You're not comfortable using aspirin because it may increase the risk of Reye's syndrome, a potentially fatal disease that affects all of the body's organs. The American Academy of Pediatrics also cautions against using aspirin in children under the age of 14 if there is a high suspicion of chicken pox or influenza.
That leaves you with either ibuprofen or acetaminophen. Which one do you choose?
"There's not a very clear-cut answer to that question," says Dr. Robert M. Ward, a professor of pediatrics and director of the pediatric pharmacology program at the University of Utah in Salt Lake City. "There are not many head-to-head trials comparing one to the other that show a superiority with respect to effectiveness. They're metabolized differently and have different toxicity patterns."
Ibuprofen works by inhibiting prostaglandins, or the chemicals in the body that cause pain and fever. No one is sure exactly how acetaminophen works, but it may be by a similar mechanism.
The two are about equal when it comes to relieving pain and lowering a fever, says Dr. Richard Gorman, a Baltimore pediatrician and chairman of the American Academy of Pediatrics' Committee on Drugs. However, ibuprofen has the added advantage of being an anti-inflammatory so it can help with swelling, something acetaminophen doesn't do, he says.
There are other ways to rank the two, including formulation and dosing. Acetaminophen for children usually comes in different flavored liquids, which are easier to swallow, Gorman says. Because ibuprofen is not as liquid-soluble, it tends to be thicker and, consequently, less palatable for some children.
The dosing interval for ibuprofen is six to eight hours. For acetaminophen, it's about four hours. This gives ibuprofen an advantage, Gorman says, because you don't have to give it as often.
Ibuprofen can cause gastric distress and vomiting while acetaminophen, in extremely high doses or over prolonged periods, can cause liver damage. "Acetaminophen is very, very widely used in thousands of kids and is pretty safe," Ward says. "Take too much, however, and it can damage the liver."
The proportion of people getting liver damage from acetaminophen is tiny, but the dangers should not be ignored. "Liver damage is extremely rare but, because of the millions of doses of acetaminophen ingested every day, liver failure does occur," Gorman says.
In a policy statement issued in October 2001, the American Academy of Pediatrics said that although the incidence of acetaminophen toxicity was low, U.S. regional poison centers had treated more than 10,000 cases (adults and children) of acetaminophen overdose in 1997.
Ultimately, the choice is yours to make.
"Both work pretty well for fever and headache," Gorman says. "It becomes a matter of preference, what you and your kids feel comfortable with and like. To pass the FDA (U.S. Food and Drug Administration), any drug has to be incredibly safe when used by patients as directed and both clearly fall into this category."
Here are some tips for using both acetaminophen and ibuprofen as safely and effectively as possible:
- Carefully follow the dosing information given on the label.
- Never give extended release, double-strength, adult acetaminophen products to young children. "This exceeds the upper limit of safe dosages for children," Ward says.
- Make sure that each child is taking the preparation intended for that child since there may be children of different ages requiring different preparations.
- Keep the measuring device with the preparation it was intended for.
- Keep in mind that in children above the age of 3 months, fevers are very common. Experts prefer that parents not treat children younger than that without calling their physician, as there is a possibility that the fever is a sign of sepsis, a bacterial infection of the bloodstream that can lead to meningitis. The child should be evaluated for this potentially serious condition, Ward says.
- Be aware that there are many different products containing acetaminophen, and that all products containing this ingredient should be included in the total daily dose for your child.
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