medical mondays: tylenol vs. motrin

We'll take a different approach this week. Instead of a topic full of symptoms and treatments, I'll cover a conversation I have with parents a lot.

And if you don't mind, go ahead and read this first.

. . . .

At the office

Throughout this post, I'll refer to acetaminophen as Tylenol and ibuprofen as Motrin. It's easier to type Tylenol and Motrin, but their generic forms can be substituted without any problem. Here are the most common questions I get asked by parents.

- Which is better, Tylenol or Motrin? It's not really possible to determine which is better, per se. Both have pros and cons. One study I read suggested that Motrin might edge out Tylenol in getting a high fever to come down. Motrin is supposed to last about 6 hours, while Tylenol has a shorter duration and can be given every 4 hours.

- Can I alternate Tylenol and Motrin if my baby has a high fever? This approach to fever reducing used to be commonly advised. Basically, the idea was to give medicine every 3 hours, alternating the Tylenol with the Motrin, so that each type of medicine has 6 hours between doses. But now we know that this much medicine is too hard on a kid's organs to be recommended. Even though you are spacing each medicine 6 hours apart (which would seem ok since Tylenol can be given every 4 hours), both require processing by the same organs, which may have a hard time handling that much medicine. It's best to give medicine no more often than every 4 hours, and try other methods for reducing fever if needed (I'm not going to cover those now, but I'll probably do a "Fever" post at some point in the future). I'll talk about this a bit more in the "At the Buck house" section...

- Am I giving my baby too much medicine? If you are dosing the medicine correctly, and maintaining appropriate times between doses, it shouldn't be a problem. Most Pediatric offices have dosing charts to give you that are really handy to have around. I tell parents that if they are having to give fever reducer around the clock for several days in a row, it's probably best to bring the kiddo in so that we can make sure something more serious isn't going on. Most of the time it's nothing, but best to check it out. There's also a lot to be said for not giving in to "fever phobia" (I really need to do a fever post).

- What is the deal with infant's vs. children's concentrations? I did not grasp the importance of this question until I had a kid of my own. In the "Infant's" kind, the manufacturers put more medicine into a smaller amount of liquid (that's why it's called Infant's Concentrated Drops) so that you don't have to shovel a whole teaspoonful (or more) of medicine into a little baby. The "Children's" kind is supposedly the regular concentration, and it has less than half the medicine in the same volume of liquid as compared to the Infant's.

HOWEVER: The Infant's Concentrated Drops are no longer being manufactured, because several instances of confusion between the types of medicine resulted in babies being overdosed. You can read more about it here. This removal of the Infant's Drops is also something that didn't matter to me until I had a baby. It is HARD to get a baby to take the full dose of medicine if it is in the Children's concentration. You can still buy the Infant's Concentrated Drops if you can find them--they just aren't making any more of it. Seriously you should go buy some if you can. We bought like 3 boxes on Amazon once we tried to give Jonathan a whole 1/2 teaspoon of the sticky-syrupy Children's kind and had no success.

Sorry for the bad quality. Thanks tylenol.com
So this is an "Infant" product, but it is not in the Infant's Concentrated form. Make sure you check which kind you have and double check your dosing chart to make sure it's for the right concentration. 

- At what age can I give my baby Tylenol or Motrin? Tylenol can really be given at any age, but if your kiddo has a fever and is younger than 8 weeks, she should be checked out by her pediatrician first. Motrin isn't recommended until 6 months. There you have it. I wish I could snazzy-up this answer, but I can't think of any funny things to say.

- Should I have given my baby Tylenol/Motrin before his shots? A study came out fairly recently that suggested that a baby's response to vaccinations is actually a bit less effective if fever reducer was given before the vaccines were administered. The study didn't conclude that this definitely happened in all cases, but it was enough for me to start telling my patients not to give anything for fever unless the baby actually develops a fever.

- Can my kid take Tylenol/Motrin with food, drink, other medicines, etc? The answer in general is yes. Motrin especially can upset a tummy if taken on an empty stomach (it sure does with mine!), so I usually recommend taking it with food or water. As far as other medicines, giving Tylenol/Motrin concurrently shouldn't be a problem, but you should make sure the other medicine doesn't already contain a fever reducer. A lot of cold medicines contain acetaminophen, so you don't want to give additional Tylenol or Motrin on top of that.

