Ibuprofen (Advil/Motrin) and Our Children: Uses and Risks

Similar to my post on acetaminophen (Tylenol), I thought I’d do an overview of ibuprofen (commonly known as Advil or Motrin) use for children.

For safety tips regarding use, see my previous post on acetaminophen. I will include any ibuprofen specific tips at the bottom of this post.

Disclaimer: this blog is not medical advice. It is for informational purposes only. Please seek medical advice from your healthcare provider.

What is ibuprofen and what is it used for in children?

Ibuprofen is a type of anti-inflammatory known as an NSAID (Nonsteroidal Anti-Inflammatory Drug). It is often used for pain in children, but also for fevers.

The current recommendations by the American Academy of Pediatrics and Canadian Paediatric Society is to not give ibuprofen to children under 6 months of age (follow your personal care professional advice as well regarding this – as there may be certain circumstances where it is recommended). The alternative would be acetaminophen (Tylenol) for both these purposes (pain and fever), but again – always discuss with your provider or a pharmacist.

Like acetaminophen, ibuprofen is dosed based on your child’s weight and age. I have linked to a few dosing charts below, but often your provider will also give you one (post-immunization, etc) or you can call them/their nurses line to ask if you have questions. Again – another excellent resource for drug related questions is your local pharmacist.

What are the side effects or risks associated with ibuprofen? Is it safe?

Like any drug, there are several possible side effects associated with ibuprofen risk – these are not limited to children of course, but may add additional risk in cases of misuse or overdose.

Gastrointestinal toxicity is one side effect, including GI bleeding. This is a risk with NSAIDs, however it is considered a lesser risk with ibuprofen specifically. Sometimes a stomachache or upset stomach (vomiting or diarrhea) may occur. Or, the opposite – constipation.

Similar to acetaminophen, some data has shown an association between ibuprofen use and asthma triggering. Again, this seems to be less of a concern with ibuprofen specifically (when compared to the antipyretic paracetamol). If your child is asthmatic or at higher risk for asthma development, it may be wise to speak to your provider if you have concerns – but the data suggests ibuprofen is low risk in this regard.

Another risk with this drug is of course overdose, by unintentional ingestion. However, complications appear to be rare in children and even adults – though overdose of the liquid form does contribute significantly to ER visits in the US in children.

Finally – renal toxicity or the impact of ibuprofen/NSAIDs on the kidneys is a concern. In children this is less common unless there are existing kidney or hemodynamic issues, or dehydration (which would impact circulating blood volume). Short-term use appears to present low risk of kidney impairment in children.

This study, which I’ve been linking to in this section, notes that there is a “class effect bias” that occurs with ibuprofen, since it tends to be related to all NSAIDs and their general side effects and not looked at singularly. When looked independently (as it should be in the case of use), it is considered a lower risk NSAID with regards to many of the things people tend to be concerned about.

When to call your doctor or seek assistance: bruises or bleeding that do not have a clear/visible cause or are severe. If your little one presents with any of these serious symptoms, you should call or head to the ER: tarry (black) stool which indicates bleeding in the GI tract; allergic reaction on the skin (rash, welts, etc); bloody urine; or any trouble breathing. These side effects are considered not common with ibuprofen but can still happen.

Studies on Ibuprofen in Children

I’ve referenced the safety study above quite a few times, but of course there are many studies on the topic.

For use for painibuprofen has been shown to be better for musculosketal pain, when compared to acetaminophen. It has been shown to be very effective for pain related to conditions like tonsillitis and sore throat, as well as otitis media.

Regarding its use in children under 6 monthsone study from 2018 found that ibuprofen does not seem to have increased side effects in this population of younger children when compared to those over 6 months of age. However, they also found that it is associated with more side effects than acetaminophen when used alone in the under 6 month population. It does note that no children studied in their study or a previous study experienced or reported any severe adverse effects. They report that prolonged NSAID use seems to be the most associated with renal effects or impairment.

What about use with acetaminophen (alternating)? For short-term use, this may be something to discuss with your physician. Long-term use has not been well studied, so the AAP advises not to alternate these two drugs regularly. Some doctors may still recommend it and provide you with guidance on how to do it and how long to do it for. Please speak to your provider regarding specific questions and schedules.

Follow your healthcare providers guidance regarding this. Sick Kids AboutKidsHealth does provide some guidance – but again, this should be discussed with your healthcare provider.

Interestingly, there is a study ongoing in the US regarding this.

Premedication for immunizations? Generally, this is not recommended because both drugs can interfere with the immune response, however in studies this doesn’t appear to be a significant impact beyond the first series of immunizations. Specifically, it seems both drugs can affect the immune response to the pneumococcal vaccine, and ibuprofen can impact the response the body has to DTaP (I spoke about both those vaccinations in my last post here). So far, it remains a recommendation only to administer medication after a vaccination for either/or fever/pain (unless advised otherwise by your provider). You should follow the age and weight guidelines for which medication and how much to administer. Your provider should also give you follow up recommendations for after care and when to seek assistance (I will be writing a post on that next week as well).

Safety Tips

  • Do not give ibuprofen (unless otherwise advised by your healthcare provider) to children who may be dehydrated (vomiting or diarrhea may cause this), as risks for renal impairment are increased.
  • Ibuprofen should not be given with another NSAID, unless otherwise advised by your healthcare provider, as it may increase the risk of renal impairment.
  • Discuss with your healthcare provider if your child has asthma or other breathing problems before giving ibuprofen. Its use is also not recommended for children with varicella – however, this is controversial, so speak to your healthcare provider.
  • As with any drugs, discuss its use with your provider or a pharmacist if you have any concerns, or there is a history of allergies or renal issues.
  • Unless advised otherwise by your provider, do not give ibuprofen to children under 6 months of age.
  • Ibuprofen can be given every 6-8 hours – please follow the guidance of your healthcare provider regarding dosing and frequency, as well as administering it with any other drugs
  • See my previous post for more general medication administration/storage safety tips here

Additional Resources

Fever Medication Chart – Alberta Health Services

Ibuprofen Dosing – Healthy Children (AAP)

Safety Review Study 1 and Safety Review Study 2 and Safety Review Study 3

About Kids Health – Ibuprofen

Acetaminophen/Ibuprofen Administration– About Kids Health (Sick Kids)

Alternating acetaminophen/ibuprofen – Evidence

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