Children and drugs: when to use ibuprofen and paracetamol

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When the baby is sick and has a fever or other types of pain, the pediatrician may advise parents to use acetaminophen or ibuprofen to relieve symptoms. These two drugs, in fact, are the recommended only ones for the treatment of pain or of fever in pediatric age. Sometimes, however, some pediatricians recommend alternating them to enhance their effect, will it really be useful? Let's take stock of the situation with Dr. Marco Parenti, professor of Pharmacology at the University of our city-Bicocca.

In this article

  • Paracetamol
  • Administration and dosage
  • Side effects of acetaminophen
  • Ibuprofen
  • Administration and dosage of ibuprofen
  • Side effects of ibuprofen
  • Alternating paracetamol and ibuprofen: risks and benefits


"Paracetamol - explains Professor Parenti - is a drug with antipyretic and pain-relieving activities. It is therefore used not only for the treatment of fever, but also of pain, as in case of headache and toothache ".

Paracetamol can also be useful in case of:

  • Earache
  • Sore throat
  • Muscle trauma pains
  • Post-surgical pains

Regarding fever, however, the guidelines drawn up by the Del Paesena Society of Preventive and Social Pediatrics remind us that it is not always advisable to use a antipyretic to lower the baby's body temperature. Antipyretics, such as acetaminophen, should be used only when the child really needs it. If it has no others symptoms and tolerates fever without too many problems, there is no need to administer any medication.

Administration and dosage

Paracetamol is a over-the-counter medication, that is, available without a prescription. As for the formulation, it is possible to find paracetamol in the form of:

  • Syrup
  • Tablets
  • Buccal sachets
  • Suppositories
  • Drops

For younger children (0-7 kg) we recommend drops to be taken orally, from 7 kg upwards, on the other hand, paracetamol can be administered in the form of syrup. For older children, typically 20 kg and up, you can choose between buccal sachets e compress. As regards the suppositoriesinstead, it is better to use them only when oral administration is not recommended, such as in case of vomiting. This is because the "against"of the suppositories are now greater than the" pros ".

"Of course - explains Parenti - it is necessary to pay extreme attention to the dosage because we are dealing with children, therefore subjects more at risk dosage for children it is expressed according to weight and not age. In fact, there is a standard dosage that must then be adjusted according to weight. "It is therefore advisable to always follow the doses indicated in the package insert. The minimum time interval between one administration and another (always in case it was needed) is at least 4 / 6 hours. Paracetamol can be taken on either a full stomach or an empty stomach.

Side effects of acetaminophen

As we have seen, paracetamol should not be given to lower fever if there are no other symptoms that indicate general malaise. Furthermore, if symptoms do not improve with the use of paracetamol within 3 days, it is a good idea to contact your pediatrician.

"Paracetamol can become toxic at the level of liver when a certain dosage is exceeded, so you have to pay attention to the dose of medicine that is administered to the child. "It is good to contact a medical health insurance if following recruitment there are:

  • Redness of the skin
  • Breathing difficulties
  • Urticaria
  • Swelling of the face, tongue, lips, hands and feet
  • Yellowish discoloration of the skin


"Ibuprofen, on the other hand - explains Professor Parenti - falls into the category of NSAIDs (non-steroidal anti-inflammatory drugs) and, compared to paracetamol, adds aanti-inflammatory action. It is important to underline this because in the case of paracetamol there is no anti-inflammatory activity. "Ibuprofen, like paracetamol, is used against fever and for the treatment of pain, "they both have excellent effectiveness"emphasizes the professor.

More or less like paracetamol, it can also be administered in case of:

  • Headache
  • Earache
  • Sore throat
  • Trauma pains
  • Chronic inflammatory diseases

As mentioned before, we remind you that in case of fever without other symptoms it is better not to administer drugs to the child while waiting for the natural course.

Administration and dosage of ibuprofen

Even in the case of ibuprofen, it is a over-the-counter medication, marketed under different names and in different formulations including:

  • Syrup
  • Tablets
  • Chewable capsules
  • suppositories

"In general, the administration to be preferred is that for orally because suppositories have some contraindications ", Professor Parenti reminds us, adding that" the same information given for paracetamol applies here too: the dosage always depends on the child's body weight ". duration of effect of ibuprofen is longer than paracetamol, but the time interval between one administration and the other increases, in fact it is necessary to wait 8 hours before giving the child a new dose of medicine.

Ibuprofen can be used in children from the age of 3 months of age or in any case in children weighing more than 5 kg.

Side effects of ibuprofen

"Ibuprofen, like all NSAIDs, can cause lesions to the gastrointestinal mucosa, for this reason it is always better to take the medicine on a full stomach" suggests Dr. Family members. In case of overdose or prolonged use, ibuprofen can cause:

  • vomiting
  • Diarrhea
  • renal toxicity
  • abdominal cramps
  • gastrointestinal bleeding

In case the child assumes other drugs, before administering ibuprofen, and also applies to paracetamol, it is a good idea to read the package leaflet to see if there are any contraindications. After 3 days of use without improvements it is recommended to contact the pediatrician.

Alternating paracetamol and ibuprofen: risks and benefits

The practice of alternating paracetamol and ibuprofen is very common among parents, both to bring down the fever and to treat other types of pain in children. Some pediatricians recommend it, others categorically forbid it. AND Useful o harmful? Let's see what Professor Parenti can tell us about it.

"True, some pediatricians recommend alternating paracetamol and ibuprofen, while others disagree with this method. The only solution is therefore to see what the scientific literature says. To bring down the fever, there is absolutely no reason to alternate. two drugs, which are equivalent to each other. The alternation in this case does not bring any improvement, on the contrary it could only do more damage ".

The question is a little different when we talk about the treatment of the pain. "In this case, the two medicines can be alternated, but taking into account that the first choice for pain must always be paracetamol. If the pain is severe, the pediatrician can evaluate the administration of a paracetamol-based preparation and codeine. If this is still not enough, then ibuprofen can be considered. "In these cases, a lot of attention must be paid to doses and times of administration, remembering to keep the baby well hydrated to avoid the risk of toxic effects and following the directions given by your doctor. The association of the two active ingredients must not be done on one's own initiative because potentially very dangerous for the health of the child.

The potentials adverse effects they can be:

  • acute renal failure
  • gastrointestinal bleeding
  • liver damage
  • risk of overdose of either drug

Sources used for this article:

Advice from dr. Marco Parenti, professor of Pharmacology at the University of our city-Bicocca.

The management of fever and pain in the pediatric age, Del Paesena Society of Preventive and Social Pediatrics, 2022

  • fever
  • paracetamol children
  • pain children
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