Is This Safe? A Crash Course in Fever and Pain Reducers for Kids.
- Alexandra Hansen
- Mar 19
- 3 min read
The other day I was running a quick errand in my local grocery store and saw something alarming. While passing through the baby aisle I found aspirin stocked in between some cold remedies and children's ibuprofen just above the formula and across from the diapers. Given this aspirin was noted to be chewable and orange flavored, it certainly appeared to be appropriately stocked in the kid's section to the non-medical eye. However, aspirin use in children can be extremely harmful, and I immediately reached out to the store as well as posted a PSA on local mom's pages to not use chewable aspirin in young children without the supervision of a physician.
Thanks to the quick action of the store, the aspirin was moved within an hour or two. This reminded me of another time I encountered a concerning medicine in a different children's aisle and prompted me to write this quick post.
Why shouldn't you use aspirin to treat your children's fever or discomfort? Aspirin use in children and adolescents - primarily those under the age of 12 - is associated with a potentially deadly condition called Reye's Syndrome. This is a rare but life-threatening process that occurs in children treated with aspirin during or after a viral illness. There are times when aspirin is used in children, but those are typically prescribed and followed closely by a specialist, usually a pediatric cardiologist. If your child has been prescribed aspirin, please do not stop the medication, but if your child has not been specifically ordered to take aspirin, please inquire about other options for pain or fever relief with your child's pediatrician or family physician.
Another aspect of children's medicine I want to touch on is dosing. In the past, there were two different formulations of acetaminophen (brand name Tylenol) liquid available: infant and children's concentrations. Unless the label was closely read, parents could easily give double the intended dose of acetaminophen as the infant liquid was intended to be a smaller volume to make it easier to give to younger infants. As many pediatricians provide weight-based dosing in milligrams (mg) as well as milliliters (mL), following the volume-based recommended dose could lead to over or underdosing depending on the situation. Underdosing, while less likely to cause direct harm, can result in increased discomfort in the child from being inadequately treated as well as increased ER and clinic visits for "fever not responding to medicine" which can lead to unnecessary and expensive work ups. Obviously overdosing on medicines is dangerous, though a single double dose of acetaminophen is unlikely to cause severe harm, repeated excessive dosing can result in liver damage. For these reasons, the infant concentration of acetaminophen was removed from the market and the 160mg/5mL concentration is what is generally available in the US.
Having learned this in Pediatric residency, imagine my alarm when I found that ibuprofen (brand names Motrin/Advil) is still sold in two different concentrations when I was buying some for my own child. The standard children's concentration of ibuprofen is 100mg/5mL, but the infant's concentration is 50mg/1.25mL, or twice the concentration. As with acetaminophen, while a single double dose of ibuprofen is highly unlikely to cause long term harm, unknowingly providing double the dose repeatedly can cause damage to the kidneys, particularly in dehydrated children. As a parent, I have actually opted to buy the infant concentration of ibuprofen when I can find it as I appreciate the smaller volume, but I always try to keep only 1 concentration in my house at any given time. I encourage you to double check any liquid medicines you have at home and confirm you know which concentration(s) you have.
As with any medical information online, please discuss any changes to your child's medical history or concerns with your pediatrician or family physician. I may be a doctor, but I am not your doctor, and I cannot provide specific or tailored advice in this format. I do hope that this general information helps inform and protect families from very understandable mistakes when it comes to treating fever and discomfort at home.
More Information about Reye's Syndrome:
Acetaminophen Dosing Tables:
Ibuprofen Dosing Tables:
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