When our children have fever or pain, we naturally want to make them feel better. Tender loving care can go a long way, but sometimes we need a little help from medications. When considering when to give medications for fever or pain and also what to give, the first thing to do is realize why we’re using the medication. Also, read below for what NOT to do when your child has a fever, and about other, non-medicine comfort measures.
Fever
Fever is one of the most common reasons caregivers seek medical evaluation for their children. There is much apprehension about fever: some people are afraid for their children when they have fever, having heard stories about fever causing brain damage and convulsions or even death. Couple that with the fact that children often look and act much sicker when they have fever, and it adds up to a lot of anxiety.
Caregivers often turn to acetaminophen or ibuprofen, and sometimes both, in an effort to make the fever go away. There’s a lot of confusion about which medicine to give, how much to give and when to give it.
The good news is most stories about the dangers of fever are absolutely false! Fever from infection rarely goes above 106 F. The body temperature has to go above about 107 F before there is any damage to the brain or body.
There is such a thing as febrile seizures, but they are limited to children between the ages of 6 months and 5 years. When they occur, they are usually very brief and do not cause complications. They are completely unpredictable and do not occur because the temperature goes above a certain level. They’re far scarier than they are dangerous.
A fever that doesn’t go down all the way with proper doses of fever medication or one that comes back before the next dose is due is neither an indicator of infection nor of the seriousness of the illness. The fact that you can’t completely control the fever is not something to worry about, as it means nothing about the infection that’s causing the fever. The fever will go away when the worst of the infection goes away.
The real reason to treat fever is to make your child feel better. Fever itself, regardless of the source of the infection, will increase the heart rate and breathing rate; make your child sleepy, cranky or clingy; and decrease their appetite. If you can get the fever down even a degree or two, your child will likely feel better, start eating and drinking better, and look much more like themselves. Then you’ll feel better too!
Fever Control
Both acetaminophen and ibuprofen are excellent medications for fever control.
We tend to limit ibuprofen to children older than six months. Children with kidney disease, bleeding problems or a few other chronic illnesses may not be able to take ibuprofen. If your child has a chronic disease, check with your primary care provider to see if he or she can safely take ibuprofen.
A few studies have suggested ibuprofen may be better than acetaminophen in helping to treat fevers over 102 – 103 F, while acetaminophen may be better for children who are also having stomach pain or upset, because ibuprofen can sometimes irritate the stomach.
Some children consistently seem to respond better to one medication than the other. Each individual illness may also respond better to a particular medication. If you get a feeling that one medication is working better than the other, use that medication.
Many medical providers recommend alternating acetaminophen and ibuprofen for better fever control. Studies suggest there may be a slight improvement in fever control when using both medications; however, there is also an increased chance the child will accidentally be given an overdose of one or both medicines, especially if more than one person is giving the child medication.
With this possible safety concern about accidental overdose, there’s little benefit in using the medicines on an alternating schedule. If you choose to alternate acetaminophen and ibuprofen, alternate them every 4 hours. For example, give acetaminophen at noon, ibuprofen at 4pm, acetaminophen at 8pm, and so on. If more than one person will be giving medications, keeping a written schedule may help reduce dosing errors.
There is absolutely no evidence that giving acetaminophen and ibuprofen at the same time helps to control the fever. This practice can also lead to significant medication overdoses thus is not safe.
Dosage
Oral dosing recommendations on the packages of medications are most often given in weight or age ranges. This can lead to under-dosing or slight over-dosing. It’s best to get a dosing chart or recommendations from your medical care provider so you can dose your child based on their current weight.
We recommend ibuprofen to be given at 10mg per kilogram of weight (about 10mg for every 2 pounds) every 6-8 hours or acetaminophen at 15mg per kilogram of weight every 4-6 hours.
Acetaminophen can also be given as a rectal suppository, but they are available in a limited selection of doses. Suppositories should not be split to modify the dose because the medication may not be suspended equally throughout the suppository, so one portion may have more medication than another. This limits the usefulness of the suppositories. It is not true that suppositories work better or faster than oral medication. Ibuprofen is not available in suppository form in the U.S.
To sum it all up, whether they have fever or pain, we use acetaminophen and ibuprofen to make our children feel better. With a few exceptions, both medications are safe to use when given in appropriate doses and with appropriate timing.
Ibuprofen may be better than acetaminophen for injuries or illnesses that also involve pain and inflammation or for higher fevers.
There is no need to alternate the two medications for fever. Keep it simple and use which ever medication seems to work better. Consult your primary care or urgent care provider to learn the safest and most effective doses to meet your child’s needs.
Pain
Pain is pretty self-explanatory – nobody wants their child to be in pain. Pain is not only upsetting, but it also can increase the heart rate, breathing and blood pressure (although not usually to dangerous levels) and make a child cranky or withdrawn.
One of our key jobs as parents and caregivers is to reduce suffering by trying to minimize or prevent pain. Acetaminophen (such as the Tylenol™ brand) and ibuprofen (such as Motrin™ or Advil™) are our main tools to do that.
