidazole. Azithromycin and cefalexin are not SDCEP dental antibiotics; they are listed below as non-SDCEP alternatives, to use per local guidance.
Phenoxymethylpenicillin — SDCEP's drug of first choice (narrow spectrum). QDS (four times daily), taken on an empty stomach 30 minutes before or 2 hours after meals. Suggested duration 3–5 days, with review ideally at 3 days. Severe infection: up to 12.5 mg/kg QDS up to 11 years; up to 1 g QDS at 12–17 years.
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| Age band | Phenoxymethylpenicillin dose |
|---|---|
| 6–11 months | 62.5 mg QDS |
| 1–5 years | 125 mg QDS |
| 6–11 years | 250 mg QDS |
| 12–17 years | 500 mg QDS |
Amoxicillin — for when compliance with four-times-daily phenoxymethylpenicillin is likely to be difficult (SDCEP). TDS (three times daily) for 3–5 days, with review ideally at 3 days. Take at regular intervals. Severe infection: up to 30 mg/kg TDS (maximum 1 g) at 6 months–11 years; double the dose at 12–17 years.
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| Age band | Amoxicillin dose |
|---|---|
| 6–11 months | 125 mg TDS |
| 1–4 years | 250 mg TDS |
| 5–11 years | 500 mg TDS |
| 12–17 years | 500 mg TDS |
Metronidazole — the SDCEP option for penicillin allergy, and an adjunct to a penicillin in severe, spreading infection or pyrexia. Weight-based reference 7.5 mg/kg, single dose capped at 400 mg, for up to 5 days (SDCEP suggests 3–5 days), with review ideally at 3 days. Not licensed in children under 1 year. Avoid alcohol during treatment and for at least 48 hours after stopping (SDCEP).
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| Age band | Metronidazole dose |
|---|---|
| 1–2 years | 50 mg TDS |
| 3–6 years | 100 mg BD |
| 7–9 years | 100 mg TDS |
| 10–17 years | 200 mg TDS |
Azithromycin — non-SDCEP alternative; use per local guidance (the SDCEP penicillin-allergy option is metronidazole). BNFc 3-day course, from 6 months: 10 mg/kg once daily (max 500 mg per dose) for 3 days, with no taper; from 46 kg, 500 mg once daily for 3 days. Take 1 hour before or 2 hours after food.
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| Body weight (child 6 months–17 years) | Azithromycin dose (for 3 days) |
|---|---|
| Up to 15 kg | 10 mg/kg once daily |
| 15–25 kg | 10 mg/kg once daily, or 200 mg once daily |
| 26–35 kg | 10 mg/kg once daily, or 300 mg once daily |
| 36–45 kg | 10 mg/kg once daily, or 400 mg once daily |
| 46 kg and above | 500 mg once daily |
Cefalexin — non-SDCEP alternative; use per local guidance (the SDCEP penicillin-allergy option is metronidazole). Only for non-severe penicillin allergy without anaphylaxis. First-generation cephalosporin, for 5 days. BNFc: 12.5 mg/kg twice daily, or the fixed doses below, which are three times daily up to 11 years. Avoid in patients with a history of severe penicillin allergy / anaphylaxis (cross-reactivity risk).
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| Age band | Cefalexin dose |
|---|---|
| 1–4 years | 125 mg TDS (or 12.5 mg/kg BD) |
| 5–11 years | 250 mg TDS (or 12.5 mg/kg BD) |
| 12–17 years | 500 mg BD–TDS |
Local anaesthetic for children
Children are dosed strictly by weight, with lower absolute ceilings than adults, and small errors are proportionally more dangerous. Calculate every paediatric LA dose from the child's weight, and in the medically compromised or adrenaline-limited patient the adrenaline (vasoconstrictor) load is often the limiting factor, not the anaesthetic mg. A standard UK dental cartridge is 2.2 ml. For adult maximums, the full cartridge maths and the signs of LA toxicity, see our local anaesthetic maximum doses guide.
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| Agent | Max dose (mg/kg) | Absolute cap (mg) | mg per 2.2 ml cartridge | Adrenaline µg per cartridge | Adrenaline ceiling | Notes |
|---|---|---|---|---|---|---|
| Lidocaine 2% with 1:80,000 adrenaline | 5 | 500 | 44 mg | 27.5 µg | 200 µg | Common paediatric LA. Child maximum 5 mg/kg (Lignospan Special SmPC 4.2). For 1:80,000 the 200 µg adrenaline ceiling (16 ml, ~320 mg) binds before the 500 mg lidocaine maximum. |
| Articaine 4% with 1:100,000 adrenaline | 7 | 385 (ages 4–11); 500 from age 12+ | 88 mg | 22 µg | 200 µg | Not recommended under 4 years (safety/efficacy data not established). Absolute maximum 385 mg at 4–11 years, 500 mg from 12 (Septanest SmPC 4.2). Higher concentration — use with care. |
| Prilocaine 3% with felypressin 0.03 IU/ml (Citanest with Octapressin) | 5 | 300 | 66 mg | n/a (no adrenaline) | n/a | Option where adrenaline is to be avoided. Up to 5 mg/kg in children over 6 months (BNFc; prilocaine SmPC 4.2). UK dental product information caps at 10 ml (300 mg, about 4.5 cartridges). Risk of methaemoglobinaemia in neonates/infants — caution under 6 months. |
The adrenaline-free local anaesthetic referenced here is prilocaine 3% with felypressin (Citanest with Octapressin; 5 mg/kg, 300 mg (10 ml) cap, 66 mg per 2.2 ml cartridge), a valid UK adrenaline-free option that matches the in-app tool.
