Paracetamol and ibuprofen are the two most commonly used options available for children for relief of mild to moderate pain. Both are available without prescription. Both are equally effective. Both can also be used to lower a fever (discussed below). If either are used for more than 48hrs a doctor should be consulted.
The big question is paracetamol or ibuprofen, which should you use and why. There are a lot of factors at play here. Is it for pain or fever? If its pain is there any inflammation? Does your child have any allergies, take any medication or have any medical conditions?
All medication should be taken at the lowest possible dose for the lowest possible duration possible. If your child has any pre-existing medical conditions or is on other medications you should check with your doctor before using any medication.
Let’s take a further look at the two options.
Pain relief for babies and children
Ibuprofen and paracetamol have shown a similar impact on pain relief. As paracetamol, when taken according to directions, has less potential for side effects it should be the first choice for pain relief in children.
Fever relief for babies and children
A low-grade fever (eg <38–38.5°C) in children will often respond to fluids and comfort, without the need to medicate. There is no evidence that treating a fever prevents febrile seizures.
Alternating paracetamol and ibuprofen
There is no benefit of doing this to lower a fever and an increased risk of negative effects. If one choice alone is not working it may be worth trying alternating between these two pain relievers. However it is very important to record what you use and when to ensure you get the dose correct and to show your medical professionals if you need to consult them at any point.
Quick reference table
| Pain | Inflammation | Fever | Suitable from | Time to work | How long it works for | Side effects | |
| Paracetamol | x | x | 1 month | 30 minutes | 4-6 hours | fewer | |
| Ibuprofen | x | x | x | 3 months | 15 minutes | 8 hours | more |
Paracetamol for babies and children
When to use paracetamol
- Paracetamol is useful for mild to moderate pain. Paracetamol lowers fever. Paracetamol has no anti-inflammatory effects. Paracetamol is the preferred choice compared to ibuprofen for mild-to-moderate pain as it has fewer adverse effects.
Dose – how much paracetamol to give:
Paracetamol can be given from 1 month old, however it is recommended to consult your doctor if your child is under 6 months old. Paracetamol needs to be given strictly according to the dose and frequency instructions on the packaging and if pain and/or fever lasts for more than 48 hours, talk to your doctor.
Caution! Get the dose right:
There are many brands of paracetamol. It is also contained in many cough and cold products and it is important to avoid using more than one paracetamol containing product at the same time. Too much paracetamol can cause liver damage.
Please be aware that paracetamol is available in different strengths. Be sure to check correct dosing before giving. If you are unsure ask your pharmacist or doctor.
How long does it take to work?
Paracetamol takes about 30 minutes after taking an oral dose to start working and will last for about 4 to 6 hours.
Ibuprofen for babies and children
Ibuprofen is an anti-inflammatory pain reliever.
Dose – how much ibuprofen to give:
Ibuprofen can be given to children from 3 months of age. Always check with your doctor or pharmacist if it is appropriate for your child before using. Ensure the correct dose is given, ibuprofen comes in several different strengths and so doses should be checked before each time it is given.
How long does it take to work?
Ibuprofen starts working within 15 minutes and works for about 8 hours.
Side effects:
Ibuprofen has been shown to be more likely to cause adverse effects including nausea and diarrhoea when compared to paracetamol. For a full list of potential side effects see the product information.
Caution:
Ensure your child is hydrated when taking ibuprofen to minimise the risk of adverse effects.
Non drug options for babies and children
Consider non-drug options where appropriate for pain relief. For example heat or cold applications, massage, exercise, immobilisation and relaxation techniques may help.
Eg for teething sucking on something cold (ensure it is safe and not a choking risk) may soothe sore teeth.
Reference: Australian Medicines Handbook 2018, Australian Medicines Handbook Pty Ltd; Adelaide.
Tanya Burgess is a registered pharmacist and mother of 3 girls. When she’s not wrangling her tribe or talking healthcare you’ll find her online at Baby Hints and Tips. This non-judgemental community is a hub for advice on all things pregnancy, baby, kids and parenting. Enjoy the support and fun at www.babyhintsandtips.com
This article was published in Issue 27 of our print magazine, April/May 2018.
