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Pain Relief Primer

Infant drops, junior syrups, chewables – who knew choosing over-the-counter medications for easing aches could be such a… pain? If you’re confused about which product to choose, we’ve got some answers.

Q. Which is better: acetaminophen or ibuprofen?

A. Doctors are just as much in the dark on this question as parents, says Ran Goldman, a specialist in paediatric emergency medicine and clinical pharmacology and toxicology at Toronto’s Hospital for Sick Children. When Goldman reviewed 13 studies comparing the two medications, this is what he found: “None came to a final conclusion on which one is better.” Both medications are effective for easing mild to moderate pain and reducing fever. That said, each drug works differently and has qualities that may make it a better choice in certain cases. It’s best to ask your pharmacist for a recommendation specific to your child’s needs.

Q. So what should you consider when selecting one drug over the other?

A. Acetaminophen (Tempra, Tylenol, Panadol) may be safer for treating illnesses involving severe vomiting, or vomiting and diarrhea, because in rare cases ibuprofen can cause kidney injury in dehydrated kids. And when even a few sips of water won’t stay in your toddler’s tummy, acetaminophen is the only over-the-counter (OTC) pain reliever available in rectal suppositories. Acetaminophen is also less likely to cause side effects than ibuprofen medications.

Ibuprofen (Advil, Motrin) may be better at treating conditions involving inflamed, swollen tissues, such as sunburn or muscle sprains. Unlike acetaminophen, ibuprofen actually reduces chemical signals that drive both inflammation and pain. Ibuprofen also provides longer-lasting relief — six to eight hours, versus four to six for acetaminophen. However, ibuprofen carries a higher risk of side effects than acetaminophen: It can irritate the stomach and trigger asthma attacks in a very small percentage of kids with asthma.

Q. Should I give a pain reliever at the first sign of discomfort, or wait to see if it gets worse?

A. That depends on whom you ask. Generally, pain relievers (analgesics) work better if you don’t wait until you’re writhing in agony. However, too frequent or too large amounts of painkillers can cause rebound headaches, so ask your doctor or pharmacist about alternatives if your child takes them more than one day a week.

Michael Rieder, chair in paediatric clinical pharmacology at the Children’s Hospital of Western Ontario, suggests dosing at regular intervals during the first day or so of an illness, then stopping to see what develops, while other doctors recommend a one-dose-at-a-time approach. Unless your doctor recommends otherwise, you can make the call based on personal preference and past experience.

Q. Should I calculate the amount of pain (or fever) medication, based on my child’s age or weight?

A. Unlike many other medications, when it comes to safe, effective dosages for kids, OTC analgesics are well studied. Experts agree that dosing by weight is the most accurate method.

The by-age amounts listed on some packaging are based on estimated average weights but, of course, weight varies widely between perfectly healthy kids of the same age. No matter how heavy your child is, do not exceed the maximum dose listed on the bottle. Wondering how to figure out the amount? “The most appropriate dose of ibuprofen for kids is about 10 milligrams per kilogram [of body weight] three times a day,” says Rieder. “For acetaminophen, it’s 15 milligrams per kilogram, four times a day.” (The dose is slightly higher for suppositories, so check with your doctor or pharmacist.)