Codeine is contraindicated under 12 (MHRA 2013)
Estimating a child’s weight (when no scales are available)
Dose from the child's actual measured weight wherever possible. If weight is genuinely unavailable, the APLS UK weight-estimation formulae give an approximation only:
- Age 1–5 years: weight (kg) ≈ (age × 2) + 8
- Age 6–12 years: weight (kg) ≈ (age × 3) + 7
Estimated weight is a recognised source of dosing error. Treat it as a fallback, weigh the child where you can, and dose to the most conservative figure your reference supports.
How paediatric doses are calculated (method, not a recipe)
Paediatric doses are derived in two ways, and the safer of the two governs:
- Age-band dose — look up the dose for the child’s age band (the tables above).
- Weight-based dose — multiply the agent’s mg/kg by the child’s weight in kg, then apply the absolute cap / daily ceiling (e.g. paracetamol max 1 g/dose; ibuprofen 400 mg/dose and 30 mg/kg/day; metronidazole 400 mg/dose; lidocaine 500 mg and the 200 µg adrenaline ceiling, ~320 mg for 1:80,000). The lower figure always wins.
- Confirm against the current BNFc / SDCEP and the individual child — reduce for low body weight, comorbidity, hepatic or renal impairment, and where adrenaline must be limited.
Worked illustration — a 5-year-old, estimated ~18 kg (APLS: 5 × 2 + 8 = 18 kg; for teaching only):
- Paracetamol: age-band dose 240 mg (4–5 years); weight-based 15 mg/kg × 18 = 270 mg, under the 1 g cap.
- Ibuprofen: age-band dose 150 mg TDS (4–6 years); 5–10 mg/kg × 18 = 90–180 mg; daily ceiling 30 mg/kg/day = 540 mg/day.
- Antibiotic (if indicated): phenoxymethylpenicillin 125 mg QDS (1–5 years band), or amoxicillin 500 mg TDS (5–11 years band) where QDS dosing is impractical; 3–5 days, reviewed at 3 days.
- Lidocaine 2% with 1:80,000: 5 mg/kg × 18 = 90 mg → 90 ÷ 44 = ~2.0 cartridges (weight-limited; well within the 200 µg adrenaline ceiling).
These are illustrative for one estimated weight and must be recalculated for the individual child.
Check paediatric dose references in Nosht
This page gives you the reference figures and the method. It does not output a dose for an individual child. For that, use the in-app Paediatric Doses tool: enter the child's age (and weight, or let it estimate weight with the APLS formulae) and pick the drug category (analgesic, antibiotic or local anaesthetic). It returns the age-band dose and the weight-based dose, applies the absolute caps and daily ceilings, flags the limiting factor (weight vs cap vs adrenaline ceiling), and surfaces safety warnings (under-1-year antibiotics, articaine under 4 years, very low weight, ibuprofen under 3 months / under 5 kg, codeine exclusion).
Check paediatric dose references
Age-band and mg/kg figures from BNFC and SDCEP in one place. A reference aid only: verify every dose against the current BNFC. Deterministic, not AI-generated, on the Pro plan.
Open the Paediatric Doses tool (Pro) →The Paediatric Doses calculator is deterministic and works from a fixed UK paediatric dental formulary dataset (BNFc / SDCEP-aligned) — it does not use a language model to generate doses, by design, for dose safety. Separately, Nosht's note-writing features optionally use clinician-reviewed AI (Anthropic Claude Haiku 4.5) to help structure clinical notes from your input; the clinical dose tools are deliberately not AI-generated.
Faster, structured UK dental notes
Nosht turns your shorthand into GDC/FGDP-aligned clinical notes you review and paste into your PMS. Optional AI assists; the dose calculators stay deterministic.
Explore the Nosht notes app →Sources
- BNFC: Paracetamol (accessed 11 October 2026)
- BNFC: Ibuprofen (accessed 11 October 2026)
- BNFC: Amoxicillin (accessed 11 October 2026)
- BNFC: Phenoxymethylpenicillin (accessed 11 October 2026)
- BNFC: Metronidazole (accessed 11 October 2026)
- SDCEP Drug Prescribing for Dentistry: Odontogenic pain (accessed 11 October 2026)
- SDCEP Drug Prescribing for Dentistry: Bacterial infections (accessed 11 October 2026)
- MHRA Drug Safety Update: Codeine for analgesia, restricted use in children (July 2013) (accessed 11 October 2026)
Frequently asked questions
What is the amoxicillin dose for a child with a dental infection?
