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Alternating Medicines to Treat a Fever in Children Older than 6 Months
Alternating Medicines to Treat a Fever in Children Older than 6 Months
Alternating Medicines to Treat a Fever in Children Older than 6 Months
Alternating Medicines to Treat a Fever in Children Older than 6 Months
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Funding for content provided by Bausch + Lomb
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Understanding Fever in Children
First and foremost: What is a fever? A fever in a child is usually a temperature of 100.4°F (38°C) or higher and is the body’s natural reaction to infection. While usually harmless and part of the immune response, a child’s fever can still cause concern for parents. The goal of treatment is often comfort, not necessarily getting your child’s temperature “back to normal.” Knowing when and how to treat a fever can be difficult and depends on several factors, including the severity of the fever, the level of discomfort your child is experiencing, and your child’s response to certain medicines.
"What medicines are recommended?"
For most children 6 months and older, the two most commonly used medicines to relieve fever-related discomfort and pain are:
- Acetaminophen (e.g., Children’s Tylenol)
- Ibuprofen (e.g., Children’s Motrin or Children’s Advil)
Ibuprofen is generally not recommended for babies younger than 6 months unless a healthcare professional has given you specific instructions to use it.
Both types of medications:
- Are safe when used as directed.
- Reduce fever and relieve pain.
- Should be dosed based on your child’s weight, not age (link out to dosing guidelines).
- Should only be administered with the dosing device (i.e., cup or syringe) provided with your medicine.
For most children over the age of 6 months, starting with one medicine - either acetaminophen (Children’s Tylenol) or ibuprofen (Children’s Motrin or Children’s Advil) - is an appropriate first step to reduce fever and discomfort.
For some children, a healthcare professional may recommend using acetaminophen and ibuprofen at different times if discomfort persists or returns before the next dose of the first medicine is due. This is not routinely needed and should not be used simply to lower a temperature number.
Alternating medicines can be confusing and can increase the risk of dosing errors or accidental overdose. Do not alternate acetaminophen and ibuprofen unless your child’s healthcare professional gives you a specific plan. If they recommend it, use a written schedule that records the medicine, dose, and exact time each dose is given.
There is research that suggests that:
- using both medicines at different times may lower temperature more than using one medicine alone over the next several hours.
- some children experience improved comfort and better sleep.
Alternating fever medicines does not treat the infection or shorten the illness.
"What do pediatric health organizations recommend?"
Many major pediatric and medical organizations agree on two key points when it comes to treating fever in children:
- The main goal of fever treatment is comfort, not normalizing temperature.
Fever by itself is often not harmful in most children. Medicines should be used to help a child feel better, stay hydrated, and rest, not just to lower the number on the thermometer.
- Using one medicine is usually preferred.
The American Academy of Pediatrics (AAP) states that although alternating or combining acetaminophen and ibuprofen can lower fever more effectively, it may also raise the risk of incorrect dosing. Therefore, regularly using both medications together is not usually advised unless directed by a healthcare provider.
The AAP and Other Pediatric Experts emphasize that:
- Families who alternate medicines should do so only with clear instructions from their child’s physician and a written dosing schedule.
- Simple regimens reduce errors and are safer for most families.
- Always consult with your child’s pediatrician with questions.
Important Update: Acetaminophen
There’s been a lot of talk recently about misleading claims that taking acetaminophen during pregnancy can cause autism. We’ve pulled together some FAQs and answers to help families.
Learn more and get the facts about acetaminophenTakeaways for Parents:
- It is safe and effective to use either acetaminophen or ibuprofen alone for most children.
- Alternating may be considered in certain situations to improve comfort or reduce stubborn fevers, if recommended by your child’s healthcare provider.
- Careful dosing, documentation, and supervision are essential when more than one medicine is used.
When Alternating May Be Considered by a HealthcareProfessional
Your child’s healthcare provider may recommend alternating if:
- your child remains very uncomfortable after receiving one medicine correctly.
