Motrin or Tylenol: The Great Debate for Treating Fever in Kids

As a pediatrician, I am asked on a daily basis from worried parents about what they should give their child with a fever,  Motrin (Ibuprofen) or Tylenol (acetaminophen) to bring down the temperature.

 This question always requires more than a one word response to the choice between antifever medications .  An explanation about if medication is even necessary for the fever and to clarify many long standing fever phobia misconceptions.  Mainly, it is not necessary to treat the number on the thermometer, nor is it always necessary to bring the temperature down.

 What is important is to address how the child is feeling and behaving regardless of their temperature. Are they happy, playful drinking fluids or are they cranky, irritable and uncomfortable? If the former then no fever reducing medicine is even necessary.  What pediatricians want parents to know is to not be scared of fever, it’s the body ‘s way of fighting off the infection. The goal of a fever reducer is to make a kid feel better so they can rest and recover.  The over the counter medicine does treat the illness nor make them better or less contagious any faster. The take home message is to use fever reducers for added comfort not just because your child has an elevated temperature documented on the thermometer.

Now that you have come to the decision that a fever reducer is warranted, here is some information on helping you decide which one to use Motrin or Tylenol.

Efficacy and Safety - Both Tylenol and Motrin are effective in bringing fever down in otherwise healthy kids over the age of 6 months.  From my longstanding experience with patients, the fever does tend to decrease  faster and remain lower a bit longer with Motrin than with Tylenol. But choosing which to give when your child is sick often comes down to what you have on hand in your kitchen or bathroom cabinet when your child needs it. Always use the measuring device that comes with the bottle or a measuring spoon or syringe. A kitchen spoon is not an accurate measure and can lead to under or even overdosing.

Length of Action- Tylenol can be given at 4 hour intervals as needed where as Motrin is every 6 hours. As a parent, it’s nice to have less dosages to administer, especially if it’s a struggle because your child does not like to take medicine in the first place.  An all to common practice in my opinion is alternating Tyenol and Motrin. Parents often do this to keep the fever “down” or suppressed. In most cases this is not needed especially if you remember treatment is for comfort and not trying to get the thermometer to read 98.6F. In addition alternating medication every 3-4 hours leads often to medication errors and overdoses which can potentially be severe. So if you are giving both,( a practice I rarely recommend) please make sure to write down which medicine, the dosage and what time it was given, so all caregivers are aware to avoid errors.

Dosing is Key- Regardless of whether you are giving Ibuprofen (Motrin) or acetaminophen (Tylenol), make sure you know the correct dosage for your child. Dosage is always based on their weight NOT on their age. This will help to ensure the medication works as weight is much more accurate than a child’s age (so keep their weight from their last check up visit handy). A common mistake I hear when a parent tells me that a fever reducer “didn’t work” is not giving the full recommended dosage. Often parents are scared of over medicating so they give a reduced or lesser amount than indicated and then are surprised it didn’t help the symptoms adequately.   Tip, if you are going to give a medication always give the correct full dosage each time.

Pros and Cons - Tylenol can be administered to infants under 6 months of age. It does not cause stomach upset and can be used for pain or for fever reducing and lasts about 4 hours. An added perk about acetaminophen is that it also comes in suppository form if your child is vomiting or refusing to take anything by mouth, often this is the easiest route to deliver the medicine in a sick infant/toddler.  The downside to Tylenol it can cause liver toxicity if given in excess or accidental overdose,  so give as directed and keep it stored high up and out of range when not in use.

Motrin is also great for fever reduction but has added benefit for reducing inflammation likes sports and muscle injuries. It keeps fever down longer and the dosing is less often at every 6-8 hours as needed. Remember Ibuprofen is for children over the age of 6 months of age, it may cause more stomach upset so avoid if your child is vomiting or not eating.

Lastly which fever reducer to give may ultimately come down to your child’s preference. Neither fever reducer will be helpful if they just won’t take it. Because both are safe and effective when taken correctly, opt for the one your child will take without a major meltdown or tantrum. This may be based on its flavor, consistency or even form ( liquid vs chewable)  And remember lots of extra TLC , added fluids to drink to avoid dehydration and even a tepid bath or cool compress on their forehead for added comfort and relief.