How can I reduce a child’s fever using medicine?

Rectal suppositories for fever reduction in children

Both Paracetamol and Ibuprofen are available in suppository form.
The main advantage to the use of this form of the drug is the ability to administer it to very young children, who cannot take oral medication, and to older children, who refuse to take medicine by mouth.
Their disadvantage, which is very important point to understand, is that suppositories are only available in set dosages (similarly to tablets) and these dosages are not always the optimal dose for your child.
This means that when administering medication in suppository form, we may have to compromise the exact dose that we would have liked to give our child.

Let’s take a real-life example. Suppose we wanted to give a child weighing 11 kg a rectal suppository. The optimal dosage for them (and you can learn more about how to calculate this here), is 165mg of Paracetamol (15mg/kg) and/or 110mg of Ibuprofen (10mg/kg).
But these dosages are not available in most countries in rectal suppository form, neither for Paracetamol nor for Ibuprofen.

What can I do if I prefer to give my child a rectal suppository, even though the exact dosage that he needs is unavailable in rectal form?

In order to do this, you can:
# Calculate the portion of the dose needed and divide/cut that portion from the suppository. For example, if you needed to remove 15mg from a 125mg, you would have to remove almost one/eighth of it. However, it is very difficult to accurately estimate how large one eighth of the suppository is. Furthermore, the drug companies clearly state that the medication is not spread evenly in the suppository and therefore different ends of it may contain different concentrations of the drug.
# Provided the suppository contains a smaller quantity than what your child is supposed to receive, then it is safe to give them the entire thing. For example, a child that weighs 8kg and needs about 80mg of Ibuprofen can receive the 60mg suppository without any concern. The problem is that by giving them the 60mg suppository, we have not given them the full quantity that they are able to receive. Usually, this is not a big deal. I would probably expect the fever to decrease, but not to the lowest temperature it could possibly get, and it would probably spike up again in a shorter amount of time than it would, had we given the full dosage. Sometimes, the child will need another dose of the drug, earlier than otherwise expected.

Do not administer a rectal suppository to a child if it contains a larger quantity of the drug than what is considered safe or required for the weight.

I think that as long as parents stick to the dosages of drugs that are safe, as stated in this website, and act according to my instructions, then the use of suppositories is safe, including cutting off/removing the relative portion of the drug that is needed (given the fact that some children are simply unable to take drugs in their oral formulations or throw up after every such trial).
However, do not give more than the allowed dosage per weight of the child or administer the drugs more frequently than what is allowed or considered safe.

How can the rectal suppository be placed in the child’s rectum?

If you are trying to administer this to a baby, they should be lying on their back. Older children can lay on their stomach, with their legs bent towards their bodies or on their sides, with their legs bent towards their stomach.
It is best to apply some lubricant material to the end of the suppository (such as a diaper paste or Vaseline) and to insert the suppository gently into the rectum. Hold the buttocks together for a few seconds so that the suppository stays in place.

The use of oral suspensions for the reduction of fever in children

Both Paracetamol and Ibuprofen are available in oral suspension form. They vary in flavour, consistency and most importantly – concentration!
What do I mean by concentration? The concentration of a drug is the amount of active drug (in milligrams, or mg) present in a set volume (in milliliters, or ml).
This can be confusing but I think it is very important to understand the concept behind this.
For example, one milliliter (ml) of suspension may contain 10mg, 25mg or 50 mg of active drug, depending on what the drug company decides to formulate.
Therefore, prior to giving a child the medication in oral suspension form, it is important to check how many milligrams of the drug are found in one milliliter of the suspension.

Here’s a real-life example, using the same child from the previous example.
If we were to give a child weighing 11kg an oral suspension to reduce, as I mentioned above, he/she would need 165mg (15mg/kg) of Paracetamol or 110mg of Ibuprofen (10mg/kg).
If you choose to give them Paracetamol, it is important to check how many milligrams of active drug are found in one milliliter of the suspension. If there are 250mg of active drug in 5ml, then this means there is 50mg in 1ml. If this child needs 165ml, then we would have to give them 3.3ml (using the ratio-proportion method: 165 multiplied by 1, divided by 50). So, this child would need 3.3ml of Paracetamol, every 4 hours.
If you choose to give them Ibuprofen, it is important to check how many milligrams of active drug are found in one milliliter of the suspension. If, for example, there are 100mg of Ibuprofen in every 1ml of suspension, then the child would need to receive 1.65ml of suspension (to cover 165mg of drug).

For more about the dosages required depending on weight, refer to this link here.
It is, of-course, also helpful to take a look at the instructions on the medication’s package. However, I think that a good understanding of the exact dosage required, depending on the weight of the child, will bring about the ideal therapy. The instructions on the packages usually state the recommended dose for a range of ages/weights and may lead to sub-optimal treatment.

My take home message is that when administering medicine in its oral suspension form, it is possible to give the exact amount required depending on the weight of the child, and by doing so, to maximize the concentration of the drug that the child receives.

The use of powder for the reduction of fever in children

This form of medicine comes in granules that are pre-packaged in sachets. These granules are usually given directly by mouth, without the need to mix in water first.
Sometimes, when you mix them with water, they lose their flavour and become quite bitter.
Similarly, to rectal suppositories, the main disadvantage of using this form is the inability to custom the dose to the child. I do not recommend taking only portions of the sachets to accommodate for the child’s weight as it is impossible to do this accurately.
The main advantage to this form is the simplicity in its route of administration (compared to oral suspensions which may require the child to swallow a large amount and tablets, which may be difficult to swallow).

Chewable tablets

These are tablets that are chewable and can be taken without water.
The main disadvantage to using this form is, again, the fact that these capsules/tablets come in pre-set dosages.
Again, the advantage is how easy and simple it is to take this medication. Some children really enjoy these.

The use of tables for the reduction of fever in children

These are more suitable for older children, who are able to swallow tablets.
Unfortunately, I have also seen younger children, as young as 5 years old, who know how to swallow tablets, but these are usually children with severe illnesses where it is difficult to compromise the treatment.
I wish for all our children to start learning how to swallow tablets when they are ready for it, and not because they have it (for some this will be at the age of 10, and for others it could at the age of 15).
The disadvantage of using this form of medicine is clear – similar to the disadvantage of using rectal suppositories or powder formulation.
Tablets come in set dosages, and you cannot customize the dosage to meet the child’s needs.
The advantage is the ease of administration, when the child is ready to take it.

Now that we have gone over some of these basic concepts, I suggest you read the next chapter “What medication should I give and how much of it”.
Good luck!