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Using paracetamol or ibuprofen

paracetamol; acetaminophen; ibuprofen; Panadol; Nurofen; pain; fever; poisoning; overdose ;

Paracetamol has been safely used for many years to help with mild to moderate pain and fever for babies over 1 month of age, young children, older children and adults.

Ibuprofen has also been used for fever and mild to moderate pain in children and adults for some years. It is not suitable for children under 3 months of age.

Paracetamol and ibuprofen do not treat the cause of the pain or fever.

Contents

Paracetamol (which in some countries is called acetaminophen) has been safely used for many years to help with mild to moderate pain and fever for babies over 1 month of age, young children, older children and adults. But if too much paracetamol is given to a child, especially a sick child, for too long, it may harm the child.

Ibuprofen is a newer drug than paracetamol, but it has also been used for fever and mild to moderate pain in children and adults for some years. It is not suitable for children under 3 months of age.

Paracetamol and ibuprofen do not treat the cause of the pain or fever.

  • Any baby or child who is unwell, or in moderate to severe pain should be seen by a doctor to find out what the cause is.

Advice from the Women's and Children's Hospital in South Australia is that paracetamol is the preferred medicine for fever and pain in young children.

  • There is no benefit in giving ibuprofen instead of paracetamol, or in giving both at the same time, or alternating them.

ALERT!
Call the Poisons Information Centre on 13 11 26 (Australia) if a child, young person or adult has taken more paracetamol or ibuprofen than is recommended. Paracetamol is often taken by people who intend to harm themselves (suicide attempts). Paracetamol in large doses can cause severe liver damage.

When you might try paracetamol or ibuprofen

Fever

  • If a child has a fever, paracetamol or ibuprofen will often cause a drop in the child’s temperature, but lowering the child’s temperature is usually not necessary, and it will not help a child get well more quickly.
  • If a child has a low fever (perhaps under about 38.5 to 39°C) many doctors would suggest parents do not need to give paracetamol or ibuprofen to their child.
  • Having a high temperature causes headache, feelings of being unwell, and aching all over the body, and lowering the temperature can help the child feel more comfortable.
  • A high temperature is one of the ways that a body’s immune system works to control infections. While theoretically lowering the temperature can make the immune system less effective, it does not seem to make much, if any, difference in how quickly a child becomes well again.
  • Using paracetamol or ibuprofen does not protect a child from febrile convulsionseven if it reduces the child’s temperature (See the topic Febrile convulsions for more information).

Pain

  • Paracetamol or ibuprofen can make pain less severe, but they do not make the cause of the pain go away.
  • They can help a child sleep more easily if the child has, for example, an ear infection, sore throat, tummy pain or sore legs.
  • If the pain lasts for more than a few hours, or it is severe, or the child is clearly unwell, it is important to find out what is causing the pain.

Immunisations

  • Several years ago, most children had some fever after their immunisations, and it was often recommended that they have paracetamol around the time of the injections.
  • Since the vaccines have been changed (in particular the whooping cough vaccine), few children develop a fever, and it is no longer recommended that paracetamol or ibuprofen be given at the time of the immunisation. Paracetamol or ibuprofen given before an immunisation will not prevent the sharp sting of the actual injection.
  • If a child becomes unwell or has a fever soon after the immunisation, it is likely this is caused by something else, such as a cold or ear infection.

Giving paracetamol

How much to give:

  • Paracetamol for children comes in several different strengths, for babies, for young children and for older children. Paracetamol is also made and sold by many different companies.
  • Common strengths include:
    • 100 mg in 1 ml (drops for babies, only very small doses are given)
    • 120 mg in 5 mls (syrup for young children)
    • 240 mg in 5 mls (syrup for children over 4 years old).
  • Give the dose that is written on the bottle or pack for a child of your child’s weight.
  • If your baby or child is taking some other medicine, check that it does not have paracetamol in it, so that she doesn't get a bigger dose than she should.

