Treating my child’s pain or fever - paracetamol or ibuprofen?

Ibuprofen and paracetamol are two very common over-the-counter (OTC) medicines used to treat pain and fever in children. Read on to learn about when and how to use these medicines safely. 

 
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About paracetamol and ibuprofen

Paracetamol and ibuprofen are the active ingredients in two very common OTC medicines used to treat pain and fever in children. Active ingredients are what make a medicine work.

Paracetamol products are approved for children 1 month and older. They come as drops, liquids, tablets that can be chewed and suppositories. They can be found in pharmacies and at supermarkets.

Ibuprofen products are approved for children 3 months and older. They come as liquids and tablets that can be chewed. They can be found in pharmacies and at supermarkets.

Paracetamol and ibuprofen are different to each other in:

  • how they work
  • how quickly they have an effect
  • how long they last in the body
  • who can take them
  • their chance of causing unwanted effects
  • how they change the way other medicines work if they taken at the same time.

What is the difference between paracetamol and ibuprofen for children?

Pain and fever are common in children. They can happen for many reasons, such as injury, illness, surgery or teething. Children may not always need medicines to relieve pain. When they do, it is good to know how to give them pain relief medicines that are safe and work well.

Fever is a rise in body heat above 38° C. It is a natural way for the body to fight off germs like viruses or bacteria. Children may also have a fever after getting a vaccine.  

Most babies and young children can handle a low-grade fever (eg, 38°–38.5° C) without needing medicine. They often just need clear fluids such as water, extra breastfeeds (if still happening) and comfort. 

Paracetamol is useful for treating mild to moderate pain and fever in children. It has only a small effect on inflammation (redness, swelling). 

Ibuprofen is one of the most common non-steroidal anti-inflammatories (NSAIDs) for treating mild to moderate pain and fever in children. Unlike paracetamol, ibuprofen can also lower redness and swelling. 

Research suggests that paracetamol and ibuprofen are very similar in how well they relieve pain in children.

Dosing instructions

The labels on over-the-counter (OTC) medicines for children often have age and average weight dosage guidance. Take extra care when reading these dosage tables or charts. Your child may be small or large for their age. Check with your health professional before using for the first time, and whenever you are unsure. They can help give you advice about dose. Always use the cup, spoon or syringe that comes in the pack to measure the dose.

Paracetamol 

OTC brands of paracetamol in Australia will tell you the right amount to take on the label. Make sure you buy the correct product for your child. The same brand can have different products for different ages. The amounts of paracetamol in each product may not always be the same.

Paracetamol medicines can be given to children: 

  • from 1 month of age, or
  • with a body weight of 4 kg and over. 

The normal time between doses for paracetamol is 4–6 hours. Do not give it more than 4 times a day. If your child still needs pain relief after two days speak with your doctor, nurse or pharmacist. 

Paracetamol given as an oral tablet (via the mouth), takes about 30 minutes to start working. When given as a suppository (via the bottom), it works more slowly, taking up to 90 minutes to have an effect. 

In children aged 1 month to 12 years, the advised oral dose is 15 mg of paracetamol/kg of body weight. The highest dose you should give at one time is 1 g of paracetamol. A child should not have more than a total of 4 g of paracetamol in a 24-hour time-frame. 

Ibuprofen 

OTC brands of ibuprofen in Australia will tell you the right amount to take on the label. Make sure you buy the correct product for your child. The same brand can have different products for different ages. The amounts of ibuprofen in each product may not always be the same.

Ibuprofen medicines can be given to children:

  • from 3 months of age or 
  • with a body weight of 6 kg and over, and 
  • with food or a milk drink.

The normal time between doses for ibuprofen is 6–8 hours. Do not give it more than 3 times a day. As with paracetamol, it is not recommended that you give ibuprofen to your child for more that two days in a row without seeing your doctor, nurse or pharmacist.

After swallowing ibuprofen, your child will usually start to feel relief from pain and/or fever within 15 minutes.

In children aged 3 months to 12 years, the advised oral dose is 5-10 mg of ibuprofen/kg of body weight. The highest dose you should give at one time is 400 mg of ibuprofen. A child should not have more than a total of 1200 mg of ibuprofen in a 24-hour time-frame.

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Always check you are giving the right amount that is shown on the pack. Talk about how to use the medicine with your doctor, nurse or pharmacist before giving it to your child.

How to give medicines to children

Small mistakes can cause big problems in little bodies, so parents and carers need to know how to give medicines to children safely.

It is important to measure out medicines and give them properly to lower any chance of accidentally giving too much or not enough. 

Medicines given incorrectly by parents and carers is one of the most common reason for accidental poisonings in Australian children under 12 months.

You can read more about giving medicines to children here.

NPS MedicineWise has also made some videos to help parents who need to give their child a medicine. 

Unwanted effects and reactions with other medicines

All medicines can have unwanted effects (side effects). You can lower the chance of your child getting side effects from a medicine. To do this, use the lowest recommended dose of the medicine for the shortest amount of time.

Many people see paracetamol as very safe. There is a low chance of side effects when you give it based on what your health professional says or by following the instructions on the pack/bottle. 

Side effects of ibuprofen vary in how often they happen and how severe they are. Side effects that may occur are feeling the need to vomit and having the runs.

If your child has other health issues check with your health professional before giving them paracetamol or ibuprofen. For instance, some children may have liver or kidney disease. Some may suffer from poor nutrition. These children may be more likely to get certain side effects when taking paracetamol. They may need to have medicines for pain and fever managed differently to what is on the pack.

You should also be careful when giving ibuprofen to a child who has heart, liver or kidney problems. Children with aspirin or NSAID-induced asthmaa may also have a higher chance of getting side effects.

Reactions with other medicines

Your child may need to take any other medicines. Always check with your health professional before giving them paracetamol or ibuprofen. Take care when you give two or more medicines at the same time. One medicine may change how the other one works. This is called an interaction. Many times there is no problem. But sometimes one medicine can stop another working as well - or can cause it to have a stronger effect - which can cause side effects..

aNSAIDs can trigger asthma symptoms in a small number of children who already have asthma.

Switching between paracetamol and ibuprofen

Not recommended if your child has a fever

There is no strong evidence to show a benefit from

  • taking paracetamol and ibuprofen at the same time for fever, or
  • switching between the two medicines. This means taking paracetamol for one dose then taking ibuprofen the next time.

Switching between two medicines can also be hard to keep track. It may also increase the chance that you give your child the wrong dose or too much of a medicine.

May be helpful if your child is in pain

Unlike treating fever, ibuprofen and paracetamol can sometimes work together to be more helpful in treating pain. There is research to show that switching between the two might give better pain relief. However there is not much research to show how safe it is to switch for more than a couple of days. 

Note that switching between paracetamol and ibuprofen can increase the chance of giving your child a wrong dose of either medicine. Keep a written record of when you give each dose. See your doctor if your child's pain doesn't improve after using ibuprofen or paracetamol.

Find out more

Do you have a question about your medicines?

Call Medicines Line on 1300 633 424 for advice from a pharmacist. Hours are Monday to Friday, 9am to 5pm AEST (excluding NSW public holidays).

This telephone service is not for emergencies, medical advice or second opinions.

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MedicineWise app

Use MedicineWise App to keep track of medicines and access important health info anytime and anywhere, especially in emergencies. Available to download onto your smart phone from the Apple Store and Google Play

Medicine Finder

Find out more about the medicines you are taking or giving to someone you care for. Use our Medicine Finder to read or download a copy of the Consumer Medicine Information (CMI).

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