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Magic Medications of the ER
Kelly Ochoa, MD
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It’s All About the Dose!
Acetaminophen and Ibuprofen are by far the two most advised medications in pediatrics, as they are both great for pain, as well as fever. I work in the pediatric emergency department, and often parents believe that we have “magic medications” in the ED that actually work for their child. I will let you in on our secret – we use the SAME medications, just at the appropriate dosages. The back of the package is often under-dosed and based on age. These meds both require weight-based dosing. If you are going to give a fever or pain medication, give the entire full dose to help your child feel better. It is better to give one full dose and get results, than numerous small doses that are ineffective. Below you’ll find a bit of useful information I like to educate all my patients on regarding these two helpful medications, as well as a calculator to determine your child’s dosing.
Ibuprofen Beats Opioids For Pain in Kids
Ibuprofen is the generic for Motrin and Advil. They are all the same! Save your money and go generic. Ibuprofen is for children 6-months and older – little infant kidneys can’t quite handle ibuprofen yet. It lasts a bit longer in your body than acetaminophen, and usually wears off after about 6-8 hours, (which is why I like this one for right before bedtime – maximize your sleep!). It should not be given more frequently than every 6 hours. Ibuprofen is typically well tolerated, but it can be hard on a child’s stomach if taken religiously over the course of a couple of days. Ibuprofen can reduce fever, and it also can help with swelling and inflammation – that is why it is my go-to for pain control in children. It has actually been shown to be equal to, if not better than, opioids for children. Ibuprofen comes in an infant concentration as well as a children’s concentration. They are the exact same medication, but the infant’s version is more concentrated – meaning you don’t need to give as much liquid for the same amount of medication. It also comes with a syringe or dropper to make it easier to give to a baby. If you have your own syringe or dropper and your infant takes medication ok, I recommend the children’s ibuprofen to save you money. The infant formulation is over twice the price of the more diluted children’s formulation. (Tip for infant medication administration – plug your child’s nose, insert a small amount into the back of the cheek, let go of nose, repeat).
Acetaminophen For the Little Ones
Acetaminophen is the generic for Tylenol, and also known around the world as Paracetamol. This medication is safe for babies to take. However, I always recommend talking to a doctor before giving medication to any infant under 3 months old. Acetaminophen is broken down in the liver and should not be dosed more often than every 4 hours. It is great for fever, and it can also be used for pain control for minor bumps and bruises, or teething.
Alternate Dosing and Use Our Dosing Calculator
I often recommend alternating between ibuprofen and acetaminophen if you need to give medication for a couple of days in a row. For example, let’s say your child spikes a fever at noon and you give a dose of ibuprofen. Ibuprofen typically lasts for 6-8 hours, but certainly fever can recur earlier than that. Now let’s say your child spikes a fever by 5pm. It is too early to give ibuprofen (not 6 hours yet between doses as noon to 5pm is only 5 hours). At 5pm, switch to a dose of acetaminophen. The two medications are safe to take together, just be sure there are 6 hours between ibuprofen doses, and 4 hours between acetaminophen doses. Be sure to remember, (or maybe even write down), which of the medications you gave last.
Check out our dosing calculator in the footer next time your child is in need of these magic medications!