For a child with a spreading or systemically involving dental infection, SDCEP's drug of first choice is phenoxymethylpenicillin four times daily (62.5 mg at 6–11 months, 125 mg at 1–5 years, 250 mg at 6–11 years, 500 mg at 12–17 years). Amoxicillin is reserved for when QDS dosing is likely to be difficult; it is given three times daily (TDS): 125 mg TDS at 6–11 months, 250 mg TDS at 1–4 years, and 500 mg TDS at 5 years and over. In severe infection, up to 30 mg/kg TDS (maximum 1 g) at 6 months–11 years, or double the dose at 12–17 years. Courses are 3–5 days, reviewed ideally at 3 days. Antibiotics support, but do not replace, removing the source of infection. Verify against the current BNF for Children (BNFc) / SDCEP and the child's allergy status before prescribing.
What is the paediatric ibuprofen dose by weight?
Ibuprofen is dosed at 5–10 mg/kg per dose, every 6–8 hours, to a maximum of 400 mg per dose and a daily ceiling of 30 mg/kg/day in children under 12 (2.4 g/day in adolescents). Typical age-band doses are 50 mg TDS at 3–5 months (only if over 5 kg), 50 mg TDS at 6–11 months, 100 mg TDS at 1–3 years, 150 mg TDS at 4–6 years, 200 mg TDS at 7–9 years, 300 mg TDS at 10–11 years, and 300–400 mg TDS at 12–17 years (BNFc allows up to 4 doses a day within 30 mg/kg/day and 2.4 g/day). Give after food, avoid in asthma sensitive to NSAIDs, renal impairment, peptic ulcer disease or dehydration, and do not use under 3 months or under 5 kg.
What is the paracetamol dose for a child?
Paracetamol is 15 mg/kg per dose, every 4–6 hours, to a maximum of 1 g per dose and 4 doses in 24 hours, with at least a 4-hour gap between doses. Age-band doses are approximately 60 mg at 3–5 months, 120 mg at 6–23 months, 180 mg at 2–3 years, 240 mg at 4–5 years, 240–250 mg at 6–7 years, 360–375 mg at 8–9 years, 480–500 mg at 10–11 years, 480–750 mg at 12–15 years, and 500–1000 mg at 16+. Verify against the current BNFc.
Which antibiotic is used for a child who is allergic to penicillin?
Per SDCEP, metronidazole is the option for a penicillin-allergic child with a dental infection: 50 mg TDS at 1–2 years, 100 mg BD at 3–6 years, 100 mg TDS at 7–9 years, 200 mg TDS at 10–17 years (single dose capped at 400 mg), for up to 5 days with review ideally at 3 days; it is not licensed under 1 year. Azithromycin and cefalexin are not SDCEP dental antibiotics; use them only per local guidance. Azithromycin (BNFc: 10 mg/kg once daily, max 500 mg per dose, for 3 days from 6 months; 500 mg once daily for 3 days from 46 kg). Cefalexin (BNFc: 125 mg TDS at 1–4 years and 250 mg TDS at 5–11 years, or 12.5 mg/kg BD; 500 mg BD–TDS at 12–17 years) is only for non-severe penicillin allergy without anaphylaxis, and is avoided where there is a history of severe penicillin allergy. Confirm the nature of the allergy and verify against the current BNFc / SDCEP.
What is the maximum local anaesthetic dose for a child?
Children are dosed strictly by weight with lower absolute ceilings, so there is no single number. A commonly used paediatric figure for lidocaine 2% with 1:80,000 adrenaline is 5 mg/kg, with an absolute lidocaine maximum of 500 mg, but the 200 µg adrenaline ceiling binds first (16 ml, ~320 mg, about 7 cartridges of 1:80,000; each 2.2 ml cartridge contains 44 mg lidocaine and 27.5 µg adrenaline). Articaine 4% (7 mg/kg; cap 385 mg ages 4–11, 88 mg/cartridge) is generally avoided under 4 years. Prilocaine 3% with felypressin (5 mg/kg; cap 300 mg) is an adrenaline-free option. Calculate from the child's weight and verify against the BNF for Children (BNFc) / DPF.
Can children have codeine for dental pain?
No. Following the MHRA Drug Safety Update (July 2013), codeine is contraindicated in children under 12 years, and codeine and dihydrocodeine must not be used for paediatric dental pain. Use paracetamol ± ibuprofen instead.
Related guides
Reference
Local Anaesthetic Maximum Doses in Dentistry: A UK Reference
Reference
Dental Drug Interactions: A UK Reference
How-to
Antibiotic Prescribing in Dentistry: SDCEP Guide & Doses (UK 2026)
How-to
Medical Emergencies in the Dental Practice: Drugs, Doses & ABCDE (UK)
Patient leaflets for these treatments
Nosht
Published by Nosht Limited
Nosht Limited makes structured clinical note templates for UK dental professionals. Articles refer to guidance from the GDC, CGDent, BSP, SDCEP and NICE. Check the current version of a source before relying on it.