Dosing acetaminophen and ibuprofen

Parents often have questions about dosing ibuprofen and acetaminophen.

Some basics include:

  • Fever greater than 100.4 rectal in a infant under 3 months old or an unvaccinated infant is a medical emergency. Infants are at risk of getting serious bacterial infections and need to be evaluated if they have a fever. Call your doctor or go to the ER.
  • Some children should not get these medicines. Ibuprofen acts on the kidneys. Infants under 6 months old have immature kidneys and should not receive ibuprofen. Other people who should not receive ibuprofen include those with blood cancers or platelet disorders. Children with liver problems (such as fatty liver) may have a lower daily limit of ibuprofen - ask your doctor. If your child has immunosupression such as neutropenia or sickle cell call your doctor if your child has a fever. They need a evaluation.
  • Generally alternating ibuprofen and acetaminophen has some benefits and risks. If one medicine alone is unable to make a child comfortable you may alternate every 3-4 hours. The risk is that a stressed, worried, and sleep deprived parent may inadvertently give the same medicine twice in a row and overdose the child. If your doctor or nurse advises you to alternate medicines, keep a written log of what you have given, what time, and what dose. Seattle Mama Doc wrote a blog on this topic.
  • Use a syringe or cap with measurements in mls to dose. Do not use kitchen spoons.
  • Dose based on  your child's weight not age
  • For acetaminophen administer every 4-6 hours but not more than 5 doses in a 24 hour period. For ibuprofen administer every 6-8 hours.
  • Not every fever needs to be medicated. Temperatures of 99-100 are often well tolerated. If a child is acting well, eating, drinking, and sleeping - you do not need to treat the fever. You want to treat the child - not the number. On the other hand, if a febrile child won't drink, sleep, or is uncomfortable - treating can help.
Acetaminophen Dosing from Seattle Children's Hospital
Ibuprofen Dosing from Seattle Children's Hospital


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