Should infants always receive acetaminophen (paracetamol) for fever?

From the Guidelines

Infants should not always receive acetaminophen (paracetamol) for fever, as it is only recommended when they appear uncomfortable or distressed. Fever itself is not harmful and is actually a natural defense mechanism that helps the body fight infection [ 1 ]. According to the 2024 American Heart Association and American Red Cross guidelines for first aid, administration of antipyretics such as acetaminophen is not effective for stopping a seizure or preventing a subsequent febrile seizure [ 1 ].

When considering the use of acetaminophen in infants, it is essential to weigh the benefits and risks. The American Academy of Pediatrics suggests that administering prophylactic acetaminophen during febrile episodes is ineffective in preventing or reducing fever and in preventing febrile-seizure recurrence [ 1 ].

Some key points to consider when deciding whether to give acetaminophen to an infant with fever include:

• For infants under 3 months with any fever, or those 3-6 months with a temperature above 39°C (102.2°F), medical advice should be sought before giving medication.
• When acetaminophen is appropriate, the correct dosage is based on the infant's weight (10-15 mg per kg of body weight), typically given every 4-6 hours, not exceeding 4 doses in 24 hours.
• Always use the measuring device provided with infant formulations and never use adult formulations for babies.
• Non-medication approaches should also be considered, such as keeping the room at a comfortable temperature, dressing the infant in light clothing, and ensuring adequate fluid intake to prevent dehydration.
• If the fever persists beyond 3 days, is accompanied by other concerning symptoms, or if the infant seems very unwell, medical attention should be sought promptly [ 1, 1 ].

From the FDA Drug Label

Directions Do not take more than directed (see overdose warning) Use the following dosage guidelines when using this product AGEDOSE ... Children under 2 years of ageConsult a doctor

• The drug label does not provide a direct recommendation for infants to always receive acetaminophen (paracetamol) for fever.
• For children under 2 years of age, it is advised to Consult a doctor. The FDA drug label does not answer the question.

From the Research

Administration of Acetaminophen to Infants

• The use of acetaminophen (paracetamol) in infants for fever management is a common practice, but its administration should be based on specific guidelines 2, 3, 4.
• According to studies, paracetamol is effective and safe for infants when used at the recommended dose of 15 mg/kg for fever and pain management 3.
• However, fever alone does not require treatment, and paracetamol should only be used when there is a combination of fever and discomfort or pain 5, 4.

Dosage and Safety Considerations

• The recommended dose of paracetamol varies between 10 and 15 mg/kg, with a maximum of four doses per day 2.
• Overdose of paracetamol can be hepatotoxic, and single ingestions of more than ten times the recommended dose are potentially toxic 2, 6.
• The use of paracetamol in newborns requires caution, and the dose should be adjusted according to gestational age 4, 6.

Alternative Treatments and Precautions

• Ibuprofen is an alternative treatment for fever and pain in infants, but its use is not recommended in certain situations, such as in children with chickenpox or dehydration 4.
• Physical methods of reducing fever are discouraged, except in cases of hyperthermia 4.
• Combined or alternating use of antipyretics is not recommended, and the dose of antipyretic should be based on the child's weight rather than age 4.