What is the recommended dose of ibuprofen (Nonsteroidal Anti-Inflammatory Drug (NSAID)) for children?

Ibuprofen Dosing for Children

The recommended dose of ibuprofen for children is 10 mg/kg every 6-8 hours (maximum 40 mg/kg/day, not to exceed 2400 mg/day), with dosing approved for infants ≥6 months of age weighing at least 5-6 kg. 1, 2

Standard Dosing by Age and Weight

For infants and children 6 months to 12 years:

• Dose: 10 mg/kg per dose 1, 3, 2
• Frequency: Every 6-8 hours 1, 2
• Maximum daily dose: 40 mg/kg/day 1, 3, 2
• Do not exceed 4 doses in 24 hours 4

For adolescents ≥12 years and adults:

• Dose: 200-400 mg per dose 3
• Maximum single dose: 600 mg 1
• Children >40 kg should use adult dosing 1

Dosing Interval Considerations

The effective dose range has been established at 7.5-10 mg/kg, with maximum temperature reduction occurring 3-4 hours after administration 3. The duration of antipyretic effect supports dosing intervals of 6-8 hours rather than every 4-6 hours 2, 4.

Age-Specific Safety Parameters

Infants 3-6 months:

• Ibuprofen is considered safe for short-term use in infants >3 months weighing >5-6 kg 2
• Special attention must be given to hydration status 2
• Dose: 5-10 mg/kg every 6-8 hours 2

Infants <3 months:

• Not recommended due to insufficient safety data 1, 2

Critical Contraindications and Precautions

Absolute contraindications:

• Dehydration, diarrhea, or vomiting - ibuprofen should never be given to dehydrated patients as this significantly increases risk of renal damage 5
• Active varicella (chickenpox) infection 5
• Persistent asthma or wheezing 5
• Known hypersensitivity to ibuprofen or other NSAIDs 5
• Neonates 5

Use with extreme caution:

• Ibuprofen should not routinely be used as an antipyretic except in rare cases - it is primarily indicated for inflammatory pain 5

Route of Administration

Oral route is preferred - the rectal route has been shown to have erratic absorption, especially in young infants, making it less reliable 2.

Comparative Efficacy

Ibuprofen has been demonstrated to be equally effective or more effective than paracetamol (acetaminophen) as an analgesic and antipyretic, with a longer duration of action 3. When both medicines are used together, they provide an additional 2.5 hours without fever over 24 hours compared to ibuprofen alone, and 4.4 hours compared to paracetamol alone 4.

Common Pitfalls to Avoid

• Never exceed 40 mg/kg/day or the maximum recommended number of doses - studies show 8-11% of parents inadvertently exceed maximum doses when using combination therapy 4
• Do not use in febrile children with signs of dehydration - this is the most critical safety consideration 5, 2
• Avoid routine use for simple fever - reserve for inflammatory pain conditions 5
• Ensure adequate hydration before and during treatment 2
• Carefully record all dose times when using multiple antipyretics to prevent accidental overdosing 4

Pharmacokinetic Profile

• Time to peak concentration (Tmax): 1.1-1.2 hours 6
• Elimination half-life: 1.6 hours 6
• Oral clearance: 1.2-1.4 mL/min/kg 6
• Pharmacokinetics are linear over the 5-10 mg/kg dose range and are not significantly affected by age in children 3-10 years 3, 6