While scrolling through Facebook recently, we stumbled upon a post on a mommy support group that asked, “Which is better, Tylenol or Motrin?”, and let’s just say the answers were... eh... concerning. This is no one’s fault, and we are not mom-shaming, at all. We realize there are so many differing opinions out there that some people have accepted as fact, instead of opinion.
As pediatric nurses we sometimes take for granted how much we know about medicine and their mechanisms. We forget that not everyone knows this, especially when it concerns children and babies. We forget that the majority of people learn how to care for children from their mom, their aunties, their grandmas, the neighbor, your hairdresser, etc. We have even spoken to a few pediatric nurses who almost forgot to correctly dose their own baby for Tylenol! It happens.
We are here to help break down the basics of each of these drugs; the mechanisms, when to use them, and how to correctly dose them.
Before proceeding we would also like to point out that none of the below information should be used in substitute of medical advice from your pediatrician. Every child and diagnosis is different and will respond differently to these medications. When in doubt, always consult your pediatrician, especially if your child has existing health conditions.
Tylenol (Acetaminophen)
Mechanism: Acetaminophen is both an analgesic (pain reliever) and anti-pyretic (fever reducer). The exact mechanism of action within our body is not known.
Pros:
Successful in reducing fever and pain
Can be used in infants under age of 6 months
Comes in suppository form in case your child cannot tolerate fluids
Easy on the stomach
Cons:
Can cause liver toxicity
Dosing:
Making sure the concentration is correct is very important. Always check the bottle. Most liquid Tylenol doses are 160 milligrams (mg) per every 5 milliliters (mL) of Tylenol.
(A side note about dosing: Dosing of any medication in children is based on your child’s weight. We base the weight in kilograms (kg). Most US parents know their child’s weight in pounds (lbs). So, just for reference, 2.2 kgs equals 1 lb. Example: a 20 lbs. child, divided by 2.2 kg, equals a 9.09 kg child, or 9kg rounding. YOU DO NOT NEED TO KNOW THIS to properly dose your child. Our tables below are in pounds. We just wanted you to know where it came from!)
The standard dosing for Tylenol is below:
10-15 mg/kg/dose every 4-6 hours as needed
Do not exceed 5 doses in 24 hours
Maximum daily dose: 75 mg/kg/day. (If your baby is premature, or less than 10 days old, consult your pediatrician)
Since the dosage can vary from 10-15 mg per kg per dose, which is a big range, below is an easier reference tool. This table provides your child’s weight in pounds, which means we already converted everything for you.
So, according to the table above, if your child weighs 8 pounds, you would give 1.25 milliliters of Tylenol. The droppers that come with the medication should have the proper markings. Table is from https://www.stlouischildrens.org/health-resources/dosage-tables/acetaminophen-tylenol-dosage-table
Motrin (Ibuprofen)
Mechanism: Ibuprofen is an NSAID (non-steroidal anti-inflammatory drug). It’s mechanism of action is not completely understood, but may be related to prostaglandin synthetase inhibition.
Pros:
Reduces fever and pain related to inflammation
Cons:
Can cause upset stomach
Cannot give to babies under 6 months of age
Renal effects with long-term or excessive use
Dosing:
Liquid children’s ibuprofen comes in two forms:
Infant drops: 50 mg per 1.25 mLs
Liquid Suspension: 100mg per 5 mLs
*Either one is okay to use, the most important thing is paying attention to which concentration of medication you have!
The standard dosing for ibuprofen is:
Infants and Children <50 kg: 4 to 10 mg/kg/dose every 6 to 8 hours
Maximum single dose: 400 mg
Maximum daily dose: 40 mg/kg/day
Since 4-10mg/kg is a big range, refer to the table below for an easier reference. Again, this table is in pounds, so make sure you’re using the correct weight. Also make sure you are using the correct concentration here, since this table lists multiple.
So, if your child weighs 20 pounds, you would give 4 milliliters of the Liquid (100mg/5mL) Motrin. The table is from https://www.stlouischildrens.org/health-resources/dosage-tables/ibuprofen-motrin-advil-dosage-table
FAQs:
Can you rotate Tylenol and Motrin?
Yes, you can. However, there are some things to consider, first.
Rotating Tylenol and Motrin is a very common practice to help both pain and fever in children. However, just because it can be effective, does not mean it is necessary. We have seen parents automatically rotate and give both medications, regardless of if the child is still symptomatic. If Motrin relieves the pain or the fever, why give the Tylenol? The less medication given, the better. If your child has pain and fever that persist after the first medication is given, then giving the other one is okay.
If you decide you do want to rotate both medications, you’ll space them each out three hours apart. For example; give Tylenol, 3 hours later give Motrin, 3 hours later give Tylenol again, and so on.
Which one is better for pain?
The answer to this relies largely on what the pain is caused by. If it is caused by something inflammatory (ie; muscle injury, cramps, etc) then Motrin works best. If it is general pain for other reasons, Tylenol tends to work better (ie; headaches, etc). However, as mentioned many times before, every person is different and therefore will respond differently to pain medications.
Which one is better for fever?
It is important to note that treating the fever with these medications is just treating the fever to make the child more comfortable. This does not shorten your child’s illness or fight infection whatsoever. These medications just simply make your child more comfortable while being sick.
The largely agreed upon consensus is that Tylenol works best for lowering fevers. However, many children require Motrin or rotating Tylenol/Motrin to break a fever. You will learn what works best for your child.
When to call PMD?
Please visit last weeks article, Ultimate Fever Guide for Babies and Children, for when to call the doctor.
Key Points:
Always pay attention to concentration of liquid medication.
Always base your dose off weight, not age.
When in doubt, always seek the opinion of your pediatrician.
This is a ton of information, and we appreciate you taking the time to go over this! We really tried to make a comprehensive guide to help educate parents. Let us know any comments or questions you may have, or if you feel something could be explained better. And as always, please share this!
Jeri Ford, RN, BSN, CPN
Other sources not listed above:
LexiComp
Mayo Clinic