Health Questions & Answers
Children's Pain Relievers

by Gregory Plemmons, MD

As parents, we often have questions about all kinds of health issues relating to our kids - from illness to prevention to child development. Come ask the experts what you want to know about pediatric health! A selection of answers to your questions will be posted on the site each week.

The question:
What pain reliever should I give to my child? What's the difference between acetaminophen and ibuprofen, and why should we avoid aspirin?

The Pediatrician Answers:
Pain relievers are also called analgesics in medicine, and there are many kinds. One of the oldest and most popular analgesics is aspirin (or acetylsalicylic acid). In the latter part of this century, acetaminophen (Tylenol), ibuprofen (Motrin, Advil), and naproxen (Aleve, Naprosyn) have all been developed as well.

Most parents today still remember the yummy bottle of orange-flavored children’s aspirin from our childhood (my cousin ate a whole bottle). In 1974, however, the incidence of Reyes Syndrome, a rare disorder affecting the brain and liver, suddenly increased -- often occurring in children following influenza ("the flu") or chickenpox, and was possibly associated with the use of aspirin.

Since then, most pediatricians have recommended the use of acetaminophen to treat pain or fever, and Reyes Syndrome has markedly decreased. Aspirin does continue to be used in other countries, however, and there does not seem to be another increase in Reyes Syndrome. We are still not sure what causes Reyes Syndrome. Thankfully, it remains rare.

Luckily, acetaminophen and ibuprofen are as effective as aspirin and also taste as good, thanks to the drug companies. Certainly, some people respond better to one than the other. Acetaminophen is very safe to use when used properly, but, if given in high doses over a period of time, can produce liver damage and death and should not be used in children with liver disease in general.

Ibuprofen is generally safe as well, although very rarely may cause occasional stomach upset and gastritis/ulcers. It leaves your body mainly through the kidney, so children with kidney disease or bleeding problems should check with their doctor first before using. Ibuprofen’s only advantage over acetaminophen is it generally lasts longer, and can be dosed every 6-8 hours, while acetaminophen requires every 4-6 hour dosage. I use both in my practice, but I always clarify the correct dose with parents at each office visit.

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About the author: Gregory Plemmons, MD is an Assistant Professor of Pediatrics in the Division of General Pediatrics at Vanderbilt University in Nashville, Tennessee. Service to under-served and culturally diverse populations is one of his special interest areas. Says Dr Plemmons, "I see my goal as to help educate parents and aid them in making informed decisions about their children, but also incorporating the experience I've had thus far as a pediatrician."