Paracetamol, Acetaminophen and Ibuprofen

This page gives general information, including doses, on drugs, such as Paracetamol, Acetaminophen and Ibuprofen which are used in children with fever and for pain relief.

The first line drug for fever and pain in children is Paracetamol in the United Kingdom and Australasia or Acetaminophen for those in North America.

There has been a study that has shown that combining paracetamol (or acetaminophen as it is known in North America) and ibuprofen is more effective at treating fever but there is no evidence on whether symptoms are also reduced more effectively with both drugs used together. No drug is completely without side effects and so the current advice remains that one or other of Paracetamol (Acetaminophen in North America) or Ibuprofen is used first alone, with the option of adding the other in if no response.

My approach is to advise Paracetamol (or Acetaminophen in North America) as first line for fever because overall Ibuprofen, even though it has a good safety profile in children, is more likely to produce side effects than Paracetamol (Acetaminophen). However, as an anti-inflammatory agent for some disorders, such as arthritis, Ibuprofen would be my drug of choice.

There has also been another study that shows an association with paracetamol use and asthma in children. This does not mean that paracetamol (acetaminophen in North America) use causes asthma, however there should be caution in using excessive amounts of paracetamol (acetaminophen), and it should only be used when necessary. Treating a temperature just because it's there is not necessary - only treat if your child is miserable with a fever.

My advice for treating fever in children is this:

• only treat if your child is miserable with the fever - don't treat a fever just because it's there
• only treat if the temperature is 38.5 C (101.3 F) or above
• use Paracetamol (Acetaminophen in North America) as the first option, and only add in Ibuprofen is there is no response
• do not use Ibuprofen in chicken-pox
• use drugs in the appropriate doses - see below
• store medications, especially Paracetamol (Acetaminophen) safely

Paracetamol / Acetaminophen

Paracetamol is also known as Pamol and Calpol.

Acetaminophen is also known as Tylenol.

These are the first line medications for infants and toddlers with fever or pain. The doses are the same whichever preparation you use.

Dose

For Fever and/or Pain :
give 20 mg/kg as a first dose and then 10 - 15 mg/kg by mouth every 4 - 6 hours as needed.
The maximum daily dose that is safe is 90 milligrams per kilogram weight per day (90 mg/kg/day), unless your baby is less than 3 months old when you should not give more than 60 milligrams per kilogram weight per day (60mg/kg/day).

Paracetamol and acetaminophen can also be given via the rectal route with a suppository.
The first dose can be as high as 40mg/kg as an initial does and then your child can have 20 mg/kg per dose (given up to every 8 hours).
The maximum daily remains at a dose of 90 mg/kg/day, unless your baby is less than 3 months old when you should not give more than 60mg/kg/day.

Average doses of Paracetamol and Acetaminophen by age

• Less than 1 year old: work out the dose by multiplying your baby's age by 15, which will give you the milligrams(mg) that you can give and then you need to work out how many milliliters(ml) that will be.
  Give no more than 90 mg per kilogram weight in a 24 hour period (or no more than 60 mg per kilogram weight if your baby is less than 3 months old).
  So if your baby is 6 kg, you can give 6 x 15 = 90 mg.
  If you have syrup that is 80mg/5ml, you give 5.6 mls (5 x 90/80).
  If you have the 120mg/5ml syrup, you can give 3.75 mls (5 x 90/120).

• 1 year old: average weight is 10 kg. So give 200 mg first then 150 mg every 4 - 6 hours as needed.
  Give no more than 900 mg in one day.
  For the 120mg/5ml syrup, give 8.3 ml (5 x 200/120) first and then 6.25 mls (5 x 150/120) every 4 - 6 hours.
  Of course, you can round the doses down so you are giving 8 ml first and then 6 ml.
  These amounts are right if your syrup is 120 mg/5ml but you will need to adjust the dose if your syrup is stronger.

• 2 years old: average weight is 12 kg. So give 240 mg first then 180 mg every 4 - 6 hours as needed.
  Give no more than 1080 mg in one day.
  For the 120mg/5ml syrup, give 10 ml (5 x 240/120) first and then 7.5 mls (5 x 180/120) every 4 - 6 hours. These amounts are right if your syrup is 120 mg/5ml but you will need to adjust the dose if your syrup is stronger.

• 3 years old: average weight is 14 kg. So give 280 mg first then 210 mg every 4 - 6 hours as needed.
  Give no more than 1260 mg in one day.
  For the 120mg/5ml syrup, give 11.6 ml (5 x 280/120) first (round down to 11 ml) and then 8.75 mls (5 x 210/120) every 4 - 6 hours (round down to 8 ml every 4-6 hours).
  For the 160mg/5ml syrup, give 8.5 ml (5 x 280/160) initially then 6.5 ml (5 x 210/160) every 4-6 hours.
  For the 240mg/5ml syrup, give 5.8 ml (5 x 280/240) initially (round down to 5 ml), then 4 ml (5 x 210/240) every 4-6 hours.