How often can it be given?

  • Paracetamol can be given every 4 hours - no more than 4 times a day.
  • If your child seems to need it for more than twenty-four hours, check with your doctor to find out what is wrong.
  • Taking even the recommended dose for more than one or two days has caused liver damage in some children who were quite unwell for other reasons.
  • Make sure your child gets plenty to drink while taking paracetamol.
  • Older children and adults weighing over 60kg, who are taking tablets should not have more than eight 500 mg tablets in any 24 hour period

Ibuprofen

  • Ibuprofen is another medicine for mild to moderate pain and fever in children over 3 months of age.
  • It does not appear to be better than paracetamol, and paracetamol is the medication that is recommended by the Women's and Children's Hospital for children.
  • There does not seem to be any benefit from giving it at the same time as paracetamol.
  • Do not use ibuprofen if your child may be dehydrated (such as due to vomiting, refusing to drink or having diarrhoea). Make sure your child gets plenty to drink while taking ibuprofen.
  • If your child has asthma ibuprofen might trigger wheezing, so it would be better to use paracetamol.
  • There are some rare, but serious side effects that might occur if ibuprofen is given to a child for a long time. It is best to give ibuprofen with food.

The usual dose of ibuprofen

  • Give the dose that is written on the bottle or pack for a child of your child’s weight. 
  • Doses can be given 6 to 8 hours apart, with no more than 3 doses in 24 hours.
  • Older children weighing over 40kg and taking tablets should not have more than 3 doses of 400mg in any 24 hour period. (Each tablet is likely to contain 200mg of ibuprofen, but always check the amount).

Aspirin

Never give aspirin to a child or adolescent under 16 years. It can cause a rare, but severe illness called Reye’s Syndrome.

When to see a doctor

You should have your child seen by a doctor if your child:

  • is less than 12 months old and has a fever
  • seems unwell, unusually sleepy or irritable
  • is becoming more unwell
  • has a rash
  • is in pain such as headache, earache, tummy pain
  • is vomiting or refusing to drink
  • has a convulsion
  • has breathing problems, cough, wheezing
  • has a fever which lasts more than 24 hours
  • has a very high temperature (eg over 40º C)
  • has been injured and is in pain
  • or if you are worried.

Paracetamol poisoning

  • Paracetamol is one of the most common medicines taken by young children in an accidental overdose.
  • Swallowing a lot of paracetamol mixture or tablets can harm a child’s or adult’s liver, and sometimes the kidneys.
  • Always store paracetamol and other medicines out of reach of children. It is best to keep them in locked or ‘child proof’ cupboards.
  • Do not take tablets out of foil wrapping until you are ready to take the tablets. The wrapping is designed to be hard for children to open, so that they do not take many tablets if they find them and want to try them.
  • Always leave the ‘child proof’ lid on a bottle of paracetamol mixture.
  • Paracetamol is also commonly taken by people who intend to harm themselves (suicide attempts). Large amounts of paracetamol are very dangerous, but the effects do not show until about 2 to 3 days after taking the tablets. It is very important to seek treatment as soon as possible. Get treatment even if the person seems quite well for the first couple of days. Treatment has to be started early, before the effects begin

Have the Poisons Information Centre telephone number next to your phone at all times.

In Australia the number is 13 11 26.

Ibuprofen poisoning

  • If too much Ibuprofen is taken, it can affect breathing and make a person very drowsy, but it does not cause the liver damage that paracetamol can cause.
  • Always store ibuprofen out of reach of children, and leave it in the packaging that it comes in (child resistant packaging).
  • Call the Poisons Information Centre (13 11 26 in Australia) for advice if a child or adult may have taken an overdose of ibuprofen.

References

Women's and Children's Hospital (South Australia). 'Fever in children: guidelines for families'.

Australian Medicines Handbook 
http://www.amh.net.au  

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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