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Q. What's better for my child when she has a fever, acetaminophen (Tylenol, Tempra) or ibuprofen (Motrin, Advil)?

A. Although some people will ask how high the fever is before answering that question, in reality, you should probably just use the medicine that has seemed to work the best for your child in the past. If she usually responds well to Tylenol, then stick with it. If Motrin or Advil work better for her, then use one of them instead.

Children's Tylenol is marketed as the 'Pediatrician's First Choice', but ibuprofen supposedly 'reduces fever faster than Children's Tylenol' and 'lasts longer', making Children's Motrin 'the #1 choice of pediatricians for long-lasting fever relief'.

One summary or Critically Appraised Topic of Antipyretics: Ibuprofen vs. Acetaminophen by the Pediatric Evidence-Based Medicine group at the University of Washington concluded that they had 'equivalent effects at maximal doses of each'.

Another study, "Comparison of multidose ibuprofen and acetaminophen therapy in febrile children," showed 'no statistically significant differences in temperature response among the treatment groups' and ' the rates of temperature reduction and maximal reduction of fever after administration of the initial dose were equal for patients receiving 10-mg/kg ibuprofen therapy and 15-mg/kg acetaminophen therapy'.

But another study, 'Efficacy and safety of acetaminophen versus ibuprofen for treating children's pain or fever: A meta-analysis,' concludes that ibuprofen is better and as safe as acetaminophen and "appears to tilt the balance toward ibuprofen." The researchers warn that the "results should be taken with a grain of salt" however, since the studies weren't very large and more research should be done.

Remember that acetaminophen does have the benefit that it comes in a suppository form (Feverall), so you may be able to use it if your child is vomiting or is refusing to take any medications by mouth. And acetaminophen can be used in younger children, while ibuprofen is usually limited to children over six months of age.

Another common question is 'Is it safe to alternate acetaminophen and ibuprofen?' If you are using the correct dosage of each medicine at the correct times, then it is probably safe in most children, although there is no research to prove that it helps or that it is safe. The problem is that it is easy to get confused and give an extra dose of one or the other medicines. And in some children, especially if they are dehydrated or have other medical problems, giving both medications can cause serious side effects, especially affecting the kidneys. If you are alternating fever reducers, then write down a schedule with the times that you are giving the medicines so that the correct medicine is always given at the correct time.

And remember that it is not always necessary to give your child a fever reducer. In most cases, fever is treated as a comfort measure. Treating a fever, especially if it is caused by an infection, will not help your child get better any faster, but it may help make her feel better. If your child has a fever, especially if it is low grade, but does not feel bad, then you don't really need to give her a fever reducer.

Sources:

Comparison of multidose ibuprofen and acetaminophen therapy in febrile children. P. D. Walson et al. Arch Pediatr Adolesc Med 1992; Vol. 146 No. 5.

Efficacy and safety of acetaminophen versus ibuprofen for treating children's pain or fever: a meta-analysis. Goldman RD - J Pediatr - 01-JAN-2005; 146(1): 142-3

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