Children's painkillers review

What products are out there, and how to give them safely.
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01 .Introduction

Child taking painkiller

The choice in over-the-counter (OTC) painkillers for children is restricted to ibuprofen or Paracetamol, although once you include the huge array of different strengths and product forms there are more than enough products to choose from. Both appear to be equally effective and are very safe, though in Australia paracetamol is slightly more favoured of the two. Paracetamol can be given from the age of one month; ibuprofen from three months.

How safe are they?

  • Paracetamol is still the drug of choice for reducing pain and fever — partly, if not mainly, because of its proven track record over decades — but there's still a very real risk of poisoning through overdose. Overdose causes jaundice, liver failure and death, and occurs when the maximum daily dose is exceeded or when repeated doses are given to children with pre-existing liver disease (such as viral hepatitis). Malnutrition and lack of food can increase the likelihood of liver toxicity
  • Ibuprofen for children has become more popular over the last decade. Side effects of ibuprofen include gastrointestinal upset, NSAID-induced asthma and kidney problems, especially if a child is dehydrated (from vomiting, diarrhoea and/or not drinking enough). 
  • Aspirin should never be given to children under 16, because it’s associated with a rare but serious disease called Reyes Syndrome which can cause delirium and coma.

The good news is that the risk of overdose or adverse side effects from OTC painkillers is generally very low if they’re used correctly. Following our Safety tips  will help you avoid those risks. 

Different forms

Painkillers for babies and children come in a variety of ‘child-friendly’ forms:

  • Drops, which are usually recommended for babies and very young children, because you can measure the dose much more precisely. It’s also one of the easiest ways to give medicine to very young children.
  • Suspensions, which are thicker because the active ingredient is ‘held’ in the liquid by a suspending agent. You must shake them well before use.
  • Elixirs and syrups are thinner liquid products with the active ingredient dissolved and an agent added to mask its bitter taste.
  • Chewable and effervescent tablets are also available, as are suppositories.


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Using painkillers safely

When giving painkillers to babies and children, follow these tips to be safe:

  • Use the right product, strength and dose for the child’s age and weight. Recommended doses, according to the child’s age and weight, are given on the product packaging. Different rules apply to very overweight children - see below.
  • Different products, and different forms of a product, may vary in strength, so always read the package carefully for the dosing instructions specific to the product you're giving.
  • Don’t keep giving the painkiller for more than 48 hours unless specifically advised to by a doctor.
  • Use the measure provided — or if there isn’t one, a metric medicine measure — to pour the dose.
  • Make sure the bottle cap is on securely after use, and keep it in a safe place out of the reach of children.
  • Check labels of all medicines, as paracetamol or ibuprofen can appear as an ingredient in a variety of medications (like cough syrup) and you don't want to double up.
  • If you don't know how to measure or use a product, or if you don't understand the label, ask your pharmacist for help.

Dose according to weight – with caveats

When determining the dose, it’s recommended you use the weight guidelines provided on packaging rather than age, because some children are bigger or smaller than average for their age.

However, there have been reports of liver toxicity effects in very overweight children on a long course of paracetamol. This is because the lean body weight is the key determinant for the dose. If a child is more than 20% overweight according to standard weight and height charts, they should be dosed according to lean weight. This can be estimated using charts as follows:
  1. Using the height chart, determine the child’s height percentile band for his/her age. For example, a 5-year old boy is 115cm, which puts him in the 90th percentile band for height.
  2. Using the weight chart, determine the predicted weight a child of that age in that percentile band. For example, the 90th percentile for the weight of a 5 year old boy is 22kg – far less than our boy’s actual weight of 29kg.
  3. Dose according to the predicted weight (22kg in this example), rather than the actual weight (29kg).

Fever and analgesia

 If your child has a fever, it may be tempting to reduce it by giving paracetamol or ibuprofen. But most doctors these days don’t recommend you do this - fever is one of the ways that a body’s immune system fights infection. However, if your child is feeling uncomfortable analgesics will make them feel better. And there’s no evidence that lowering fever means children stay sicker longer. Note, though, that using analgesics to reduce fever doesn’t prevent febrile convulsions.

Analgesia and immunisation

Kids almost never need analgesia before or after immunisation: it won’t reduce the sting of the needle, and modern vaccinations are less likely to cause fever than those of some years ago.

More information

The following information sheet about Using Paracetamol or Ibuprofen from the Children, Youth and Women’s Health Service has a lot of useful information about these medicines and their appropriate use.

Also see our article about headache, migraine and painkillers and the dangers of medication overuse headache.
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