Kids Health Info

Pain relief for children - Paracetamol and Ibuprofen

    • Pain is common in many injuries and illnesses in children, as well as after having an operation (post-operative pain).
    • Children with pain often need an analgesic (pain-reliever) medicine such as paracetamol and/or ibuprofen to help reduce or control their pain.
    • Giving your child regular pain-relieving medicines will help you to manage their pain at home.
    • Paracetamol and ibuprofen do not treat the cause of your child's pain; both medicines just relieve the feelings of the pain.

    How do you know when your child is in pain?

    Older children can often tell you that they have pain, although some children might not be able to tell you exactly where their pain is.

    Things that can show that your child has pain include: 

    • crying;
    • screaming;
    • pulling a face;
    • changes in sleeping and eating patterns;
    • becoming quiet and withdrawn;
    • refusing to move, or being unable to get comfortable.

    Treatment: 

    Paracetamol

    Paracetamol has been safely used for many years for mild to moderate pain in infants over one month old, children, adolescents and adults. However, if too much paracetamol is given to a child for too long, it may harm the child. 

    Ibuprofen

    Ibuprofen can be used for mild to moderate pain in children, adolescents and adults. It should not be used in children under three months of age or be given to children with bleeding disorders. 

    Any infant or child who is unwell, or in moderate to severe pain, should be seen by a doctor to find out the cause.


    When to use paracetamol or ibuprofen 

    • Paracetamol or ibuprofen can make pain less severe, but neither medicine will make the cause of the pain go away.
    • They can help a child sleep more easily if they have a painful condition such as an ear infection, sore throat, sore tummy or a broken bone.
    • If the pain lasts for more than a few hours, or it is severe, or the child is clearly unwell, it is important to find out what is causing the pain.

    Giving paracetamol 

    How much to give:

    • Paracetamol for children comes in several different strengths, for babies, for young children and for older children. Paracetamol is also made and sold by many different companies, and different brands may have different names (e.g. Panadol, Panamax, Dymadon).
    • Common strengths include:
      • 100mg in 1ml (drops for babies, only very small doses are given)
      • 120mg in 5ml (syrup for children 1-5 years)
      • 240mg in 5ml (syrup for children 5-12 years)
      • 500mg in 1 tablet (for older children and adults)
    • Give the dose that is written on the bottle or pack according to your child's weight.
    • If your baby or child is taking any other medicine, check it does not also have paracetamol in it.  If it does, your child will get a bigger dose than they should. 

    How often can it be given?

    • Paracetamol can be given every four to six hours - no more than four times in 24 hours.
    • If you need to give your child paracetamol for more than 48 hours, it is important to see a doctor to find out the cause of your child's pain or fever. 

    Giving ibuprofen 

    How much to give:

    • Ibuprofen for children comes in several different strengths, for babies, for young children and for older children. Ibuprofen is also made and sold by many different companies, and different brands may have different names (e.g. Nurofen, Brufen, Advil, Dimetapp).
    • Common strengths include:
      • 200mg in 5ml (syrup for babies over 3 months)
      • 100mg in 5ml (syrup for children 1-5 years)
      • 200mg in 5ml (syrup for children 5-12 years)
      • 200mg in 1 tablet (for older children and adults) 
    • Give the dose that is written on the bottle or pack according to your child's weight. 

    How often can it be given?

    • Doses can be given every six to eight hours - no more than three times a day.
    • If your child has asthma, ibuprofen may cause wheezing.  If so, it would be better to use paracetamol.
    • There are some rare but serious side effects that might occur if ibuprofen is given to a child for a long time.
    • It is best to give ibuprofen with or soon after food or milk. 

    It is ok to alternate giving paracetamol and ibuprofen so that your child's pain is well controlled. 

    NOTE - if you do this, it can be easy to accidentally give too much of either medicine.
    Keep a diary of when you give each dose of paracetamol and ibuprofen so you don't give your child too much of either medicine.

    We do not recommend giving aspirin for pain to a child or adolescent under 12 years, unless it is advised by your doctor. It can cause a rare but serious illness called Reyes Syndrome.

    Paracetamol poisoning

    Paracetamol is one of the most common medicines taken by children in an accidental overdose.

    • Swallowing a lot of paracetamol mixture or tablets can harm a child's or adult's liver, and sometimes their kidneys.
    • Always store paracetamol and other medicines out of reach of children. It is best to keep them in a locked or 'child proof' cupboard.
    • Do not take tablets out of their foil wrapping until you are ready to take the tablets. The wrapping is designed to be hard for children to open.  Keeping the tablets wrapped will mean that a child may not be able to take as many if they find them.
    • Always leave the 'child resistant' lid on a bottle of paracetamol mixture. 

    Ibuprofen poisoning

    • If too much Ibuprofen is taken, it can cause stomach upsets, or sometimes it can affect breathing and make a person very drowsy.
    • Always store ibuprofen out of reach of children and leave it in the packaging that it comes in (child resistant packaging).
    • Call the Poisons Information Centre (13 11 26 in Australia) for advice if a child or adult may have taken an overdose of ibuprofen. 

    Have the Poisons Information Centre telephone number next to your phone at all times.
    In Australia the number is 13 11 26. 

     Key points to remember

    • Pain-relieving medicines do not treat the cause of your child's pain.
    • Any infant or child who is unwell, or in moderate to severe pain, should be seen by a doctor to find out the cause of the pain.
    • If your child has accidentally had too much paracetamol or ibuprofen, call the Poisons Information Centre (13 11 26 in Australia) or seek urgent medical advice.

    More information

    Developed in consultation with the Emergency Consultant and Pharmacy Department. First published April 2013.


Disclaimer 
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.