What is the recommended dose of ibuprofen (nonsteroidal anti-inflammatory drug) for a 20-pound infant?

Ibuprofen Dosing for a 20-Pound Infant

For a 20-pound (approximately 9 kg) infant, the recommended dose of ibuprofen is 90 mg (10 mg/kg) every 8 hours as needed, but ibuprofen is not recommended for infants under 6 months of age. 1, 2

Age Considerations and Safety

• Ibuprofen is generally not recommended for infants under 6 months of age due to limited safety data and higher risk of adverse effects 2
• For infants older than 6 months weighing 20 pounds:
  • Dosage: 10 mg/kg per dose = approximately 90 mg per dose
  • Frequency: Every 8 hours (maximum of 3 doses in 24 hours)
  • Maximum daily dose: 30-40 mg/kg/day 1, 3

Dosing Calculation

The European Society for Paediatric Anaesthesiology (ESPA) recommends:

• Oral ibuprofen: 10 mg/kg every 8 hours 1
• For a 9 kg (20-pound) infant: 9 kg × 10 mg/kg = 90 mg per dose

Alternative Options for Infants Under 6 Months

If the infant is under 6 months of age, acetaminophen (paracetamol) is the preferred medication:

• Recommended dose: 10-15 mg/kg every 6 hours 1
• For a 9 kg infant: 90-135 mg per dose
• Maximum daily dose: 60 mg/kg/day 1

Administration Considerations

• Oral formulations are preferred for outpatient management
• Ensure accurate dosing using weight-based calculations rather than age-based estimates
• Use appropriate measuring devices (not household spoons) to avoid dosing errors
• Administer with food to minimize gastrointestinal irritation

Precautions and Contraindications

• Do not administer ibuprofen to infants who:
  • Are dehydrated or have diarrhea/vomiting 4
  • Have known sensitivity to NSAIDs
  • Have bleeding disorders or are on anticoagulant therapy
  • Have kidney disease or impaired renal function
  • Have asthma with sensitivity to aspirin or other NSAIDs 4

Monitoring

• Monitor for signs of gastrointestinal distress (vomiting, abdominal pain)
• Watch for signs of allergic reactions (rash, swelling)
• Discontinue if any adverse effects occur
• Do not exceed the recommended maximum daily dose to avoid renal and other complications

Common Pitfalls to Avoid

1. Using adult formulations or concentrations for infants
2. Confusing dosing between different medications (ibuprofen vs. acetaminophen)
3. Exceeding the maximum recommended daily dose (studies show this occurs in 11% of children) 5
4. Using ibuprofen for fever management in dehydrated infants
5. Administering ibuprofen to infants under 6 months without medical supervision

Remember that ibuprofen should be used primarily for pain management rather than just fever reduction in infants, as the risks may outweigh benefits when used solely as an antipyretic in very young children.