When our children have fever or pain, we naturally want to make them feel better. Tender loving care can go a long way, but sometimes we need a little help from medications. When considering when to give medications for fever or pain and also what to give, the first thing to do is realize why we’re using the medication.
Pain is pretty self-explanatory – nobody wants their child to be in pain. Pain is not only upsetting, but it also can increase the heart rate, breathing and blood pressure (although not usually to dangerous levels) and make a child cranky or withdrawn.
One of our key jobs as parents and caregivers is to reduce suffering by trying to minimize or prevent pain. Acetaminophen (such as the Tylenol™ brand) and ibuprofen (such as Motrin™ or Advil™) are our main tools to do that.
Both are great medications for fever and pain, but ibuprofen has an added benefit of fighting inflammation, which acetaminophen does not. For this reason, ibuprofen is sometimes preferred for pain from injuries or illnesses involving inflammation.
Fever is one of the most common reasons caregivers seek medical evaluation for their children. There is much apprehension about fever: some people are afraid for their children when they have fever, having heard stories about fever causing brain damage and convulsions or even death. Couple that with the fact that children often look and act much sicker when they have fever, and it adds up to a lot of anxiety.
Caregivers often turn to acetaminophen or ibuprofen, and sometimes both, in an effort to make the fever go away. There’s a lot of confusion about which medicine to give, how much to give and when to give it.
The good news is most stories about the dangers of fever are absolutely false! Fever from infection rarely goes above 106 F. The body temperature has to go above about 107 F before there is any damage to the brain or body.
There is such a thing as febrile seizures, but they are limited to children between the ages of 6 months and 5 years. When they occur, they are usually very brief and do not cause complications. They are completely unpredictable and do not occur because the temperature goes above a certain level. They’re far scarier than they are dangerous.
A fever that doesn’t go down all the way with proper doses of fever medication or one that comes back before the next dose is due is neither an indicator of infection nor of the seriousness of the illness. The fact that you can’t completely control the fever is not something to worry about, as it means nothing about the infection that’s causing the fever. The fever will go away when the worst of the infection goes away.
The real reason to treat fever is to make your child feel better. Fever itself, regardless of the source of the infection, will increase the heart rate and breathing rate; make your child sleepy, cranky or clingy; and decrease their appetite. If you can get the fever down even a degree or two, your child will likely feel better, start eating and drinking better, and look much more like themselves. Then you’ll feel better too!
Both acetaminophen and ibuprofen are excellent medications for fever control.
We tend to limit ibuprofen to children older than six months. Children with kidney disease, bleeding problems or a few other chronic illnesses may not be able to take ibuprofen. If your child has a chronic disease, check with your primary care provider to see if he or she can safely take ibuprofen.
A few studies have suggested ibuprofen may be better than acetaminophen in helping to treat fevers over 102 – 103 F, while acetaminophen may be better for children who are also having stomach pain or upset, because ibuprofen can sometimes irritate the stomach.
Some children consistently seem to respond better to one medication than the other. Each individual illness may also respond better to a particular medication. If you get a feeling that one medication is working better than the other, use that medication.
Many medical providers recommend alternating acetaminophen and ibuprofen for better fever control. Studies suggest there may be a slight improvement in fever control when using both medications; however, there is also an increased chance the child will accidentally be given an overdose of one or both medicines, especially if more than one person is giving the child medication.
With this possible safety concern about accidental overdose, there’s little benefit in using the medicines on an alternating schedule. If you choose to alternate acetaminophen and ibuprofen, alternate them every 4 hours. For example, give acetaminophen at noon, ibuprofen at 4pm, acetaminophen at 8pm, and so on. If more than one person will be giving medications, keeping a written schedule may help reduce dosing errors.
There is absolutely no evidence that giving acetaminophen and ibuprofen at the same time helps to control the fever. This practice can also lead to significant medication overdoses thus is not safe.
Oral dosing recommendations on the packages of medications are most often given in weight or age ranges. This can lead to under-dosing or slight over-dosing. It’s best to get a dosing chart or recommendations from your medical care provider so you can dose your child based on their current weight.
We recommend ibuprofen to be given at 10mg per kilogram of weight (about 10mg for every 2 pounds) every 6-8 hours or acetaminophen at 15mg per kilogram of weight every 4-6 hours.
Acetaminophen can also be given as a rectal suppository, but they are available in a limited selection of doses. Suppositories should not be split to modify the dose because the medication may not be suspended equally throughout the suppository, so one portion may have more medication than another. This limits the usefulness of the suppositories. It is not true that suppositories work better or faster than oral medication. Ibuprofen is not available in suppository form in the U.S.
To sum it all up, whether they have fever or pain, we use acetaminophen and ibuprofen to make our children feel better. With a few exceptions, both medications are safe to use when given in appropriate doses and with appropriate timing.
Ibuprofen may be better than acetaminophen for injuries or illnesses that also involve pain and inflammation or for higher fevers.
There is no need to alternate the two medications for fever. Keep it simple and use which ever medication seems to work better. Consult your primary care or urgent care provider to learn the safest and most effective doses to meet your child’s needs.
Lou Romig, MD, FAAP, FACEP, Medical Director
After Hours Pediatrics Urgent Care