Came across this re fever meds

[Fuschia]

http://www.dailymail.co.uk/health/article-1051958/Ibuprofen-paracetamol-taken-alternately-Confusion-grows-safety-mixing-child-painkillers.html

[Curmudgeon]

was always advised to give both paracetomal and ibuprofen to my children - by GPs and paeds at Kings - from 4 - 9 years ago

also hospital will administer both together

[samstopit]

me too, I didn't realise there was confusion over whether or not to use them alternately tbh. My GP and NHS direct were quite clear about using them alternately to keep the temp down.

[Fuschia]

I do it and so did the hospital when twin 2 was an inpatient bit I

Aware the NICE guidelines on fever in children advise against it

[buggie]

Looking at the feverish illness in children guidelines, it doesn't seem to say not to use ibuprofen/paracetamol alternately, just that research is inconclusive in it's effectiveness. I feel any illness/fever should be treated on a case by case basis - sometimes either paracetamol or brufen will be enough, but in more serious infections the fact that each has a different way of inhibiting the prostoglandins that help raise the body's thermostat, it would make sense that giving them alternately could help more effectively make the child comfortable*/lower the temp.

A bigger problem is often parents under dose their children and then wonder why either paracetamol or brufen hasn't been effective. The instructions on dosages on the bottle are v conservative (when looking at the age guidelines, go by the age of clothing they wear rather than chronological age) & GP's are on the whole worse - they prescribe 5mls of the lower dose paracetamol syrup (120mg paracetamol in 5ml of syrup) for anyone from 1yr to 6yrs of age.

In A&E we weigh the children and work out the dose appropriate for them - can't understand why they don't do a dosage chart like this on the bottle - xkg = ymls of calpol (if anyone's interested it's roughly 0.8ml per kg for paracetamol and 0.5ml per kg for ibuprofen).

*would always say aim when child ill is to make them comfortable rather than lower temp - if temp high but happy and eating/drinking well then let them be.

[The Nappy Lady]

Buggie

That is so useful, I'm going to write it on a label & stick it inside my meds cabinet....thank you.

My family doc actually said same as you - too many people under dose, if child is I'll five them the maximum stated dose & also v important to use right meds for age - I.e. Buy the stronger stuff for my six year old, which I hadn't bothered to do up to that point (IIRC she was 5.5 at the time).

[crystal7]

That's interesting Buggie. I'm still giving my 10kg ish 2 year old 5mls of Calpol- is that way too little?! It seems to work (though we use it rarely- touch wood!).

[prickle]

We were recommended to alternate paracetemol and ibuprufen as in the article by A&E at St Thomas's well over 10 years ago. They told us that the recommended technique of swabbing babies with luke warm water was positively dangerous - it just cools the skin but not the core of the body.

I have used the alternating technique ever since, always starting with ibuprufen, wait a couple of hours for it to kick in and then give paracetimol. Glad to have this confirmed that its ok. Works a treat for adults too.

Incidentally, paracetemol syrop we bought in Denmark had dosage per kg instead of standard dosage so perhaps method used in europe?

[buggie]

crystal7 - could have extra 3mls (or to be precise 3.3333333mls ;-)), but if the 5mls works then grand, and if they have it at some point and after half hr or so they don't seem any better then you've got the extra 3mls in reserve.

Another trick (especially good if child is bad at taking medicine) would be to buy the 6yr+ paracetamol (250mg/kg) and reduce dose I mention above - 0.4ml rather than 0.8ml per kg. If you are using the 6yr+ for an older child it's still 0.4ml/kg.

(btw Molly - sorry being rubbish and not been in touch - things moving painfully slowly and worry I'll jinx things by getting too ahead of myself!!)

[buggie]

Prickle - have seen similar from France - was v clever in that the syringe had kg's marked off instead of mls so the parent just had to know the child's wt to give accurate dose. Really don't know why we don't have similar here, also think the continent have got it right when it comes to using suppositories... in all my career I've never had a child manage to spit one out! ;-)

[new mother]

related query if anyone knows the answer ...how does teething powder work? is it an anti-inflammatory?

[buggie]

no idea but it seems to do something good for the bugglet!! We've got the Nelson's teething powder and it contains chamomilla which I'm guessing is related to camomile tea. I know from experience that camomile tea bags can be good on insect bites/inflammed eyes to reduce the swelling. Only worry I have is the ease the bugglet takes it - she opens her mouth as soon as she sees the packet... I know being a nurse you'd expect her to take medicine well, but this is ridiculous!!