Ear Infections Using Paracetamol or Ibuprofen

using paracetamol or ibuprofen

Paracetamol (which in some countries is called acetaminophen) has been safely used for many years to help with mild to moderate pain and fever for babies, young children, older children and adults. But if too much paracetamol is given to a child, especially a sick child, for too long, it can harm the child.

Ibuprofen is a newer drug than paracetamol, but it has also been used for fever and mild to moderate pain in children and adults for some years. It is not suitable for children under six months of age. Paracetamol and ibuprofen do not treat the cause of the pain or fever. Any baby or child who is unwell, or in moderate to severe pain should be seen by a doctor to find out what the cause is. Ibuprofen does not appear to be more effective than paracetamol, and ibuprofen should not be given at the same time as paracetamol.

ALERT!
Call the Poisons Information Centre on 13 11 26 (Australia) if a child, young person or adult has taken more paracetamol or ibuprofen than is recommended. Paracetamol is often taken by people who intend to harm themselves (suicide attempts). Paracetamol in large doses can cause severe liver damage.

When you might try paracetamol or ibuprofen

Fever
If a child has a fever, paracetamol or ibuprofen will often cause a drop in the childs temperature, but lowering the childs temperature is usually not necessary, and it will not help a child get well more quickly. If a child has a low fever (perhaps under about 38.5C to 39C) many doctors would suggest parents do not need to give paracetamol or ibuprofen to their child. Having a high temperature causes headache, feelings of being unwell, and aching all over the body, and lowering the temperature can help the child feel more comfortable. A high temperature is one of the ways that a bodys immune system works 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. Using paracetamol or ibuprofen does not protect a child from febrile convulsions even if it reduces the childs temperature (See the topic Fever for more information).

Pain
Paracetamol or ibuprofen can make pain less severe, but they do not make the cause of the pain go away. They can 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, or it is severe, or the child is clearly unwell, it is important to find out what is causing the pain.

Immunisations
Several years ago, most children had some fever after their immunisations, and it was often recommended that they have paracetamol around the time of the injections. Since the vaccines have been changed (in particular the whooping cough vaccine), few children develop a fever, and it is no longer recommended that paracetamol or ibuprofen be given at the time of the immunisation. Paracetamol or ibuprofen given before an immunisation will not prevent the sharp sting of the actual injection. If a child becomes unwell or has a fever soon after the immunisation, it is likely this is caused by something else, such as a cold or ear infection.

ALERT!
Never give aspirin to a child or adolescent under 16 years. It can cause a rare, but severe illness called Reyes Syndrome.

Giving paracetamol
How much to give
Paracetamol for children comes in several different strengths: for babies, for young children and for older children. Paracetamol is also made and sold by many different companies. Common strengths include: 100 mg in 1 mL (drops for babies, only very small doses are given) 120 mg in 5 mL (syrup for young children) 240 mg in 5 mL (syrup for children over four years old). The usual dose of paracetamol is 15 mg (not 15 mL) of paracetamol per kg body weight per dose, but we recommend that you give the dose that is written on the bottle or pack for a child of your childs weight, rather than calculate a dose, as errors can be made. If your baby or child is taking some other medicine, check that it does not have paracetamol in it, so that she doesnt get a bigger dose than she should.

How often can it be given?

Paracetamol can be given every four hours and no more than five times a day. If your child seems to need it for more than 24 hours, check with your doctor to find out what is wrong. Taking even the recommended dose for more than one or two days has caused liver damage in some children who were quite unwell for other reasons. Make sure your child gets plenty to drink while taking paracetamol. Older children weighing over 60 kg, who are taking tablets should not have more than eight 500 mg tablets in any 24 hour period.

Ibuprofen
Ibuprofen is another medicine for mild to moderate pain and fever in children over six months of age. It does not appear to be better than paracetamol. It should not be given at the same time as paracetamol. Do not use ibuprofen if your child may be dehydrated (such as due to vomiting, refusing to drink or having diarrhoea). Make sure your child gets plenty to drink while taking ibuprofen. The usual dose of ibuprofen is 10 mg (not mL) of ibuprofen per kg body weight per dose, but we recommend that you give the dose that is written on the bottle or pack for a child of your childs weight rather than calculate a dose as errors can be made. Doses can be given six to eight hours apart, with no more than three doses in 24 hours. Older children weighing over 40 kg and taking tablets should not have more than three doses of 400 mg in any 24-hour period. (Each tablet is likely to contain 200 mg of ibuprofen, but always check the amount).

When to see a doctor

You should have your child seen by a doctor if your child: is less than 12 months old and has a fever seems unwell, unusually sleepy or irritable is becoming more unwell has a rash is in pain such as headache, earache, tummy pain is vomiting or refusing to drink has a convulsion has breathing problems, cough, wheezing has a fever which lasts more than 24 hours has a very high temperature (e.g. over 40C) has been injured and is in pain or if you are worried.

Paracetamol poisoning
Paracetamol is one of the most common medicines taken by young children in an accidental overdose. Swallowing a lot of paracetamol mixture or tablets can harm a childs or adults liver, and sometimes the kidneys. Always store paracetamol and other medicines out of reach of children. It is best to keep them in locked or child proof cupboards.

Do not take tablets out of foil wrapping until you are ready to take the tablets. The wrapping is designed to be hard for children to open, so that they do not take many tablets if they find them and want to try them. Always leave the child proof lid on a bottle of paracetamol mixture. Paracetamol is also commonly taken by people who intend to harm themselves (suicide attempts). Large amounts of paracetamol are very dangerous, but the effects do not show until about two to three days after taking the tablets. It is very important to seek treatment as soon as possible. Get treatment even if the person seems quite well for the first couple of days. Treatment has to be started early, before the effects begin. Have the Poisons Information Centre telephone number next to your phone at all times. In Australia the number is 13 11 26. The number is near the front of the telephone directory.

Ibuprofen poisoning
If too much Ibuprofen is taken, it can affect breathing and make a person very drowsy, but it does not cause the liver damage that paracetamol can cause. 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) for advice if a child or adult may have taken an overdose of ibuprofen.

Delivering a Healthy WA

For more information contact:

Local Community Child Health Nurse Local Family Doctor Ngala Family Resource Centre Helpline 8.00 a.m. 8.00 p.m. 7 days a week Telephone (08) 9368 9368 Outside metro area Freecall 1800 111 546 www.ngala.com.au Parent Help Centre/Parenting Line Telephone (08) 9272 1466 (24hr service) Outside metro area Freecall 1800 654 432

Children, Youth and Women's Health Service, reproduced with permission. The South Australian Government does not accept responsibility for the accuracy of this reproduction. The original version is published at http://www.cyh.com Produced by Child & Adolescent Health Service 2007 To order this publication and others phone 1300 135 030 or visit www.health.wa.gov.au

Warning This document is published as general information only. You should always consult a healthcare professional for diagnosis and treatment of any health condition or symptoms. Disclaimer The advice and information contained herein is provided in good faith as a public service. However the accuracy of any statements made is not guaranteed and it is the responsibility of readers to make their own enquiries as to the accuracy, currency and appropriateness of any information or advice provided. Liability for any act or omission occurring in reliance on this document or for any loss, damage or injury occurring as a consequence of such act or omission is expressly disclaimed.

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