This post is also available in: Svenska
Facts and advice about acetaminophen and ibuprofen dosages given to children at home. Written by pediatricians. Acetaminophen and ibuprofen are perhaps the most widely used medicines for children at home. They help with pain and fever. But what dosage should you give? Can you combine them, and what are the side effects?
Acetaminophen, ibuprofen or both?
Acetaminophen, also known as paracetamol is taken for pain relief and fever. It comes in many other brands such as Alvedon (SE), Panadol (UK/AUS), Tylenol (US) etc. Although it is a widely used drug, no one has really managed to explain its mechanism of action.
Side effects of acetaminophen
In recommended doses, acetaminophen does not have many side effects. However, be careful giving acetaminophen every day for a long time because it’s not usually so effective then and in addition to that, you can get headaches when trying to quit.
In the event of a severe overdose, you can have severe liver damage. This can be life-threatening and leads to liver transplantation within a few days. There are antidotes that work if given before you have symptoms of liver damage. If a child has ingested more than 175 mg of acetaminophen per kilogram of body weight as a single dose, there is a risk of liver damage. If this has happened, give medical charcoal and seek the pediatric emergency room. In particular, make sure to store acetaminophen in a child-safe place.
Should I dare to give acetaminophen?
I still think you should give your child acetaminophen. But only when needed, and in the right doses. Fever itself is not dangerous for children, so you usually do not need to give any medication to bring down the fever. The exception is if the child is very dull and cannot take in liquid.
Many people give acetaminophen or ibuprofen for fear of febrile seizures. It’s completely unnecessary. Although febrile seizures are a very nasty experience (even though it’s usually harmless), anti-pyretic drugs do not prevent them.
Pain relief for children
If the child is in pain, you should definitely give painkillers. Acetaminophen is the best option. Unfortunately, the doses on the packages are a little too low to be effective. Doses should be 10-15 mg per kilogram of body weight at repeated dosing. In the children’s emergency room, an even higher dose is often given as a single dose or first dose.
- A child weighing 5 kg should receive 50-75 mg of acetaminophen per dose. That means a 60 mg suppository or 2-3 ml of liquid acetaminophen 24 mg/ml.
- A child weighing 10 kg should receive 100-150 mg of acetaminophen per dose. This means a 125 mg suppository or 5 ml of liquid acetaminophen 24 mg/ml
- A child weighing 15 kg should receive 150-225 mg of acetaminophen per dose. It is safe to give a 250 mg suppository or 8 ml of liquid acetaminophen 24 mg/ml or a 250 mg mouth orodispersible tablet.
A child weighing 20 kg should receive 200-300 mg of acetaminophen per dose. This means a 250 mg suppository or 10 ml of liquid acetaminophen 24 mg/ml or a 250 mg mouth orodispersible tablet.
The acetaminophen doses last for 6-8 hours, so give acetaminophen 3-4 times a day if the pain lasts.
Ibuprofen for children
Ibuprofen, also known as Advil brand, is an anti-inflammatory, analgesic and anti-pyretic medication. If one has special need for the anti-inflammatory effect, as in arthritis in children, ibuprofen is often chosen first-line. In other cases, as a rule, acetaminophen is first-line therapy. Ibuprofen can cause serious liver side effects even in the right dose in very rare cases.
Especially for a chickenpox infection, care should be taken with ibuprofen due to a possible increased risk of bacterial infections of the spots.
Ibuprofen suppositories often sting, so its liquid form is preferred. In ibuprofen’s case, you can follow the dosage information on the package which is completely correct (7.5 mg/kg three times daily).
Combining acetaminophen and ibuprofen for children
If you can manage with only acetaminophen or only ibuprofen, then do so. It is better not to combine the two from an adverse reaction point of view. The risk of unusual, unpredictable side effects increases when combining two drugs.
However, there is no increased risk of common side effects with combination therapy. So if the child is in a lot of pain and acetaminophen does not help, you can combine acetaminophen and ibuprofen for a few days.
It is especially common to have so much pain from blisters in the mouth that children may need to be given the combination to be able to drink at all.
- Only give acetaminophen (aka paracetamol) or ibuprofen when it is really needed, often when the child is in pain.
- Preferably give acetaminophen.
- Never overdose acetaminophen, and if that happens, give medicinal charcoal and seek the pediatric emergency room.
- Combine acetaminophen and ibuprofen if you really need it.