Ibuprofen in Children
Dec 24, 2014
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
I've got something to confess. It will put me on par with people who kick puppies and those who pick their teeth with garden implements in public. My confession makes me a horrible person. I really don't like kids Christmas concerts. I know the kids work really hard to learn their parts. I know the teachers work even harder to get everything ready. It seems to me several times over the years I have filled antibiotics for the Christmas concert musical director the day after the big event. So the teachers are working themselves to sickness if not quite to death. I know some adults look forward to Christmas concerts every year. I know for some it isn't really Christmas until they've seen children dancing and singing. I guess I'm just closer to Bad Santa than I am to Miracle on 34th Street. I'm more Grinch than Jimmy Stewart. I have to admit the concerts have gotten better as my kids have gotten older. This year's Grade 7 Concert band event was mercifully short and relatively entertaining. Barker's Christmas concert was well planned, executed and less than an hour long. That could be the shortest Christmas concert I've ever been to, and I am thankful. I truly am. But I remember when my daughter was in Kindergarten and Grade 1. My wife was smart enough to go to the afternoon show. I had to single parent toddler Eric through 2 hours of skits and songs. Three year old Eric didn't like sitting still for 2 hours for anything, let alone to hear his sister sing a little song. And when your oldest kid is in Kindergarten and Grade 1, you don't know any of the older kids. So you see your kid do their thing for 2 songs, at the beginning, and then watch other kids you don't know for the next hour and 45 minutes. I wasn't as smart as other parents who got baby sitters for their toddlers. I also wasn't as brave as other fathers who told me they just left the concert after their kids sang.
Another time you have to be brave as a parent is when your child breaks a bone and you have to take them to the emergency room. Pain control for children in the ER is changing. Giving codeine to children for pain has fallen out of favour. Codeine has to be broken down into morphine in the body to work. However, some children break down codeine really slowly and don't get any pain relief. Even more scary is that some children break down codeine very quickly and can get a morphine overdose. So lately morphine and ibuprofen have been the pain killers of choice in the emergency room for children.
There was an interesting study published in The Canadian Medical Association Journal (CMAJ) in October 2014. Naveen Poonai et al. looked at 134 children aged 5 to 17 who showed up at an emergency room with a broken leg or arm that didn't require surgery. Half the kids were randomly assigned to receive 10 mg/kg of ibuprofen every 6 hours as needed for 24 hours. The other half were given 0.5 mg/kg of morphine every 6 hours as needed for 24 hours. Both groups were allowed acetaminophen if needed for breakthrough pain. The pain control was the same in both groups, but the morphine group had more side effects.
This obviously wasn't a very large study, but it was interesting for a few reasons. First it was done in children. Most studies intentionally exclude children and then we have to assume the results apply to children as if they were just small adults. This doesn't always hold, so it was nice to see the study actually done in children. The next interesting thing is the study was down with the children at home. They were followed for 24 hours after they left the hospital. Again it is nice to see what actually happened in real children's homes.
Ibuprofen is an NSAID. That means non-steroidal antiinflammatory drug. It is good for pain, fever and inflammation. It is better at treating pain due to injury like a pulled muscle or broken bone than acetaminophen because acetaminophen only treats pain and ibuprofen treats pain and inflammation. In an injury, there is usually inflammation. The downside is ibuprofen is harder on the stomach than acetaminophen. The good news from this small study in the CMAJ is that over the counter ibuprofen is an excellent pain killer for children. In fact it is on par with morphine. Seeing your child in pain is tough. But knowing you have a very effective pain killer available in any pharmacy can make you and your child feel better.
I am shamefully jealous of the fathers who were courageous enough to leave with their kids after their songs were done at the Christmas concert. I've also had several conversations with fathers of older children who quietly tell me that although the miss many things about having young children, Christmas Concerts aren't one of them. But before I get myself and any more fathers out there in trouble, there are fathers who don't deserve a lump of coal. Legend has it that during this year's Christmas Concert in Winnipegosis a super dad appeared. During the final song when all the children from Grades 1 to 8 were on stage singing, one child was obviously not feeling well. Suddenly, the legend goes, super dad raced through the crowd, plucked up his charge with his magical fire/rescue jacket and vanished with the sick child before anything unfortunate could happen on stage. This Super Dad kinda redeems the anti-Christmas concert fathers like me a little by association. So from this Grinch-like father to you and your family, Merry Christmas and Happy New Year!
As always if you have any questions or concerns about these or other products, ask your pharmacist.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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Oral Morphine Vs. Oral Ibuprofen in Children in CMAJ -www.cmaj.ca/content/early/2014/10/27/cmaj.140907