Fever Medication Use in Children-Ask Dr. Paul Library

DEAR DR.PAUL: I am confused. There are different types of medications available for fever. Which ones are safe for using in children?

DR.PAUL ANSWERS: Very good question! As a child, I remember the little pink baby Aspirins very well; However times have changed. Today, there are 3 medications that have an "anti-pyretic effect" meaning they can decrease fever:

  • Acetylsalicylic Acid (ASA) commonly known as Aspirin
  • Acetaminophen available as Tylenol, Tempra and Panadol
  • Ibuprofen available as Advil and Motrin

These medications can also control pain and inflammation. Let me talk about ASA first, because we now do not use this medication for fever control in children. Although my generation grew up on Aspirin for fever and pain control, ASA use has been linked to Reye's Syndrome, a dangerous and potentially fatal condition that involves liver failure and brain damage. Reye's Syndrome has been associated with the use of ASA during certain viral infections including chicken pox and influenza. As a result, ASA should never be used for fever/pain control in children. There are some uses for ASA, especially in older men for prevention of heart attacks, but this is a different age group and circumstance. Again with a few very rare exceptions (medical conditions only upon medical recommendation/supervision) ASA should not be used in children.

Acetaminophen, is a medication that has a long and favorable track record and is considered to be appropriate for use in children for fever and/or pain control.. Acetaminophen is available in liquid, drop or pill form and is given every four to six hours, as needed. Acetaminophen is also available in suppository form which can come in handy when a child needs to take fever medication but is throwing up, say with a "gastro" or stomach flu. Although acetaminophen is considered safe when used as recommended, taking it regularly, for more that a week at a time can be dangerous. Over dosage of acetaminophen can result in liver damage. So it is important to exactly follow the dosage based on a child's age or weight and not to give it regularly for more than 4 days.

Ibuprofen is a newer anti-inflammatory/fever medication which has not been around as long as acetaminophen. Most experts agree that ibuprofen is a relatively safe and very effective medication, but still recommend acetaminophen as a first line fever medication given its longer track record.

On a final note here are some general facts/points:

  • Overdosing by accidental ingestion of these fever medications can be very serious. These medications, as all others, should be stored well out of the reach of children.
     
  • Acetaminophen and ibuprofen are available in combined preparations with decongestants or cough medicines. I believe that these combination forms should be avoided.
     
  • If a child is on antibiotics for a bacterial infection(say an ear infection) and has fever, then acetaminophen can be given as well for fever control during the first 48 hours which is the time usually needed for to antibiotics to start working.

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