- discomfort returns before the next dose of the first medicine is due.
- single therapy has not provided enough relief.
In these situations, alternating therapies may help – but it must be done carefully to prevent dosing errors or accidental overdoses.
If your child is vomiting, drinking poorly, urinating much less than usual, or has other signs of dehydration, contact a healthcare professional. Ask before giving ibuprofen.
A NOTE ABOUT DYE-FREE PRODUCTS: Dye-free medications and supplements are a great option for individuals who prefer or require products without dyes, such as those with allergies, sensitivities, or personal preferences. Importantly, both dye-containing and dye-free options are held to the same rigorous safety and quality standards. If you’re unsure which is right for you or your family, talk to your pharmacist or healthcare provider. They can help you choose the option that best suits your needs.
"How do I alternate my child's fever medications safely?"
If your child’s physician recommends alternating acetaminophen and ibuprofen:
- Write everything down. Record the medicine’s name, strength or concentration, dose in mL, and the exact time it was given.
- Follow correct intervals between medication doses.
- Acetaminophen may only be given as directed on the package label or by your child’s healthcare professional. For children under 12, acetaminophen may be given every 4 hours while symptoms last, with no more than 5 doses in 24 hours. - Dose by weight. Use your child’s weight in pounds (lbs) or kilograms (kg) to calculate correct dosing.
- Only use single active ingredient medicines (e.g., Children’s Tylenol, Children’s Advil). Do not use multi-symptom medicine products. They can contain the same active ingredients, potentially resulting in an accidental overdose.
- Stop treatment once your child is comfortable.
Remember to treat your child's discomfort, not necessarily the number on the thermometer.
When You Should Call Your Child’s Pediatrician
Contact your healthcare professional if:
- your child is younger than six (6) months of age.
- a fever lasts more than three (3) days (>72 hours).
- a fever is 104°F (40°C) or higher.
- your child is vomiting, dehydrated, or lethargic.
- any underlying medical conditions are present.
- you are unsure which medicine to use, how much to give, or when the next dose is due.
References:
- http://www.washingtonpost.com/wp-dyn/content/article/2005/09/30/AR2005093001998.html
- http://www.mayoclinic.com/health/drug-information/DR602285/DSECTION=precautions-
- http://www.drugs.com/drug-interactions/multivitamin.html
- http://www.naturemade.com/resource-center/articles-and-videos/immune-health/timing-your-vitamins
- http://www.nlm.nih.gov/medlineplus/druginfo/natural/912.html
- http://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
- http://www.prevention.com/food/healthy-eating-tips/your-breakfast-giving-you-cancer
- http://ods.od.nih.gov/factsheets/Iron-HealthProfessional/
- http://www.ag.ndsu.edu/pubs/yf/foods/fn1607.pdf
- http://www.fda.gov/Food/DietarySupplements/UsingDietarySupplements/ucm110567.htm
Safe Use Tips & Takeaways
Heart Health Takeaways
- A fever is generally considered to be a temperature of 100.4°F (38.0°C) or higher.
- Temperature in infants can be most accurately measured using a digital rectal thermometer.
- Talk to your doctor before giving a pain reliever or fever reducer containing ibuprofen if your baby is younger than 6 months (ibuprofen is generally notrecommended for children < 6 months).
- Talk to your doctor before giving acetaminophen to a child younger than 2 years to obtain the proper dosing instructions - acetaminophen / ibuprofen.
- Before giving your child any medicines, make sure you know your child’s weight. Dosing is based on weight, not age. Be sure to always double check if the drug facts label may list child weight in kilograms or pounds.
- Make sure to read the package label very carefully for proper dosing.
- Always use the measuring device (i.e., cup or syringe) that comes with the medicine. Do not mix and match dosing devices.
- Don’t give aspirin to anyone under 12 years of age unless instructed by your doctor.
- Do not give sponge baths or attempt to reduce your child’s fever with cool or cold water. This can cause shivering and result in an increased body temperature.
