Dr Phil Kieran: Paracetamol or ibuprofen or both for my sick child?
"Let’s first look at what they have in common. Both are painkillers, and they can bring down a temperature. They are also safe for children to use as long as the instructions are followed. Other than that, they aren’t really the same."
The difference between paracetamol and ibuprofen can be confusing and cause a lot of worry for parents trying to pick which one they should use in any given situation.
Let’s first look at what they have in common. Both are painkillers, and they can bring down a temperature. They are also safe for children to use as long as the instructions are followed. Other than that, they aren’t really the same.
Paracetamol has been around for a long time and can be used in children over the age of two months. It is almost always the first-line recommendation. Because it is so freely available, people tend to think it is a weak painkiller, but it can be very effective. Paracetamol is unusual in medicines as no other drug acts in the same way as it does. Paracetamol is broken down in the liver, so we do not recommend it for people with conditions that cause liver problems.
Ibuprofen is in a category of medications known as non-steroidal anti-inflammatories (NSAIDs). It can be given to children over three months, so slightly older than is the case for paracetamol.
Ibuprofen is primarily excreted through the kidneys in urine, so we would avoid it in people with kidney issues. This could include those who are dehydrated, so I would always caution against ibuprofen use in children who have any vomiting or diarrhoea, as this can increase the risk of kidney issues. Some people with asthma are sensitive to NSAIDs, so it might be a good idea to be cautious if there is a strong history of asthma.
Because they are metabolised in different ways in the body, paracetamol and ibuprofen can be and often are given together. I don’t recommend routinely giving both at the same time, but this is mainly because you want to give the least medications possible to a child. It makes sense to give a medication and then take time (30-60 minutes) to see if it has worked before giving another medicine.
Paracetamol can be given up to four times per day, and ibuprofen up to three times per day.
I recommend that anyone giving their child medications keep a sheet of paper with a record of what was given and when. My wife and I usually text each other when we have given painkillers to our children - that way we have a written and timed record to track what medication has been administered and when the next dose can be given, if needed.
Also, of note, you should not give ibuprofen to a child with chickenpox as it seems to increase the risk of skin infections and scarring.
- If you have a question for Dr Phil Kieran, please send it to parenting@examiner.ie
