What is the best choice for children’s fever?

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Over the counter (OTC) there are two ingredients that are appropriate for use in the treatment of fever in children. These are acetaminophen and ibuprofen. The acetaminophen containing products are represented by Tylenol®, Tempra®, Atasol®, Panadol® and many generic or private label brands. The ibuprofen containing products include Motrin®, Advil® and private label brands. Both ingredients are considered to be safe and effective when used to treat fever from various causes in children.

Which product is the better choice really comes down to how each child has previously responded to the medication in previous episodes. In theory, both agents are equally effective, so that either drug would be a good choice. The effectiveness will vary from child to child, as one ingredient will provide better results in one child, as compared to the use of that same agent in another child. Unrelated to effectiveness, the slightly different dosing properties of the two medications will see the acetaminophen being dosed every four to six hours, while ibuprofen has a slightly longer action which means it can be dosed every six to eight hours. That does not describe effectiveness, simply different drug characteristics. As well, acetaminophen is much less likely to cause any stomach related adverse effects, and is therefore better tolerated by more children. Ibuprofen, which certainly can be well tolerated by many children is considered to be just slightly more likely to cause stomach related adverse effects such as upset stomach, heartburn and stomach pain. For that reason it is best to dose Ibuprofen with food, to better prevent stomach related effects.

Where acetaminophen is not proving to be effective in reducing fever symptoms, or the dosing interval proves to be shorter than four hours to maintain adequate fever control, a switch to the ibuprofen ingredient will often (not always) result in better fever control. Remember, ibuprofen has substantial anti-inflammatory properties not shared by acetaminophen which sometimes explains the better results obtained with the use of ibuprofen. For fevers, that are measured by body temperatures of less than 40° C (~103° F), the use of acetaminophen as first line treatment, is the better choice given this drug's long history which has proven its effectiveness, tolerability and safety. Acetaminophen can also be used in conjunction with many other medications and in the presence of many other chronic disease histories, such as asthma and diabetes. The use of either drug should only be done after you have ensured that the child is NOT allergic to the particular drug or had any previous history of an adverse reaction. Repeated dosing, following appropriate dosing guidelines should be continued for no longer than 48 hours, before consulting with a Pharmacist or Physician to rule out serious infection.

Since Fever can be associated with such a wide variety of illnesses, minor and severe, parents are always encouraged to consult with their Pharmacist before using and to also obtain an accurate dosing guideline given the child's age and weight. As well, the use of a thermometer to accurately measure body temperature will provide essential information for you, as well as the Pharmacist or Physician, when consulted. It is a small investment that will pay dividends many times over - so do not delay, purchase a digital thermometer which can be used for oral, under the arm or rectal, temperature measurement.

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