Ibuprofen for Kids?

A child with a fever is every parents nightmare and is usually the first indication that a child is ill.

Watching the thermometer steadily increasing, feeling the heat radiating from the child and the listlessness is a simply horrible experience for everyone.

What to do?

A common practice is to reach for the ibuprofen and dose the child up as quickly and as often as possible. But how efficacious and safe is this practice?

What is Ibuprofen?

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). Ibuprofen is commonly taken to alleviate mild to moderate pain and to minimise the impact of fever in children over 3 months of age.

Ibuprofen blocks the production of prostaglandins, substances our body releases in response to illness and injury. Ibuprofen blocks the enzyme cyclooxygenase that makes these prostaglandins, resulting in lower levels of prostaglandins being produced. As a consequence, inflammation, pain and fever are reduced.

Ibuprofen’s painkilling effects work very quickly after a dose is taken however its anti-inflammatory effects can take a considerable amount of time, sometimes a few weeks.

Ibuprofen does not treat the cause of the child’s pain but relieves the feelings of the pain with the above action.

Ibuprofen is made and sold by many different companies. Different brands therefore have different names with some of the most common ones being Nurofen, Brufen, Advil and Dimetapp.

Ibuprofen Uses

Fever

Having a high temperature causes headache, feelings of being unwell and aching all over the body. Lowering the temperature can help the child feel more comfortable.

It is worth considering however that a high temperature is one the body’s mechanisms to control infections. While theoretically lowering the temperature can make the immune system less effective, it does not seem to make much, if any, difference in how quickly a child becomes well again. Low grade fevers are usually caused by viruses and will go away without medicine and without causing any damage.

• Ibuprofen will often cause a drop in the child’s temperature if they have a fever. Lowering the child’s temperature is usually not necessary, and it will not help a child get well more quickly.
• If a child has a low grade fever ( 38.5 to 39°C) many doctors would suggest parents do not need to give ibuprofen to their child.
• Using ibuprofen does not protect a child from febrile convulsions even if it reduces the child’s temperature.

Pain

• Ibuprofen can make pain less severe but it does not make the cause of the pain go away.
• Taking ibuprofen may help a child sleep more easily if the child has, for example, an ear infection, sore throat, tummy pain or sore legs.
• If the pain lasts for more than a few hours, it is severe, or the child is clearly unwell, it is important to find out what is causing the pain and medical assistance should be sought.

Side Effects of Ibuprofen

Gastrointestinal 

Gastrointestinal (GI) bleeding is one of the more well known and documented side effects (up to 25%) from taking too much ibuprofen.

People who take high doses of ibuprofen on a regular basis are three times more likely to experience GI bleeding than those who do not take painkillers.

These effects in some cases can be seen as early as two days after first taking the drug which is why it should be taken with food or milk to reduce possible ulcerative effects on the stomach lining.

However, ibuprofen has another, unwanted side effect as it reduces blood flow to the stomach and duodenal lining. This impairs healing and reduces the mucous layer that forms a protective barrier in the gut.

Without this layer, stomach acid can damage the gut lining.

Additional GI side effects include indigestion, nausea, vomiting, diarrhoea, abdominal pain, and flatulence. More serious GI effects have been uncommonly reported and have included hidden blood loss, ulcer, GI haemorrhage with or without tearing and pancreatitis.

The incidence of gastrointestinal blood loss with ibuprofen is dose-related, occurring in up to 17% of patients (adults) receiving 1,600 mg per day and in 23% of patients receiving 2,400 mg per day. This dosage is of course much lower for a child.

Less Common

Liver

Side effects affecting the liver have included elevations in liver function tests in up to 15% of patients. Rarely, jaundice, cholestasis (decrease in bile flow), hepatitis and hepatic failure have been reported.

Ibuprofen has also been implicated in the so-called acute vanishing bile duct syndrome in children which occurs when there is an extreme and chronic decrease in bile flow as well as a loss in intra-hepatic bile ducts.

Hypersensitivity

Documented hypersensitivity side effects have included rashes, itchy skin, bronchospasm and allergic reactions, particularly in patients with asthma or nasal polyps.

There are reports of a severe allergic reactions which require immediate hospitalisation. For example a 12 year old boy presented to the hospital with fever and cough of 1 day duration after receiving 150 mg dose of ibuprofen (5 mg/kg). He developed a generalised rash, facial swelling and shortness of breath 1 hour after ingestion.

Suggested Dosing

Ibuprofen for children comes in several different strengths: for babies, for young children and for older children.

Common strengths of ibuprofen include:

• 200mg in 5mL (syrup for babies over 3 months)
• 100mg in 5mL (syrup for children 1-5 years)
• 200mg in 5mL (syrup for children 5-12 years)
• 200mg in 1 tablet (for older children and adults)
• Doses can be given every six to eight hours but no more than three times a day.

Ibuprofen Poisoning

• If too much Ibuprofen is taken, it can cause stomach upsets, or sometimes it can affect breathing making a child wheeze. It can also make a person very drowsy.
• Always store ibuprofen out of reach of children and leave it in the packaging that it comes in (child resistant packaging).
• Call the Poisons Information Centre (13 11 26 in Australia or 0800 POISON (0800 764 766 in New Zealand)) for advice if a child or adult may have taken an overdose of ibuprofen.

Do not give ibuprofen if the child is dehydrated due to vomiting or diarrhoea.

It is advised that children with asthma should not take ibuprofen due to the potential for respiratory distress.

As a general guide ibuprofen is dosed at 20mg/kg in divided doses. For children weighing less than 30 kg, the total dose per day should not exceed 500 mg per day. Any more than this over the long term could result in gastrointestinal issues.

Final Word

A child with a fever and / or experiencing pain is extremely challenging and confronting for parents to deal with. It is a natural response to want to alleviate any discomfort as quickly as possible and ibuprofen is a fast acting medication to alleviate fever in particular.

However if a child has a low fever (38.5 to 39°C) the advice is that we should allow the body to fight the infection with its normal mechanisms and without dosing with ibuprofen.

Temperatures above this range should suggest to parents to take their child to hospital to ensure that there is nothing more sinister and to reduce the risk of febrile convulsions.

However if you do decide to dose with ibuprofen, stick to the dosing guidelines and give each dose with food or milk as the risk of developing gastrointestinal issues, even in the short term is a very real concern.

Further Reading

• Paracetamol – A Dose of Toxic Liver
• Are You Being Poisoned by Paracetamol?
• Paracetamol Increases Asthma Risk in Children
• Pregnancy Medication Use Found to Increase Risk of Childhood Asthma & Allergies
• Panadol – No Better Than A Dummy Pill
• Tennis Elbow – Better Solutions Than Ibuprofen
• Nurofen, Stomach Ulcers and Bleeding from the Bowel

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