Both are great medications for fever and pain, but ibuprofen has an added benefit of fighting inflammation, which acetaminophen does not. For this reason, ibuprofen is sometimes preferred for pain from injuries or illnesses involving inflammation.
Children and Fevers: What Else You Should Know
Fever is the body’s natural immune system response to infection. Perhaps its goal is to raise the temperature of the body to create an environment that’s inhospitable to unwanted visitors. Here’s what you need to know:
- What is considered a fever and is it dangerous?
- How can you treat a fever at home?
- How should you treat a fever outside of the home?
What is considered a fever and is it dangerous?
A normal body temperature for most children is between 97.5°F and 99.5°F (37°C to 37.5°C). Temperature can fluctuate throughout the day and is usually lowest between 4:00 a.m. and 8:00 a.m. and highest in the early evening.
Children under 3 months
Fever is usually defined in children as a body temperature of 100.4°F or higher. A rectal temperature should be measured on children less than 3 months old, as it’s the most accurate way to measure small temperature changes.
In children less than 3 months of age, the difference between a rectal temp of 100.2°F and one of 100.4°F is the difference between needing a good physical examination and perhaps no tests, and needing a lot of tests done (blood, urine, nasal swabs or even a spinal tap) and possibly being admitted to the hospital for antibiotics.
Fever of any degree should be taken very seriously for children under 3 months and for any child with a proven significantly weak immune system. In these children, the relatively weak immune system may not be able to help fight off an infection and they can get sick very quickly.
Children over 3 months
In children over 3 months, there is no specific degree of fever that should trigger an immediate visit to a health care provider. The elevated body temperature won’t cause damage to the brain or body unless it gets above 107°F, which generally doesn’t happen with children with normal brain function.
Children with severe damage to specific parts of the brain can sometimes get fevers well over 106°F with infections, but most children won’t get fever higher than 106°F. Some children with temps of 104°F or even 106°F can be running around and playing, while another child with a temp of just 101°F might feel, look and act very sick. In this scenario, it’s the child with the 101°F fever who is the most worrisome!
Fever can make any child sleepy, cranky, clingy, achy and not interested in eating or drinking. They’ll also breathe faster, and their hearts will beat more quickly. The real reason to treat the fever is to help relieve these symptoms.
As the temperature comes down, the child should perk up and look and act much more like themselves, even if the temperature doesn’t go all the way down to normal. If your child is still looking and acting sick when their temp comes down, that’s the time to be concerned, because it means the infection itself, and not just the fever, is causing the symptoms.
Many times, pediatricians will recommend having an older infant or child seen if the temperature is over 102°F – 103°F, not because the fever is dangerous, but because the infection causing it may require testing and/or specific treatment.
If the child appears relatively well when the temperature comes down, is not having a lot of trouble breathing, isn’t having lots of vomiting or diarrhea, is drinking fluids well and not having any severe pain, there’s no need to see a doctor as an emergency, although you should certainly seek an evaluation at any time if you’re concerned.
How can you treat a fever at home?
What TO do when your child has a fever
- Give acetaminophen (such as Tylenol®) or ibuprofen (such as Motrin®), dosed by weight as indicated on the packaging or as instructed by a pediatric provider. In general, ibuprofen should not be given to infants less than 6 months old.
- Drink plenty of fluids. Your child should be urinating on their own once every 4-8 hours.
- Keep the room at average temperature (70°F – 74°F).
- Provide lightweight clothing and blankets.
- Give warm baths
- Keep your child home from school until their temperature has normalized for 24 hours.
- Make sure your child gets plenty of rest!
What NOT to do when your child has a fever
- DO NOT give Aspirin to children under 18. This can cause a condition called Reye’s syndrome, which causes swelling in the liver and brain.
- DO NOT give your child:
- cool baths
- rubbing alcohol on the skin
- ice packs
- bundling with clothes and blankets
These measures can affect your child’s natural temperature regulation, and in some cases increase their fever.
- DO NOT give caffeinated drinks (soda, tea, coffee). Caffeine increases urination, which can speed up dehydration.
How should you treat a fever outside of the home?
If your child’s primary care physician is not available, consider taking your child to an urgent care center or the emergency room.
Urgent care clinics have capabilities to provide Xrays and laboratory tests to help with accurate diagnosis and treatment. Not all urgent cares are the same; pediatric urgent care centers treat children from birth to 21 years of age. A pediatric urgent care clinic is staffed by pediatricians or sometimes family physicians, nurse practitioners and/or physician assistants who have experience and training in taking care of children.
It’s best to go straight to an emergency room (ER) if your child appears very sick or badly injured, is having severe trouble breathing, is having uncontrollable bleeding or severe pain, is having a seizure, is confused or is not responding to you as they usually do. In these cases, it’s often best to call 9-1-1 to have your child evaluated and treated even before you can make it to the hospital on your own.
Lou Romig, MD, FAAP, FACEP, Medical Director
After Hours Pediatrics Urgent Care