Acetaminophen is commonly used as an antipyretic and pain reliever in young children and overall is quite safe considering the amount used by families for their children every day. Unfortunately, on occasion a therapeutic misadventure occurs and a young child develops severe acetaminophen induced liver injury. Compared to the incidence in adolescents and adults, healthy children less than 6 years of age rarely develop clinically significant liver injury from a one time, single, large, unintentional ingestion of acetaminophen. The high risk exposure is the infant/toddler who is receiving more than one supratherapeutic dosing of acetaminophen based products, usually for an acute febrile illness.