Paracetamol and ibuprofen for babies: doses, timing and what is safe
Having the right medicine ready and knowing exactly how to use it is one of those things that genuinely matters at 2am when your baby is miserable. Here is everything you need to know about paracetamol and ibuprofen for infants, based on NHS, WHO and MHRA guidance.
What each medicine does
Both paracetamol and ibuprofen lower fever and relieve pain. Ibuprofen also has an anti-inflammatory effect that paracetamol does not, which makes it particularly useful for things like ear pain or teething inflammation. Neither is "stronger" than the other in a general sense. They work through different mechanisms, which is why they can sometimes be used at different times.
Age and weight rules before you give anything
Paracetamol can be given to babies from 2 months of age, but only if your baby weighs more than 4 kg and was not born more than 2 weeks premature. If your baby is younger than 2 months and you think they need pain relief, call your GP or 111 rather than giving medicine on your own.
Ibuprofen infant suspension is licensed from 3 months of age, and only for babies who weigh more than 5 kg. It is not suitable for younger or lighter babies. If your baby is between 2 and 3 months, paracetamol is the only option.
Dose is by weight, not age
This is the most important thing to get right. The age bands printed on packaging are guides only. The dose that matters is the one calculated from your baby's current weight.
For paracetamol, the standard dose is 15 mg per kg of body weight. For a 6 kg baby, that is 90 mg. Most infant paracetamol suspension contains 120 mg per 5 ml, so a 6 kg baby would need 3.75 ml. The packaging will include a weight-based dosing table. Use that table, not an online calculator or advice from another parent.
For ibuprofen, the dose is 5 to 10 mg per kg of body weight. The packaging table will give you the correct volume for your baby's weight. The lower end (5 mg/kg) is appropriate for pain or mild fever; the higher end (10 mg/kg) may be needed for a higher fever, but only within the limits on the packaging.
How often can you give each medicine?
Paracetamol: every 4 to 6 hours, with a maximum of 4 doses in any 24-hour period. Leave at least 4 hours between doses. Never give a fifth dose.
Ibuprofen: every 6 to 8 hours, with a maximum of 3 doses in 24 hours. Always give with or after food or milk to protect your baby's stomach.
Alternating paracetamol and ibuprofen
You may have heard that you can alternate the two medicines to keep fever or pain controlled for longer. The NHS advises that you should only do this if a healthcare professional specifically tells you to. It is not a routine approach. The main risk is losing track of which medicine was given when and accidentally overdosing on one of them. If your baby's fever is not controlled on one medicine at the correct dose and frequency, that is a reason to call your GP or 111, not to start alternating on your own.
When you must not give ibuprofen
There are two situations where ibuprofen is clearly off limits:
Chickenpox: Do not give ibuprofen to a child who has chickenpox. The MHRA and NHS both advise against it because ibuprofen during chickenpox has been linked to serious secondary skin infections, including necrotising fasciitis (a severe, rapidly spreading skin infection). Use paracetamol instead for the duration of the illness.
Dehydration or vomiting: Ibuprofen is processed by the kidneys and can cause problems if your baby is not taking enough fluid. If your baby is vomiting repeatedly, has not had a wet nappy for several hours, or you are worried about dehydration, use paracetamol and focus on encouraging fluids. Call your GP or 111 if you are concerned.
Aspirin should never be given to anyone under 16 years old, without exception.
How to measure accurately
Always use the oral syringe that comes with the medicine. A household teaspoon or a kitchen measuring spoon holds an inconsistent volume and is not safe for measuring medicine. Draw the liquid up slowly to the marked line, hold the syringe horizontally at eye level to check the line, then dispense the medicine gently into the side of your baby's cheek, not the back of the throat. Give it slowly so your baby can swallow comfortably.
If you have lost the syringe, ask your pharmacist for a replacement. They will give you one for free.
When medicine is not the right answer
A fever is your baby's immune system working. The NHS says you do not need to treat a fever just because it exists. If your baby has a temperature of 38 to 39 degrees Celsius and is feeding normally, interested in their surroundings, and not clearly distressed, you do not need to give medicine. Lightly dressed, in a cool room with plenty of fluids is often enough.
Medicine is for your baby's comfort, not for the number on the thermometer. A baby with a 38.5 degree temperature who is miserable and crying benefits from pain relief. A baby with a 39 degree temperature who is drinking, smiling and looking around probably does not need medicine right now.
Frequently asked questions
Can I alternate paracetamol and ibuprofen for my baby?
The NHS says only do this if a healthcare professional advises you to. It is not routine practice, and the main risk is losing track of doses. If one medicine is not controlling your baby's fever or discomfort, call your GP or 111.
What is the right dose of paracetamol for my baby?
The dose is based on your baby's weight, not their age. The standard amount is 15 mg per kg of body weight, given every 4 to 6 hours, with no more than 4 doses in 24 hours. Check the weight-based table on the packaging for the exact volume to give.
Why can't I give ibuprofen with chickenpox?
Ibuprofen during chickenpox has been linked to serious secondary skin infections. Both the NHS and the MHRA advise strongly against it. Use paracetamol for pain and fever relief throughout the chickenpox illness.
From what age can I give ibuprofen?
Ibuprofen infant suspension can be given from 3 months of age if your baby weighs more than 5 kg. Paracetamol is appropriate from 2 months if your baby weighs more than 4 kg and was not born significantly premature.
How do I measure liquid paracetamol accurately?
Use only the oral syringe included with the medicine. A household teaspoon is not accurate enough. Draw the liquid to the correct line, check it at eye level, and give it slowly into the side of your baby's cheek. Ask a pharmacist for a free replacement syringe if you have lost yours.
Is it safe to give paracetamol every day during teething?
The NHS does not recommend daily paracetamol for teething. Cold teething rings, gentle gum massage, and sugar-free teething gel (for babies over 5 months) are the first steps. Use paracetamol on days when your baby is clearly distressed and not settling with other measures.
Keep track of every dose, every time
Cubby lets you log medicines with dose and time so you always know exactly what was given and when, even at 3am.
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