What is fluoride?
Fluoride is a natural mineral found in water, soil, and some foods. It strengthens your enamel, repairs early signs of damage, and makes teeth more resistant to acids from bacteria and sugar.
Is fluoride toothpaste still the most effective option, or are fluoride-free formulas just as good?
Fluoride is still the gold standard for cavity protection. Fluoride-free options can clean your teeth, but they don’t offer the same enamel-strengthening power.
Is fluoride safe for daily use?
Yes. When used as directed, fluoride is safe and effective. It’s been trusted and recommended by major health organizations for over 70 years.
How does fluoride actually protect teeth?
It strengthens enamel, repairs early signs of decay through remineralization, and makes teeth more resistant to acids from bacteria and sugary foods.
Are there any risks to using fluoride long-term?
The main risk—especially for young kids—is swallowing too much, which can lead to mild fluorosis (faint white streaks on teeth). Using the right amount prevents this. For parents, supervise brushing to ensure kids spit out the toothpaste and don't swallow it.
At what age should kids start using fluoride toothpaste?
As soon as the first tooth appears!
* Under 3 years: a tiny rice-sized smear
* Ages 3–6+: a pea-sized amount
Supervise brushing so they don’t swallow it.
* Under 3 years: a tiny rice-sized smear
* Ages 3–6+: a pea-sized amount
Supervise brushing so they don’t swallow it.
Is fluoride still safe and recommended for kids with all the claims online?
Yes. A lot of online claims can be confusing, but decades of research show fluoride is safe and strongly recommended for cavity prevention when used properly.
How much fluoride should my child get from toothpaste?
Use age-appropriate amounts and brush twice a day. If your water isn’t fluoridated, ask your dentist about additional options.
How do I know which kids’ toothpaste claims are real and not just marketing?
Check for the ADA Seal of Acceptance and choose brands your dentist recommends.
Do fluoride-free or “natural” toothpastes protect kids from cavities?
They can help clean teeth, but they don’t provide the same cavity protection as fluoride toothpastes.
Are fluoride-free toothpastes just as effective for adults?
Not for cavity prevention. Fluoride-free toothpastes can help with cleaning and freshening breath, but they do not protect against cavities the way fluoride does. For adults, or anyone who is prone to cavities, fluoride toothpaste remains the most effective option for preventing tooth decay.
Do fluoride alternatives like nano-hydroxyapatite (nHAp) make a difference?
Yes—nHAp can help with sensitivity and early enamel repair. But it hasn’t matched fluoride’s cavity-prevention strength in studies.
How do I compare fluoride vs. fluoride-free options if I have sensitivity or enamel wear?
Fluoride is best for strengthening enamel and cavity prevention. nHAp may help with sensitivity and enamel repair. Some people benefit from using both in a balanced routine. Talk to your dentist about what's right for your specific needs.
Are whitening toothpastes safe to use with fluoride or fluoride-free products?
Most are safe but can be abrasive. Choose gentle formulas and avoid using them every single day—especially for kids.
What should I look for when choosing an OTC toothpaste?
Pick products with proven active ingredients (like fluoride), check for the ADA Seal of Acceptance, and avoid unnecessary additives or sweeteners.
Does fluoride affect hormones or the brain?
No credible scientific evidence shows fluoride at levels used in toothpaste or properly fluoridated water (0.7 mg/L) disrupts hormones or causes neurodevelopmental harm.
What should I do if my community stops adding fluoride to the water?
Use fluoridated toothpaste, consider fluoride rinses (for ages 6+), and talk to a dentist about fluoride supplements for kids (if needed).
Do fluoride supplements have side effects?
They’re safe when used under dental guidance and typically recommended for children in areas without fluoridated water or at high risk for cavities.
What’s the best way to make sure I’m getting enough fluoride?
Brush twice daily with fluoride toothpaste, drink fluoridated tap water if available, and ask your dentist for personalized advice if you’re cavity-prone.
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