Fever Control for Children

Ibuprofen is best for busting fever

Something all parents with small children should know: Ibuprofen (Motrin/Advil) is much more effective than acetaminophen (Tylenol) for fever and pain control.

Almost every provider in our country will tell parents with a sick child with fever to “alternate Children’s Ibuprofen and Tylenol for their fever.” It sounds reasonable doesn’t it? The providers who recommend this probably haven’t thought this out completely. They have heard it all their lives and are just passing it along. These are good people. To me, this is not the best advice. Here is why:

Therapeutically this makes no sense. If you alternate these medications, the result will be low blood levels of each drug. This has no therapeutic advantage and arguably a disadvantage. Alternating these medicines will not be as effective in lowering fevers as just using the most effective drug…Ibuprofen. Alternating medication will result in only having half the blood level of the really good stuff (Ibuprofen) on board. Just sticking with Ibuprofen is easier, less confusing, and more effective approach. When Children’s Ibuprofen became available, it was a “Godsend” to parents. There is a role for tylenol (acetaminophen) however, read on.

Recommending alternating medications implies to parents that these are equivalent drugs. They are not even close. Ibuprofen (Motrin) is far more effective for pain and fever than Tylenol (acetaminophen) and lasts about twice as long. It is very Mom and child-friendly.

If you alternate medications, it is confusing and hard to keep track of what you gave your child the last dose, and when you gave it. It’s a challenge to remember the details of medicating your sick child (with two drugs) in the middle of the night. You will probably have to write it down to keep track of it. If you don’t…. you will probably hear: “Honey, what did we give her last?… When?? I tend to like my parents. It is stressful enough to have a sick child without giving them another chore to do.

Most importantly, water. Pushing fluids is #1 for fever control. Medicines are #2. If you do not push fluids on your sick feverish child, medications may not work well at all. This is frequently overlooked and undervalued. When your child has a high fever, they are losing more water through their skin than you would believe. The body’s natural cooling system is our sweat glands just pumping water to the skin surface to evaporate. This evaporation causes our bodies to cool off. It’s what gives us the “chills”. I need to address “over bundling” here. Too many parents bring their sick, feverish children in with heavy coats and blankets wrapped around their bodies. These kids cannot cool off with all these heavy garments covering their skin. The first thing we do is unwrap them, which some parents want to resist. “They’re cold”. I understand the impulse to do this. We only remove the overgarments and blankets. I do not take off their clothes. With children and adults, if you are having chills, put on a light long sleeve shirt until the chill passes. It will pass shortly. I would rather a child be a little uncomfortable for a few minutes than for them to have a seizure from a high fever. Seizures can cause brain damage and is completely preventable. That’s why we want to treat high fevers…to prevent seizures. Also, if a parent is using Ibuprofen for fever, and the child’s fever is not coming down rapidly, the child is “dry” or underdosed (usually both). If this happens pushing fluids and adding Tylenol should help greatly. See below.

More about Tylenol (acetaminophen). Acetaminophen is weak on pain and fever control when used alone. We have seen many, many sick feverish children with high fevers that have had a dose of acetaminophen an hour before arriving. If you have a mild pain or headache or low-grade fever, it may be helpful. It is short acting (3-4 hours). (This is all written in comparison to Ibuprofen, which is very effective if dosed properly, and lasts 6-8 hours.) Generally speaking, acetaminophen as a primary drug is only minimally effective. Acetaminophen’s value is as a very good “piggyback”, or secondary drug. That’s when it shines. Acetaminophen “plays well with others”. Parents, if you have given the correct amount of Ibuprofen and after 4 hours you notice that their fever is creeping back up and you are beginning to worry, dose them with acetaminophen too. Ibuprofen should not be dosed any more often than every 6 hours. Also, if you find that your child suddenly has a fever of 103 or higher, feel free to give BOTH Ibuprofen and acetaminophen together in appropriate doses (on the bottle). Usually very safe and effective, and given that way to many very sick children in our office. Their modes of activity are completely different.

If your child has a fever, we recommend checking their temperature every 30 minutes until the fever is well under control. Yes, push fluids like a parent.

Disclaimer: If there is a medication allergy, intolerance, or medical reason your child should not use one or both of these medications…..DON’T.

The Milk Myth

           Milk is good for you!

Myth: “Avoid dairy products if you have a respiratory infection; milk will cause you to produce more mucous.” This is something many of us have heard all our lives. This is a myth that will never die, because it is so believable. Because Doctors, Nurses, Chiropractors, and “old wives” have heard it all their lives, they continue to pass this on to their patients and anyone else who will listen. It is believable because when we drink milk, it feels like there is more mucous in our mouth. This sensation is from all the FAT in milk. It’s like an oil slick in your mouth. To your mouth, it feel like mucous. You won’t get that sensation from Fat free milk. MILK IS THE ONLY BEVERAGE WE DRINK WITH FAT IN IT. There is no evidence to support this myth.

Milk is probably the best source of calcium for us and our kids. I only recommend Organic milk. Because of its fat content, milk is also a wonderful lubricant for swallowing large or dry uncoated pills.