Ibuprofen or acetaminophen: Which is better for treating a kid’s fever?

The Pediatric Insider

© 2017 Roy Benaroch, MD

Ask babies with fever how they feel, and they’ll say… well, they probably won’t say anything, because they’re babies. But ask older kids, and they’ll look at you funny, and maybe say “Why are you asking me?” Kids these days, am I right?

Fevers make kids feel bad. Achy and miserable and bleh. So for comfort, I think it’s a good idea to treat fever in a child who’s uncomfortable. What’s important isn’t the number – how high the fever is – but how the child feels. Feeling bad? Let’s help you feel better.

(By the way, even though they make your child feel miserable, fevers will not harm your child in any way. Don’t be afraid of fevers.)

To treat a fever: first, offer extra fluids. Fevers are dehydrating, and a popsicle tastes good. Then reach for a fever reducing medicine, typically a brand of acetaminophen (like Tylenol) or ibuprofen (Advil or Motrin.) But which one’s better? A November, 2016 study in Clinical Pediatrics gives ibuprofen the edge, though not by much. Ibuprofen worked a little faster (peak effect in 90 minutes, versus 2 hours for acetaminophen), and lasted somewhat longer (by about an hour, though there was a lot of variability.) My usual advice is to use whichever one you’ve got at home and what’s seemed to work best in the past.Although serious side effects are rare, either medication can cause serious problems. Acetaminophen, especially in overdoses, is toxic to the liver (so be careful using this in a child who already has liver disease.) Ibuprofen, especially with prolonged use, can cause gastric irritation and bleeding, and rarely kidney problems. It’s important to use what you’re using correctly, at the correct dose and at the correct interval (both can safely be given every 6 hours.)

Which brings us to another idea: if either is good, can a combination of them be better? In an alternating strategy, one drug is alternated with the other, so something is given every three hours, and the same drug comes around for a dose every six. Several studies (summarized here) have shown that this can reduce fever somewhat better than either drug alone, but with a much greater chance of medication errors and overdoses. If you want to try this, write down what you’re giving and when, and make sure you (and your spouse) understand the schedule.

There are a lot of myths about fever. 98.6 F is not and has never been the “normal” temperature. Fevers, themselves, cause no harm. They also don’t help very much. In the modern world, fever is not a necessary or particularly useful part of your immune response. If a fever is making your child feel bad, treat it. With acetaminophen or ibuprofen, your choice.

Not feel good by Sophie

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3 Comments on “Ibuprofen or acetaminophen: Which is better for treating a kid’s fever?”

  1. Rachel Says:

    I find it hard to believe a high fever isn’t hard on a child. Some of our children have often had high fevers lasting for almost a week. Our three year old is getting them at least once a month since summer. I don’t know what’s going on. Dentists have told me high fevers soften the enamel on teeth and our children have had a lot of problems with their baby teeth. Maybe the black walnut tincture would help!?!? :/ no

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  2. Dr. Roy Says:

    Rachel, I didn’t say a high fever wasn’t hard on a child. I said “By the way, even though they make your child feel miserable, fevers will not harm your child in any way. Don’t be afraid of fevers.” Fevers can make kids feel awful, and I didn’t mean to minimize that or imply that they shouldn’t be treated or evaluated. I just meant that the fever, itself, isn’t damaging.

    I know of no evidence that fevers in a child will damage their teeth in any way, but I don’t follow the dental literature. I’ll see if I can find a ref on that.

    If your child has a high fever for a week, please take him/her to the doctor to figure out the cause. Fevers once a month are not ordinary and should be investigated. Here’s just one of many things that could cause that: http://www.aboutkidshealth.ca/En/HealthAZ/ConditionsandDiseases/InflammatoryConditions/Pages/Periodic-Fever-Adenitis-Pharyngitis-Aphthous-Ulcer-PFAPA-Syndrome.aspx

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  3. Rachel Says:

    Thank you! That’s how I was feeling about the recurring fevers. Every time I took him to the doctor they took a strep test which was always negative so they told me it’s probably a virus and sent me home. It was getting a little frustrating. But I also realize it takes a while to make some of these diagnoses.

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