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). Your child may need pain-reliever medicine (analgesic), such as paracetamol or ibuprofen, to help reduce or control their pain.

    Paracetamol and ibuprofen do not treat the cause of your child's pain; both medicines just relieve the feelings of the pain.

    It is important to give the correct dose of pain-relieving medicine. Give the dose that is written on the bottle or pack according to your child's weight.

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

    Signs that 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. Younger children may show you that they have pain by:

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    • becoming quiet and withdrawn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

    Care at home

    If you can’t relieve your child’s pain by comforting them and helping them to relax, distracting them or providing a cool compress, giving them pain-relieving medicines can help.

    • Paracetamol can be used for mild to moderate pain in babies 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 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.
    • Never give aspirin for pain to your child if they are under 12 years, unless it is advised by your doctor. It can cause a rare but serious illness called Reyes Syndrome.

    Paracetamol or ibuprofen can make your child’s pain less severe and help them feel more comfortable, but neither medicine will make the cause of the pain go away.

    Paracetamol and ibuprofen can help your child sleep more easily if they have a painful condition, such as an ear infection, sore throat, sore tummy or a broken bone.

    If your child’s pain lasts for more than a few hours, the pain is moderate to severe, or your child is clearly unwell, take your child to a doctor to find out the cause.

    Giving paracetamol

    Giving ibuprofen

    How much to give:

    • Paracetamol for children comes in several different strengths: for babies, for young children and for older children. Paracetamol is also produced and sold by many different companies, and different brands may have different names (e.g. Panadol, Panamax, Dymadon).
    • Always give the dose that is written on the bottle or packet according to your child's weight.
    • If your baby or child is taking any other medicine, check that the medicine does not also have paracetamol in it. Do not give more paracetamol if your child has had some in other medicine.

    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, you should take them to see a doctor.

    How much to give:

    • Ibuprofen for children comes in several different strengths: for babies, for young children and for older children. Ibuprofen is also produced and sold by many different companies, and different brands may have different names (e.g. Nurofen, Brufen, Advil, Dimetapp).
    • Always give the dose that is written on the bottle or packet according to your child's weight.

    How often can it be given?

    • Doses can be given every six to eight hours, but no more than three times a day.
    • There are some rare but serious side effects that might occur if ibuprofen is given to a child for a long time. If you need to give your child ibuprofen for more than 48 hours, you should take them to see a doctor.

    Note: Short-term use of ibuprofen, at appropriate doses, may be taken with a glass of water and no food. If this causes stomach upset, you should try offering your child some food or milk.

    Giving your child both paracetamol and ibuprofen

    So that your child's pain is well controlled, it is OK to alternate giving paracetamol and ibuprofen, or even to give both at the same time. 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.

    Overdoses of pain-relieving medicine

    • Paracetamol is one of the most common medicines taken by children in an accidental overdose. Swallowing a lot of paracetamol mixture or tablets could harm your child's liver, and sometimes their kidneys.
    • If too much ibuprofen is taken, it can cause stomach upsets, or sometimes it can affect breathing and make a person very drowsy.

    If your child has had too much paracetamol or ibuprofen, call the Poisons Information Centre (13 11 26 in Australia) or take them to the nearest hospital emergency department.

    To prevent your child finding and taking medicine:

    • Always store 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 give or 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 or ibuprofen mixture.

    Key points to remember

    • Give the dose that is written on the bottle or pack according to your child's weight.
    • Pain-relieving medicines do not treat the cause of your child's pain.
    • Any baby 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.
    • Do not give paracetamol or ibuprofen to your child for more than 48 hours without seeing a doctor.
    • If your child has had too much paracetamol or ibuprofen, call the Poisons Information Centre (13 11 26 in Australia) or take them to the nearest hospital emergency department.

    For more information

    • Kids Health Info fact sheet: Fever in children
    • The Royal Children’s Hospital: Comfort Kids (for tips on non-medical ways to relieve your child’s pain)

    Common questions our doctors are asked

    I don’t know how much my child weighs. Should I just give them the dose of medicine the package recommends for their age?

    The recommended dosage for medicine is worked out based on a child’s weight. The ages given on the medicine packaging or bottle are a guide only. If you don’t know your child’s weight, give the dose listed for their age. If your child is substantially lighter than most children their age, give the dose recommended for younger children (the next age bracket down).

    If I'm taking my child to the doctor or emergency department, should I wait until they're seen by a doctor before giving pain relief?

    No – simple pain relief will not mask any signs of serious illness. You can give your child pain relief before taking them to the doctor or to hospital, to make sure they're as comfortable as possible.

    My child has a fever, but is not in pain. Should I give him a pain reliever to reduce the fever?

    If your child seems well and is happy, there is no need to treat a fever. A fever helps the body's immune system fight off infection. If your child is miserable or uncomfortable, you can give them paracetamol or ibuprofen to help them feel better.


    Developed by The Royal Children's Hospital Emergency and Pharmacy departments. We acknowledge the input of RCH consumers and carers.

    Reviewed May 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.


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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.