Parents' guide to paracetamol + ibuprofen

by Dr Richie Austerberry
Artist: @ellieloomes
 
 
Paracetamol and ibuprofen are two of the most common medications given by parents to children in Australia, yet they can often be a source of confusion for parents.
 
In this blog we answer common questions we get asked at Night Doctor so you can have confidence in making the right decisions when considering giving your child these medications.

What are paracetamol and ibuprofen?

Paracetamol (e.g. Panadol / Panamax / Dymadon)

The exact way paracetamol works is still not completely understood which you may find surprising given how many years we have been using it for! What is known is that it stops the production of “pain messengers” called prostaglandins.
 
If you hurt your finger, then pain signals travel from your finger through your nervous system to your brain and that is how you become aware of the pain. By reducing the prostaglandin messengers in the brain, paracetamol reduces the amount of pain that you feel.
 
Certain infections also lead to the release of prostaglandins, but these ones cause our brain’s thermostat (the hypothalamus) to make us hotter. Again, by reducing prostaglandin production, paracetamol is believed to help settle fevers.

Ibuprofen (e.g. Nurofen / Brufen / Advil)

Ibuprofen works in a similar way to paracetamol. However, unlike paracetamol, ibuprofen reduces prostaglandins throughout the body, not just in the brain. As a result, it not only reduces pain and fever, but also reduces inflammation in our body which paracetamol is not very good at.

When should I give paracetamol or ibuprofen?

If you think your child has mild to moderate pain, a fever, or inflammation, you should consider giving them paracetamol and/or ibuprofen.

Pain

Many injuries and illnesses cause children pain. Older children can often tell you where their pain is, but in younger children it may not be as obvious. The following might suggest your child is in pain1:
  • Crying or screaming

  • Pulling a face

  • Changes in sleeping and eating patterns

  • Being quiet and withdrawn

  • Not wanting to move, or not able to get comfortable

If your child looks unwell, or in moderate to severe pain they should be reviewed by a doctor to determine the cause.

Fever

Fever in most children is when their body temperature rises above 38oC and is usually caused by an infection. It is a normal process that helps the body's immune system fight the infection. Many children cope well with low grade temperatures (e.g. 38-38.5oC) and can be kept comfortable with regular drinks of fluids (e.g. water, diluted fruit juice, cordial), or if less than 6 months - extra breastfeeds, cooled boiled water or bottles.2
 
If your child is miserable with a fever, then giving paracetamol or ibuprofen can often make them more comfortable and more willing to drink - which is important to remain hydrated.
 
Many parents get concerned when a temperature does not come down after giving medication. There is no evidence that fever causes harm to your child’s brain or any of their organs, and so you should not focus on bringing down the number itself, but instead on making your child comfortable.2 If your child is comfortable with a fever, there is no need to give paracetamol or ibuprofen.
 
If you are giving paracetamol and/or ibuprofen and your child continues to look unwell you should seek a doctor review.

Inflammation

Some illnesses cause inflammation (redness, heat and swelling) and may benefit more from ibuprofen as it is an anti-inflammatory. Common conditions we see at Night Doctor include injuries, middle ear infections and throat infections such as tonsillitis.

Is it safe to give paracetamol and ibuprofen together at the same time?

The quick answer is yes, you can. Paracetamol and ibuprofen do not react with each other to harm your child. The potential risk of using them both together is that you will get confused with how much you have given and then give your child too much.

Remember that:

  • Paracetamol can be given every 4-6 hours - MAXIMUM FOUR DOSES IN 24 HOURS

  • Ibuprofen can be given every 6-8 hours - MAXIMUM THREE DOSES IN 24 HOURS

Always check the medication packaging / bottle to be sure about the recommended frequency and maximum daily doses for your child’s age and weight.
 
We have created this Night Doctor Paracetamol + Ibuprofen Diary to allow you to record when you have given the medications, so you have an accurate record and can avoid giving too much within any given 24 hour period.

When should I use both paracetamol and ibuprofen?

Fever

Studies have shown no benefit of either combining paracetamol or ibuprofen, or alternating between the two when treating fever. Therefore we recommend sticking to one only.3

Pain

Unlike treating fever, ibuprofen and paracetamol have been shown to complement each other, providing improved pain relief when given alternately.3 Therefore, if one medication is not controlling your child’s pain, you can try introducing the second and alternating between the two.
 
Again, when alternating paracetamol and ibuprofen, be sure to keep a diary so you do not give more than the recommended daily doses of each.

How long will it take before it starts working?

  • Paracetamol orally - approx 30 mins3

  • Paracetamol suppositories (rectally) - can take up to 90 mins3

  • Ibuprofen orally - approx 15 mins3

The pack says don’t give for more than two days without seeing a doctor. Will it harm my child if I do?

It is recommended you seek a doctor review if needing to treat your child with paracetamol and/or ibuprofen for more than 48 hours, as it is important to determine the cause of your child’s fever or pain.
 
If your child looks unwell or has moderate to severe pain despite giving paracetamol and/or ibuprofen, you should seek a doctor review.

Should I give ibuprofen with food or milk?

Giving a few doses of ibuprofen to your child without food is unlikely to cause them harm. In fact it is likely to make them feel better quicker as it gets absorbed quicker. For these reasons, the Australian Medicines Handbook (AMH) guidelines have recently changed and now recommend taking it with water rather than food.4 However, if your child complains of an upset tummy after taking it, AMH still recommends you give the next dose with food (or milk).4
 
If you want to read more about the change of advice, this article is a good place to start.

My baby spits it out. Have you got any tips?!

It’s all about the cheek technique! Avoid squirting the medication in the front and middle of the mouth as it is very easy for your baby to spit it out. What you need to do is5:
  • Hold your baby as you would when nursing or feeding them

  • Put the syringe into the mouth (e.g. beyond the lips) and squirt the medication between the side of the tongue and the cheek. This makes it easy for them to swallow and harder for them to spit out.

  • Wait until they swallow that dose before giving them more

  • Make sure they have swallowed it all before laying them down

Summary

  Paracetamol Ibuprofen
Used to treat
Mild to moderate pain
Fever
Mild to moderate pain
Fever
Inflammation
Minimum
Age + Weight
(for safe use)
Must be:
older than 1 month
AND
more than 4kg
Must be:
older than 3 months
AND
more than 6kg
Frequency and maximum
doses
Can be given every 4-6 hours
MAX 4 times a day
Can be given every 6-8 hours
MAX 3 times a day
Common brands
Panadol
Panamax
Dymadon
Nurofen
Brufen
Advil
Forms available
Drops
Oral liquid
Tablets
Suppositories (rectally)
Tablets (including chewable form)
Capsules
Oral liquid

 

References

  1. Pain relief in children - paracetamol + ibuprofen - The Royal Children's Hospital Melbourne

  2. Fever in children - The Royal Children's Hospital Melbourne

  3. Treating my child's pain or fever - paracetamol or ibuprofen? - NPS MedicineWise

  4. Australian Medicines Handbook

  5. How do I use an oral syringe to give my baby medicine? - BabyCentre

 
This information is general and may not apply to you or another person. If you have any concerns about your health or the health and wellbeing of a child, consult a doctor or other healthcare professional. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.


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