• 4 years old: average weight is 16 kg. So give 320 mg first then 240 mg every 4 - 6 hours as needed.
  Give no more than 1440 mg in one day.
  For the 160mg/5ml syrup, give 10 ml (5 x 320/160) initially then 7.5 ml (5 x 240/160) every 4-6 hours.
  For the 240mg/5ml syrup, give 6.5 ml (5 x 320/240) initially then 5 ml (5 x 240/240) every 4-6 hours.

Additional information

Caution is required if your child has impaired liver function, impaired renal function, G6PD deficiency, or PKU (the chewables may contain phenylalanine). If your child has any of these conditions, speak to your doctor first.

Use judiciously - only use as necessary for high fever and discomfort. Increased use of paracetamol has been associated with an increase in childhood asthma, so don't use more than you need to. But don't be afraid to use Paracetamol (Acetaminophen) if you need to.

Take care to keep the paracetamol (acetaminophen) stored safely out of reach of your child. Paracetamol (acetaminophen) poisoning is common in children and is dangerous.

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If Paracetamol or Acetaminophen do not control the discomfort, Ibuprofen can be added, although this is not usually necessary. Remember, a fever in itself is not a bad thing.

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Ibuprofen

Ibuprofen is also known as Advil, Anadin, Brufen, Nurofen, or Motrin.

Dose

For Fever and/or Pain :
give 5 - 10 mg/kg by mouth every 8 hours as needed with or after food or milk.
The maximum daily dose is 20 mg/kg/day

Average doses of Ibuprofen by age

• Less than 1 year old: work out the dose by multiplying your baby's age by 10, which will give you the milligrams(mg) that you can give and then you need to work out how many milliliters(ml) that will be.
  Give no more than 20 mg per kilogram weight in a 24 hour period.
  So if your baby is 6 kg, you can give 6 x 10 = 60 mg every 6 hours.
  If you have syrup that is 100mg/5ml which is the same as 20mg/ml, you give 3 mls (60/20).
  If you have the 50mg/1.25ml which is the same as 40mg/ml syrup, you can give 1.5 mls (60/40).

• 1 year old: average weight is 10 kg. So give 50 - 100 mg (5 x 10 to 10 x 10) every 8 hours as needed.
  Give no more than 200 mg in one day.
  For the 100mg/5ml syrup which is the same as 20mg/ml syrup, give 2.5 to 5 ml (50/20 - 100/20) every 8 hours.
  If you have the 50mg/1.25ml which is the same as 40mg/ml syrup, you can give 1.25 to 2.5 mls (50/40 - 100/40).

• 2 years old: average weight is 12 kg. So give 60 - 120 mg (5 x 12 to 10 x 12) every 8 hours as needed.
  Give no more than 240 mg in one day.
  For the 100mg/5ml syrup which is the same as 20mg/ml syrup, give 3 to 6 ml (60/20 - 120/20) every 8 hours.
  If you have the 50mg/1.25ml which is the same as 40mg/ml syrup, you can give 1.5 to 3 mls (60/40 - 120/40)

• 3 years old: average weight is 14 kg. So give 70 - 140 mg (5 x 14 to 10 x 14) every 8 hours as needed.
  Give no more than 280 mg in one day.
  For the 100mg/5ml syrup which is the same as 20mg/ml syrup, give 3.5 to 7 ml (70/20 - 140/20) every 8 hours.
  If you have the 50mg/1.25ml which is the same as 40mg/ml syrup, you can give 1.75 to 3.5 mls (70/40 - 140/40)

• 4 years old: average weight is 16 kg. So give 80 - 160 mg (5 x 16 to 10 x 16) every 8 hours as needed.
  Give no more than 320 mg in one day.
  For the 100mg/5ml syrup which is the same as 20mg/ml syrup, give 4 to 8 ml (80/20 - 160/20) every 8 hours.
  If you have the 50mg/1.25ml which is the same as 40mg/ml syrup, you can give 2 to 4 mls (80/40 - 160/40)

Additional information

Caution is required with children who have had an asthma attack induced by anti-inflammatory drugs like ibuprofen, in children with liver or renal failure and in children with peptic ulcer disease.

Do not give Ibuprofen if your child has chicken pox.

It is important that you give ibuprofen with food or milk as it can irritate the stomach lining.

Stop taking Ibuprofen if your child develops a rash that blisters or involves the mouth or eyes - see your doctor. Stevens Johnson syndrome is a serious skin condition (although it is not common) that has been associated with use of Ibuprofen in children.

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