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Baby Medicines: Ibuprofen or Paracetamol?

Which is best for your baby if he or she is unwell?

Posted: 25 September 2008
by Debra Stottor

Much has been written recently about the pros and cons of using ibuprofen and paracetamol to relieve fevers in babies, so we thought we’d better clear a few things up.

When can I start giving my baby painkillers?
Paracetamol is not licensed for use in children under 3 months but may be used after 2 months under medical supervision, eg, after your baby's first vaccinations. (Some over-the-counter treatments now say 'suitable from 2 months' but discuss with the pharmacist when you buy it, if you are concerned.)
Ibuprofen can be given to babies from the age of six months old.

What’s the difference between ibuprofen and paracetamol?
Ibuprofen blocks the production of various chemicals in the body that arise in response to injury or disease and cause inflammation.
Paracetamol blocks a different enzyme in the brain and spinal cord involved in the transmission of pain.

Does ibuprofen work better than paracetamol?
Apparently. Recent research has shown that ibuprofen is better at alleviating childhood fever than paracetamol and should be the drug of first choice. The Bristol-based trial involving 156 children aged between six months and six years showed ibuprofen reduced temperature faster than paracetamol.

Can I use both together?
The research mentioned above also says alternating the two drugs could help, which some GPs already recommend. But guidelines published last year by the National Institute for Health and Clinical Excellence (NICE) say that, due to the lack of evidence, the two drugs should not be given together or alternated. The obvious concern is that it would be easier to accidentally give a child an overdose if using two medicines - because of a disparity in measurements and the number of times each should be given across 24 hours.

Does paracetamol cause asthma?
Recent research has shown that using paracetamol as a baby increases your risk of developing asthma about five years later by about 46%. However, researchers do not know if the drug directly increases asthma risk or another underlying factor is to blame. What is clear is that increasing use of paracetamol in children has coincided with rising cases of asthma over the past 50 years.
The report’s authors stress that this is not sufficient reason to stop using it where necessary. Study leader Professor Richard Beasley from the University of Auckland said: "Paracetamol is still the preferred agent, but the large amounts used around the world are unnecessary. Its use should be limited to treat high fevers (38.5C or above)."

Isn’t there a link between ibuprofen and asthma?
Yes. People who suffer from asthma are advised not to take ibuprofen or other non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin (which should never be given to under-16s), as it can have harmful side-effects. If your baby has asthma or there is a history of it in your family, seek medical advice before giving it.

What else can I do to relieve a fever?
Medicine need not be your first line of defence when your baby has a temperature, although if she is obviously in discomfort or has had febrile convulsions (fits) in the past, it’s probably advisable to administer the correct dose of either ibuprofen or paracetamol. If she seems quite well, ie, is alert and still active, you may be able to relieve her fever without painkillers. .

Try the following:

  • Make sure your baby is in light, cotton clothing – remove a layer if she seems hot.

  • Keep her room cool, and remove a layer or two of blankets to avoid overheating.

  • Give plenty of fluids, eg, breast milk or formula, or for older babies try diluted fruit juice or clear soups.

  • Give her a sponge bath: sponge her down with lukewarm water, and rather than drying her off, let the water evaporate.

  • Always contact your doctor if a fever lasts longer than 3 days. Check out our article on Raised Temperature: When to Call the Doctor for more on this.

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