Be Careful When Alternating Between Acetaminophen and Ibuprofen

medicineAs most parents have discovered, pediatric medicine is as much of an art as it is a science.  Pediatricians subscribe to their own philosophies, best practices and standards of care, all typically, while at times perhaps loosely, in accordance with the American Academy of Pediatrics (AAP).

What does this mean for parents? Sometimes they’ll receive conflicting medical advice.

According to the American Academy of Pediatrics clinical report entitled Fever and Antipyretic Use in Children published in March, 2011, while “there is some evidence that combination therapy may result in lower body temperature for a greater period of time, there is no evidence that combination therapy results in overall improvement in other clinical outcomes.”

The study also points out that combination therapy may place infants and children at risk because:

  • There is no consensus on dosing instructions for the combination therapy.
  • There is a potential for dosing errors and adverse outcomes.
  • The dosing becomes more complicated and can contribute to the unsafe use of the drugs.


While pediatricians may or may not recommend alternating the doses, a bigger question of concern seems to be when is giving fever reducing medication appropriate? The AAP recommends that fever reducing medication be given to a child if he feels uncomfortable or lethargic and to help him feel better, not simply to normalize a child’s body temperature.

Fever in children is the body’s reaction to infection. As a fever rises, more white blood cells are released to fight the infection. If the fever is suppressed, the number of white blood cells may be reduced, weakening the body’s response to the infection.

And while fever is an indication of illness, fever in itself doesn’t cause brain damage or death. It’s this fear that had lead to the reinforcement of the idea that alternating acetaminophen and ibuprofen to reduce fever is a good one, according to an editorial Dr. Michael James Coogan wrote in response to a 2011 U.S. News & World Report article.

While deciding to trust your pediatrician’s advice is a personal one, regardless of if your pediatrician advises using either acetaminophen or ibuprofen or both, parents should make certain that they understand:

  • When to give a fever reducer.
  • The appropriate dosage for the child’s weight.
  • The appropriate dosing interval.
  • The proper formulation of medication.
  • Any potential drug interactions.
  • How to properly handle and store medications.

Parents should also be sure that they have and use an appropriately calibrated medication dispenser.

Always consult with your pediatrician before administering medication to your children.