What over-the-counter (OTC) medications can be given to a child for fever, pain, and allergic reactions?

Over-the-Counter Medications for Children with Fever, Pain, and Allergic Reactions

For fever and pain in children, acetaminophen and ibuprofen are the recommended first-line over-the-counter medications, while diphenhydramine is appropriate for mild allergic reactions, with epinephrine auto-injectors being essential for severe allergic reactions or anaphylaxis. 1, 2, 3

Fever and Pain Management

Acetaminophen (Paracetamol)

• First-line choice for both fever and pain in children 1
• Recommended dosing: 10-15 mg/kg every 4-6 hours 4
• Maximum daily dose: 60 mg/kg/day, not to exceed 5 doses in 24 hours 1
• Available in various formulations including liquid, chewable tablets, and suppositories 1
• Primary purpose: Pain reliever/fever reducer 5

Ibuprofen

• Effective alternative to acetaminophen for fever and pain 2
• Recommended dosing: 4-10 mg/kg every 6-8 hours 6
• More effective than acetaminophen at reducing fever at 2,4, and 6 hours post-treatment 6
• Not recommended for infants younger than 6 months 7
• Should not be given to children who are dehydrated or vomiting 7

Important Considerations for Fever Management

• The primary goal should be improving the child's overall comfort rather than normalizing body temperature 7
• Focus on monitoring activity, observing for signs of serious illness, and encouraging appropriate fluid intake 7
• Both acetaminophen and ibuprofen have similar safety profiles when used appropriately 2
• Avoid alternating or combining medications unless specifically recommended by a healthcare provider, as this may increase risk of dosing errors 7

Allergic Reaction Management

For Mild to Moderate Allergic Reactions

• Diphenhydramine (Benadryl) - first-generation antihistamine 8
  • Recommended for hives, itching, and other mild allergic symptoms 9
  • Dosing: 1-2 mg/kg or 25-50 mg per dose (depending on age) 9
  • May cause drowsiness as a side effect 10

For Second-Generation Antihistamines

• Loratadine - non-sedating antihistamine option 10
  • Adults and children ≥6 years: 10 mg once daily 10
  • Children 2-5 years: 5 mg once daily 10
  • Causes minimal sedation at recommended doses 10

For Severe Allergic Reactions/Anaphylaxis

• Epinephrine auto-injector is the critical first-line treatment 3
  • For children weighing 10-25 kg: 0.15 mg auto-injector 3
  • For children weighing ≥25 kg: 0.3 mg auto-injector 3
  • Should be administered in the mid-outer thigh as soon as anaphylaxis is recognized 3
  • After administration, call emergency services immediately 3

Important Cautions and Considerations

• Never give aspirin to children or teenagers with fever due to risk of Reye's syndrome 1
• Store all medications safely out of children's reach 7
• Use proper measuring devices for liquid medications to ensure accurate dosing 7
• For children under 4 years, do not use over-the-counter cold medications without consulting a healthcare provider first 9
• In cases of overdose, acetaminophen can be hepatotoxic - single ingestions of more than ten times the recommended dose are potentially toxic 1
• For anaphylaxis, never substitute antihistamines for epinephrine, as delayed epinephrine administration is associated with poor outcomes 3

When to Seek Medical Attention

• Fever in infants younger than 3 months 7
• Fever lasting more than 3 days 7
• Signs of respiratory distress, altered mental status, or severe pain 3
• Any signs of anaphylaxis (difficulty breathing, swelling of face/throat, dizziness, widespread hives) 3
• Symptoms that worsen despite appropriate over-the-counter treatment 7