As a pediatrician, I am asked by worried parents about what they should give their child with a fever, Motrin (ibuprofen), or Tylenol (acetaminophen) to bring down the temperature daily.
This question always requires more than a one-word response to the choice between anti-fever medications. An explanation of medication even being necessary for the fever and to clarify many long-standing fever phobia misconceptions.
Mainly, it is not necessary to treat the number on the thermometer, nor is it always necessary to bring the temperature down.
What is important is to address how the child is feeling and behaving regardless of their temperature. Are they happy and playful drinking fluids, or are they cranky, irritable, and uncomfortable?
If the former, then no fever-reducing medicine is even necessary. Pediatricians want parents to know not to be scared of fever; it’s the body’s way of fighting off the infection. The goal of a fever reducer is to make a kid feel better so they can rest and recover. Over-the-counter medicine doesn’t treat the illness or make them better or less contagious any faster. The take-home message is to use fever reducers for added comfort, not just because your child has an elevated temperature documented on the thermometer.
Now that you have decided that a fever reducer is warranted, here is some information on helping you decide which one to use Motrin or Tylenol.
Efficacy and safety
Tylenol and Motrin effectively bring the fever down in otherwise healthy kids over the age of six months. From my long-standing experience with patients, the fever does tend to decrease faster and remain lower a bit longer with Motrin than with Tylenol. But choosing which to give when your child is sick often comes down to what you have on hand in your kitchen or bathroom cabinet when your child needs it. Always use the measuring device with the bottle, a measuring spoon, or a syringe. A kitchen spoon is not an accurate measure and can lead to under or even overdosing.
Length of action
Tylenol can be given at four-hour intervals as needed; Motrin is every six hours. As a parent, it’s nice to have fewer dosages to administer, especially if it’s a struggle because your child does not like to take medicine in the first place.
An all-too-common practice, in my opinion, is alternating Tylenol and Motrin. Parents often do this to keep the fever “down” or suppressed. In most cases, this is not needed, especially if you remember treatment is for comfort and not trying to get the thermometer to read 98.6F. In addition, alternating medication every three to four hours often leads to medication errors and overdoses which can potentially be severe.
So if you are giving both( a practice I rarely recommend), please make sure to write down which medicine, the dosage, and what time it was given so all caregivers are aware to avoid errors.
Dosing is key
Regardless of whether you are giving ibuprofen (Motrin) or acetaminophen (Tylenol), make sure you know the correct dosage for your child. Dosage is always based on weight, not on their age. This will help to ensure the medication works as weight is much more accurate than a child’s age (so keep their weight from their last checkup visit handy). A common mistake I hear when a parent tells me that a fever reducer “didn’t work” is not giving the full recommended dosage. Often parents are scared of over-medicating, so they give a reduced or lesser amount than indicated and then are surprised it didn’t help the symptoms adequately. Tip: If you are going to give medication, always give the correct full dosage each time.
Pros and cons
Tylenol can be administered to infants under six months of age. It does not cause stomach upset and can be used for pain or fever reduction, lasting about four hours. An added perk about acetaminophen is that it also comes in suppository form if your child is vomiting or refusing to take anything by mouth. Often, this is the easiest route to deliver the medicine to a sick infant/toddler.
The downside to Tylenol is it can cause liver toxicity if given in excess or accidental overdose, so give it as directed and keep it stored high up and out of range when not in use.
Motrin is also great for fever reduction but has added benefits for reducing inflammation, like sports and muscle injuries. It keeps the fever down longer, and the dose is less often every six to eight hours as needed. Remember, ibuprofen is for children over the age of 6 months of age. It may cause more stomach upset, so avoid it if your child is vomiting or not eating.
Lastly, which fever reducer to give may ultimately come down to your child’s preference. Neither fever reducer will be helpful if they won’t take it.
Because both are safe and effective when taken correctly, opt for the one your child will take without a major meltdown or tantrum. This may be based on its flavor, consistency, or even form (liquid vs. chewable). Remember, lots of extra TLC, added fluids to drink to avoid dehydration, and even a tepid bath or cool compress on their forehead for added comfort and relief.
Jennifer Trachtenberg is a pediatrician and can be reached at Ask Dr. Jen.
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