- Does Tylenol cause asthma? Ok, I am lying a little. No parent has every asked this question. But this was the reason I wanted to write this post in the first place--this link between Tylenol and asthma has been in the news lately after an article was recently published in the journal Pediatrics. The studies suggested that there could indeed be a link between the two. Whenever a new study like this is popularized, people (aka local news anchors) go crazy drawing assumed conclusions and getting everyone scared. Usually, though, further studies are needed to determine if there really is a cause-and-effect relationship, and if so, how strong that relationship is.

- Can I give my kid aspirin? No. The answer is No. Unless you use the word "aspirin" to refer to any kind of pain or fever reducer (in which case that is very annoying to your pediatrician because we all freak out when you talk about giving aspirin to a kid). Aspirin is different from acetaminophen or ibuprofen, and can cause problems in sick kids. Don't give them aspirin.

In the textbook

Well, if you are doing research in a textbook about Tylenol and Motrin, you will find a lot of pictures like this:

ibuprofen

And unless you are my husband or my mother, you don't care about pictures like that. So I'll be brief with this section because looking at pictures like that is known to induce drowsiness.

What you also might find in a textbook search of these two medicines is a description of how they work. The most notable take-away from this kind of description might be that Motrin would affect some of our body's inflammation factors, making it useful as an anti-inflammatory drug. Inflammation is just the fancy medical word for a spot of injury or pain. Tylenol doesn't affect inflammatory pathways much, but Motrin is great if you have a sprained knee, or menstrual cramps. Or if your baby is teething. Or has an inflamed ear (aka ear infection).

At the Buck house

Here at home we find ourselves giving Jonathan Tylenol more often than Motrin. I have this idea in my head that Motrin upsets his tummy since my own tummy is sometimes sensitive to it. Maybe that's true, maybe not. Also, we bought all that Infant's Tylenol on Amazon, so we gotta use it up.

This is how we determine which medicine to give Jonathan
(note: Advil = Motrin)

I guess he prefers Tylenol. Sorry Advil.

Don't try this at home.

Indecisive like his mommy.

I think Jonathan had a slight fever after his four month shots, but other than that, we have only found the need for medicine because of teething pain. I haven't seen much difference in Tylenol vs. Motrin in terms of its effectiveness for him. For a while there I think we were assuming he was teething when he actually wasn't. So we were giving him medicine for a few days when he didn't really need it, which we try to be more careful about now. I think we err on the other side nowadays--only giving him something if we can REALLY tell he is uncomfortable.

So, will I continue to give my kid Tylenol after reading the asthma study? Shoot, I don't know. Probably. This is where research kind of annoys me. It's just too much for my mama-brain to think about. No one in our family has asthma, so hopefully Jonathan's risk is already low. And we try to be sparing about how many times we give him medicine. I will probably consider using Motrin now more than I had previously, but that definitely doesn't mean I will cut out Tylenol all together. I'll keep looking out for more studies that can point me more clearly in one direction or the other. Oh and you KNOW I will fill you in on the details if I find more info!

Some more thoughts on the alternating schedule: I definitely do not think it's a practice that should be implemented regularly. And I will continue to advise against it when talking to patients. I think too much medicine is, well... too much. I will say though, that we have been lucky that Jonathan has not had a really high fever yet. So I haven't been faced with the miserable baby at 3am with 103 temp who is only 3 hours into his Tylenol dose. To be honest, in that situation, I might offer him a dose of Motrin. I want to be real here. Do I think it's the best idea? No. But in the real-life situation will it be the option I choose? Maybe so. Sometimes when I do these posts I worry that I will just sound all advice-y and scary, and that is never my intention. I want to warn against alternating Tylenol and Motrin for your not-too-high, no big deal fever. But if you (or I) give an extra dose once or twice in our kid's life, that is okay.

. . . .

Hope you learned something! Next week I think we'll cover sore throats to round out our sick season topics. Thanks for reading and happy Monday!