Can my child receive any one of the fever-reducing medications (Paracetamol/acetaminophen or Ibuprofen)?

Who should avoid taking paracetamol (Tylenol or acetaminophen)?

 Children with underlying liver disorders – ibuprofen is preferred in these children
 Children with chronic kidney disease – these children should only be receiving paracetamol (and not ibuprofen) but we must remember to adjust the dose of paracetamol they receive, depending on the degree of kidney failure they suffer from

Who should avoid taking ibuprofen or Motrin?

 Children under 3 months – this age group is only allowed paracetamol.
 Children who have a history of gastric ulcers or gastric bleeding, or have an active gastric ulcer – paracetamol is preferred in these children.
 Children who have a history of asthma, urticaria, or have had allergic reactions following use of aspirin or other non-steroidal anti-inflammatory drugs.
 This is very important – in children who have no significant past medical history but whose present illness may lead to dehydration (that is, if they are vomiting or have diarrhea and/or are not drinking sufficient fluids) then paracetamol is preferred over ibuprofen. Note that this does not apply to illnesses where the child has one or two episodes of diarrhea but more so for those cases where there are multiple episodes of diarrhea and significant decrease in fluid intake.

A couple more important notes:

1. Remember that some of the above recommendations were derived following adverse events that were witnessed when these groups of children were exposed to drug doses higher than the maximum permissible dose.
2. The guidelines I have written above may possibly be too comprehensive. If you stick to the maximal permissible doses I mention on this website, you could probably treat those groups of children I mention above safely with both these groups of medications. Nonetheless, if your child falls into one of the above groups, it is best to consult with your primary care physician before giving them these medicines.

Note that there may be other groups of children who should avoid these medications due to different underlying conditions, but it is difficult to cover all these different conditions here.

What do parents need to keep in mind? Most children who have no past medical history, and are over 3 months, can take both these medicines safely (there is no need to test for liver or kidney function prior to their administration), as long as we stick to the permissible doses and do not exceed the maximum. What are these permissible doses? Click here to find out.