What’s the best pain reliever or fever reducer for kids?

When your kids are sick, the only thing on your mind is helping them to feel better—as soon as possible. It’s hard to watch little ones suffer with a fever or pain. Not all higher-than-normal temperatures or aches and pains require treatment. But, if your child’s does, it’s important to treat these conditions safely.

Sickness often strikes in the middle of the night, and an overtired child usually means an exhausted parent. On top of that, there are a lot of options to choose from. If you find yourself feeling overwhelmed in the children pain reliever aisle, or the children fever reducers section of the pharmacy, use this guide to choose the best over-the-counter medication.

Does your child need medication?

While many people believe any temperature higher than 98.5 Fahrenheit requires meds, the truth is: Not all fevers require treatment. “I always like my families to know that there’s a lot of misinformation out there regarding fever in children,” says Corey Fish, MD, FAAP,  a pediatrician and the co-founder and chief medical officer at Brave Care. “Fever is a symptom of an illness much like a cough or runny nose. The important consideration isn’t the symptom, it’s the cause of the symptom.”

Old guidance said that a fever higher than 104 degrees Fahrenheit merited a trip to the emergency room, and that all fevers need to be reduced. Now, many pediatricians recommend treating fever only if it’s making your child uncomfortable. Meaning, treating it won’t cure your child any faster, it can just help make being sick a little easier. “A parent never HAS to give medicine to bring a fever down,” Dr. Fish says. “I typically recommend letting the fever run its course, keep up on lots of fluids, and give acetaminophen or ibuprofen based off how the child is feeling, not the number on the thermometer.”

The same goes for pain. If it’s a scraped knee, or run-of-the-mill sore throat, you don’t always need to reach for ibuprofen for kids. A bandage, or natural treatment like a popsicle, could help the ache go away. For more severe, inflammatory conditions—like a toothache, tonsillitis, or ear pain—an over-the-counter remedy could be a good choice.

Which is better: Children’s Tylenol or Children’s Motrin?

There are two main types of medication for treating pain and reducing fevers for kids: Children’s Tylenol (also known as acetaminophen) and Children’s Motrin or Children’s Advil (also known as ibuprofen). These are the main considerations when choosing which to use:

Safety and effectiveness

“Tylenol (acetaminophen) and Advil (ibuprofen) are safe for most children, after checking with the healthcare provider to make sure that they do not have a medical condition that contraindicates one or the other,” says Leann Poston, MD, a pediatric medicine practitioner and contributor for Ikon Health. 

For example, some children are allergic to non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, but not acetaminophen. Or, a liver disorder may make acetaminophen dangerous for some children. “When choosing between Tylenol [acetaminophen] and Advil [ibuprofen], consider that Ibuprofen can be harder on the stomach, cardiovascular system, and kidneys, but it decreases inflammation, and Tylenol does not,” Dr. Poston explains.

They are both acceptable treatments, according to the American Academy of Pediatricians (AAP). Though, it’s important to note that other NSAIDs are not recommended, or safe, for kids. Aleve (naproxen) is not used for fever in infants or children under age 12. While many adults reach for Bayer, Dr. Fish says, “Aspirin of any kind should never be given to children due to concern for a rare but serious side effect called Reye’s syndrome.”

RELATED: Tylenol vs. NSAIDs

Effectiveness

“Both these medications are effective at treating both pain and fever,” says Dr. Fish. It really depends on personal preference, and what works best for your child. 

Some studies show that acetaminophen is better for treating fevers with flu-like symptoms. Yet, ibuprofen reduces inflammation, and lasts longer than acetaminophen, according to the Hospital for Special Surgery. In other words, let symptoms and your child’s response to treatment in the past be your guide.

Age

“Ibuprofen should not be used in infants younger than 6 months old,” says Dr. Fish. Acetaminophen is safe for infants and children of all ages, according to the AAP; however, do not use acetaminophen under 12 weeks of age unless directed by your pediatrician because fever during the first 12 weeks of life should be documented in a medical setting. 

For children younger than 3 months old (or 90 days), you should always call your pediatrician immediately for a fever greater than or equal to 100.4, explains Dr. Fish.

Dosage and type

When medicating a child’s fever or pain, “Always take the lowest effective dose,” Dr. Poston says. “Dose based on weight, and do not exceed the maximum dose per day.” 

RELATED: Learn how to measure your child’s medication properly

If your child can’t swallow pills, or has trouble keeping food down, there are liquid, chewable, and suppository forms available. “The best option for a vomiting child is probably acetaminophen because it can be administered rectally if needed and it has less potential to upset the stomach compared to ibuprofen,” Dr. Fish says.

If you use a liquid form, just be sure to use the enclosed measuring cup or syringe. It is easy to administer the wrong dose using a kitchen teaspoon. Too little medication won’t be effective, and too much can be dangerous. “There is a specific dosing schedule and maximum dose per day to avoid side effects that can be serious,” explains Martha Rivera, MD, pediatrician at Adventist Health White Memorial in Boyle Heights, California. “Acetaminophen is metabolized in the liver. NSAIDS [ibuprofen] are metabolized in the kidneys.” Too high of a dose can cause liver or kidney damage. 

The American Academy of Pediatrics offers dosing charts and guidance for acetaminophen here and ibuprofen here.

RELATED: How much ibuprofen is safe to take?

Alternating Tylenol and Motrin

“Tylenol and Advil can be alternated to help bring down a stubborn fever or for pain, however, the risk for overdose is higher,” says Dr. Poston. You can give Ibuprofen every six hours, and acetaminophen every four hours. Alternating between the two can reduce the amount of time between doses when your child is untreated. For example, you could give a child acetaminophen at 9 a.m., ibuprofen at 12 p.m., acetaminophen again at 3 p.m., and ibuprofen again at 6 p.m.

It can be hard enough to remember when the last time you gave your child a single medication in the middle of the night. Adding a second medication further complicates the situation. “Choose one or the other initially,” Dr. Poston says. “If you do dose with both, write down your dosing schedule to minimize the chance for overdose. Dosing with both allows you to give a medication every three hours instead of four for Tylenol [acetaminophen] and six for ibuprofen.”

Whichever medication you choose, both treatments are intended for short-term relief of symptoms. If your child’s pain or fever persists for more than 24 hours or your child is exhibiting other signs of distress, don’t hesitate to reach out to your pediatrician for help.

“Bottom line is parents know their children,” Dr. Rivera says. “When there is concern that there is a signal that [the] child is not well please contact [your] health provider for guidance, counseling, and appropriate dosing.” As always, it is important to store medications out of reach of children. Keep the childproof caps on bottles, and read labels of combination products (such as allergy, cough, or cold formulations) to prevent overdosing ingredients. If your child accidentally takes a medication or you overdose your child, call Poison Control immediately at 1-800-222-1222 before doing anything else unless 911 emergency care is needed.