By Wendy Glauser
From the print edition, March 2012
Julie George, a Waterloo, Ont., mom of two, admits she gave both her son Ian, 5, and daughter Ella, 2, Infants’ Tylenol to help them sleep through their teething pain when they were babies. “They needed to sleep and we needed to sleep,” she says. Most times, one dose was enough, and she tried not to give it during the day “unless they were really cranky.”
Indeed, over-the-counter (OTC) pain relievers like acetaminophen (found in Tylenol, Tempra, Panadol and more) or ibuprofen (present in Advil and Motrin) can be a godsend for parents with babies battling an ear infection. But even these pain medications can harm babies’ systems if given inappropriately or in excess. Here’s what you need to know.
Dr. Steven M. Moss, a pediatrician at North York General Hospital and The Hospital for Sick Children in Toronto, says parents should consult a physician before giving any OTC drug like Tylenol or Advil to an infant under three months of age. “You want to find out why the baby is in pain,” he explains, as it could be something more serious.
When administering an OTC pain reliever at home, Dr. Mark E. Feldman, an associate professor of medicine at the University of Toronto and a pediatrician at The Hospital for Sick Children, stresses that parents should pay strict attention to the dosage limits that are clearly printed on the packaging. For acetaminophen, the maximum one-time dosage is 15 milligrams per kilogram of the baby’s weight and it shouldn’t be given more frequently than every four hours (but not more than five doses in a 24-hour period). For ibuprofen, toxicity concerns arise when the dose exceeds 10 mg per kg of body weight or if given more than every six hours.
Additionally, says Dr. Feldman, “ibuprofen is irritating to the bowel and kidneys, so it should be given with something in the stomach.” Acetaminophen doesn’t need to be given on a full stomach. In cases of severe pain, ibuprofen can be alternated with acetaminophen every three hours because the drugs are metabolized differently in the body—ibuprofen by the kidneys, acetaminophen by the liver—says Dr. Feldman, however this course of action shouldn’t be taken without a physician’s okay. And always use the measuring device that comes with the medication. Do not use droppers from other medications—they might have medications in them—or a spoon from the kitchen because you cannot be accurate with the dosage.
Ibuprofen and acetaminophen are antipyretics, meaning they bring down a fever, but parents should not try to treat fevers in babies on their own with an OTC drug, says Dr. Moss. Instead, they should take babies younger than three months with a fever—a reading of 38.1ºC (100.5ºF) or higher if measured rectally or 37.3ºC (99.1ºF) or higher if measured in the armpit—to a doctor immediately. Often, feverish infants that age are hospitalized and it’s standard procedure that the child’s blood and/or urine be tested to rule out any serious bacterial illnesses. For children between three and 12 months, Dr. Moss advises parents to consult their physician before they administer an OTC drug because the child’s fever may need to be investigated before it is treated.
OTC Pain Relievers and Immunizations
Until recently, physicians would recommend that babies be given an antipyretic prior to an immunization, says Dr. Moss. Now, however, doctors are no longer sure this is the best course of action. For one, a study published in The Lancet in 2009 suggested that antipyretics might weaken the immune system’s response to a vaccine, which would reduce the vaccine’s effectiveness. Plus, “there’s so much less fever associated with vaccines than there used to be,” says Dr. Moss. Breastfeeding during and after a vaccination can alleviate some of the pain associated with a vaccination, as can the application of a topical anesthetic (numbing agent) to the injection site one hour prior. After the vaccination your baby may be fussy, have slight swelling at the injection site or have a low-grade fever. These reactions are common, and you can ask about providing OTC pain and fever relief. If you do notice anything that isn’t normal (high fever, convulsions, unusually sleepy) after the immunization, contact your doctor.
For more information about medicine for your little one, check out our guide to your baby’s medicine cabinet must-haves.