Dosing of Panadol and Ibuprofen for a 3-Year-Old with Ulnar Fracture
For a 3-year-old girl weighing 14.3 kg with an ulnar fracture, the recommended doses are: Panadol (acetaminophen) 215 mg (15 mg/kg) every 4-6 hours as needed, and ibuprofen 143 mg (10 mg/kg) every 6-8 hours as needed.
Medication Dosing Details
Acetaminophen (Panadol)
- Dose calculation: 15 mg/kg × 14.3 kg = 214.5 mg (round to 215 mg)
- Frequency: Every 4-6 hours as needed
- Maximum daily dose: Not to exceed 60 mg/kg/day (858 mg/day)
- Administration: Oral liquid formulation preferred for accurate dosing
Ibuprofen
- Dose calculation: 10 mg/kg × 14.3 kg = 143 mg
- Frequency: Every 6-8 hours as needed
- Maximum daily dose: Not to exceed 40 mg/kg/day (572 mg/day)
- Administration: Oral liquid formulation preferred for accurate dosing
Pain Management Strategy
First-Line Approach
- Ibuprofen is preferred as the primary analgesic for fracture pain based on research showing superior efficacy compared to acetaminophen for musculoskeletal injuries 1, 2
- Studies demonstrate that ibuprofen provides better analgesia and functional outcomes with fewer side effects than acetaminophen with codeine for pediatric fractures 2
Alternating or Combined Therapy
- For moderate to severe pain, alternating acetaminophen and ibuprofen can provide more consistent pain relief
- Allow at least 2-3 hours between different medications when alternating
- Document clearly which medication was given at what time to avoid dosing errors
Important Considerations
Monitoring
- Assess pain regularly using age-appropriate pain scales
- Monitor for side effects, particularly gastrointestinal symptoms with ibuprofen
- Ensure adequate hydration during treatment
Safety Precautions
- Use calibrated medication syrup or suspension for accurate dosing
- Avoid adult formulations or "eyeballing" doses without proper measurement tools
- Limit treatment duration and consult healthcare provider if pain persists beyond expected recovery period
When to Seek Additional Medical Attention
- If pain is not adequately controlled with prescribed medications
- If the child develops fever, increased swelling, or changes in skin color around the fracture site
- If any adverse effects from medications occur (vomiting, abdominal pain, rash)
Evidence Summary
Research shows that ibuprofen provides superior analgesia compared to acetaminophen for acute musculoskeletal injuries in children 1. A randomized controlled trial demonstrated that ibuprofen resulted in significantly greater improvement in pain scores compared to acetaminophen and codeine for children with musculoskeletal trauma 1. Additionally, children receiving ibuprofen had better functional outcomes and fewer adverse effects than those receiving acetaminophen with codeine 2.
While one study found no significant difference between ibuprofen and paracetamol for outpatient pediatric fracture pain 3, the weight of evidence suggests ibuprofen is at least as effective as acetaminophen, with potentially better functional outcomes and fewer side effects.