Medicine Dosing Recommendations
Below are dosing recommendations for several common over-the-counter products. All doses in pediatrics are determined by weight, not age. Remember to check the label for the type of medicine you are giving, as well as the dosage. If you have any questions about dosage, please call your pediatrician during office hours. Make sure you do not mix medicines containing the same active ingredient (Tylenol and Feverall, for example), and do not give fever medicines to infants younger than 2 months old, unless they have just received vaccinations.
Any fever greater than 100.4 degrees in an infant younger than 2 months should be considered an emergency, and your child must be seen in the emergency department immediately.
Motrin and Tylenol
Both Motrin and Tylenol are safe and effective fever medicines. In most cases the Motrin will kick in more quickly and last longer (6 hours for Motrin vs. 4 hours for Tylenol), but if your child isn’t eating well, the Tylenol is gentler on the stomach. Either medication will usually bring down the fever within an hour. If the fever is down partially but still over 101 degrees, you can give the fever medicine that you didn’t originally give because Tylenol and Motrin are metabolized by different organs in the body (the liver for Tylenol, the kidneys for Motrin). You just can’t give the Tylenol sooner than every 4 hours, and you can’t give the Motrin sooner than every 6 hours. All liquid Tylenol medicines are now the same strengths (they used to be different). Motrin still exists in different forms – Infant Motrin is different from Children’s Motrin. I don’t advise giving any medication preventatively – only if there is a fever at that moment.
Remember that fever medicines are only meant to temporarily ward off fever, and won’t eliminate the causative factor: the infection (bacterial or viral) that originally brought on the fever. So don’t get frustrated if the fever returns as the medicine wears off. The real question is what is causing the fever, and that often requires an exam by a pediatrician. No fever (except in a newborn younger than 2 months old) is an emergency in itself, so bring down the fever first, and then reassess. Read more about fevers here.
If your child spits up the medicine within five minutes of taking it, it is best to re-administer the entire dose. If she spits up after 10 minutes, it is not necessary to repeat the dose.
You should always have your child checked if you don’t know what the source of the fever is, especially if it is a young child. If your pediatrician has examined your child, it is safe to give fever medicines for up to 5 days. No normal fever lasts more than 5 days, and if your child’s condition changes or deteriorates, you should schedule another exam immediately. Sometimes bacteria can come on top of a virus, called a secondary infection, and this would change the management, perhaps calling for antibiotics. It is safe to give fever medicines with other medicines, including antibiotics, when needed. If your child still has a fever 48 hours after starting antibiotics, he should be re-examined.
Acetaminophen/Tylenol
Acetaminophen is the generic term for Tylenol, and all brands containing this active ingredient are available without a prescription. Children older than 2 months of age can be given any of the liquid acetaminophen products; they all have the same dosages now. Give the correct dosage for your child's weight as needed, but no more than every 4 to 6 hours.
Suppositories are an option if your child is vomiting too much to tolerate oral medication. Any child who can swallow a pill and is over 50 pounds can take a 325 mg tablet, even though it is labeled as “adult” Tylenol. Children over 100 pounds can take two adult pills; they can also take 4 teaspoons (20 ml) of the liquid instead, which is the same dose.
Give Tylenol every 4 to 6 hours, as needed, and not more than 6 times in 24 hours unless directed by a healthcare professional.
Ibuprofen/Motrin
Ibuprofen is the generic term for Advil and Motrin, and all brands are available without a prescription. Give the correct dosage for your child’s weight every 6 to 8 hours. I recommend giving children’s Motrin only after 6 months of age; the infant version is different from the children’s version – it is actually more concentrated, which allows you to give less of it (since infants are more prone to spitting up). I like using the infant version in general, as it is less volume, but the children’s version comes in a larger bottle and is a bit cheaper.
Any child weighing more than 44 pounds can take one 200 mg “adult” pill, and anyone weighing more than 88 pounds can take 400 mg, which is two adult pills.
Give Motrin every 6 to 8 hours, as needed, and not more than 4 times in 24 hours unless directed by a healthcare professional.
Diphenhydramine/Benadryl
Diphenhydramine is the generic term for Benedryl, and all brands are available in liquid form without a prescription to use for hives and itching with certain rashes. It can be given every 6 hours as needed. If your child is experiencing difficulty breathing, wheezing, tongue swelling, lip tingling, vomiting, or other signs of a serious allergic reaction, you should go to the emergency department immediately. It is safe to use Benadryl even with a baby – in the correct dose – but you should confirm with your pediatrician that this is the right medicine to use for your situation. All liquid Benadryl medicines are the same strength; some are labeled children’s/pediatric, but all the liquid formulations are the same 12.5mg / 5ml strength.
Benadryl comes in many forms: liquid, chewables, quick-dissolve strips, tablets/capsules. There is even a topical (on the skin) application, but the absorption can be unreliable. When comparing the different forms of Benadryl, remember that it is the total milligrams per dose that is the important value.
Benadryl can make some kids drowsy, so you might want to consider giving a slightly lower dose during the day. Zyrtec, Allegra and Claritin are also allergy medicines, but they work more slowly throughout the day.
Give every 6 hours, as needed, and not more than four times in 24 hours unless directed by a health care professional.
* Babies 12-20 pounds can use Benadryl if advised by a doctor. The dose is 2.5 ml (1/2 teaspoon)
Claritin and Zyrtec
These are safe, over-the-counter medicines for allergies. Children 6 months to 2 years should take 2.5 ml, and children 2 years to 6 years should take 5 mg or 5 ml. Children over 6 years old can officially take 10 mg (2 teaspoons), but I don’t recommend giving the full 10 mg until a child is at least 10 years old, so just give 7.5 ml until then. Read more about allergies here.
Cough and Cold Medicines
The FDA and pediatricians do not recommend the use of decongestants or cough suppressants in children under 6 years old. It is unclear as to whether these products have any benefit at all, and recent studies show that there may be significant side effects. If you choose to use these products in older children, please visit the manufacture’s websites for dosing information and for more information on their products. Some common brands of decongestants or cough suppressants include Pediacare, Triaminic, Dimetapp, Robitussin and Sudafed.