What is the recommended dosage of acetaminophen (paracetamol) or ibuprofen for a 5-year-old child with fever, considering their weight and potential underlying medical conditions such as asthma or respiratory issues?

Antipyretic Dosing for a 5-Year-Old Child with Fever

For a 5-year-old child with fever, use acetaminophen 10-15 mg/kg every 4-6 hours (maximum 5 doses per 24 hours) as first-line therapy, or ibuprofen 5-10 mg/kg every 6-8 hours as an equally effective alternative with superior antipyretic efficacy. 1, 2

First-Line Medication Selection

Acetaminophen (Paracetamol)

• Dosing: 10-15 mg/kg per dose, administered every 4-6 hours 1, 2, 3
• Maximum: Not to exceed 5 doses in 24 hours 1
• Safety profile: Preferred first-line agent due to relative safety and effectiveness 1
• Administration: Can be given with or without food, though food may improve gastrointestinal tolerance 1

Ibuprofen

• Dosing: 5-10 mg/kg per dose, administered every 6-8 hours 1, 4, 5
• Advantages: Less frequent dosing required compared to acetaminophen, longer duration of action 6
• Efficacy: More effective as an antipyretic than acetaminophen at 2,4, and 6 hours post-treatment 4, 5
• Comparable safety: Similar safety profile to acetaminophen when used appropriately 2, 4

Special Considerations for Asthma/Respiratory Issues

Ibuprofen Use in Asthma

• Ibuprofen can be used safely in most children with asthma when following standard contraindications 7
• Caution advised: Monitor for any respiratory symptoms, though ibuprofen is generally well-tolerated for short-term fever treatment 7
• Recent associations between paracetamol use and asthma frequency/severity require additional investigation 6

Contraindications for Ibuprofen

• Avoid in: Children older than 60 years or with compromised fluid status or renal insufficiency 1
• Risk factors: Respiratory failure, metabolic acidosis, and renal failure can occur in overdose or presence of risk factors 1

Critical Safety Messages

What NOT to Do

• Never use aspirin in children under 16-18 years due to Reye's syndrome risk 1, 8
• Do not routinely alternate acetaminophen and ibuprofen—use single-agent therapy 8, 2
• Avoid combination therapy due to increased risk of dosing errors and toxicity 1

Important Caveats

• Antipyretics do not prevent febrile seizures or reduce their recurrence risk 1, 8, 2
• The primary goal is improving the child's overall comfort, not normalizing body temperature 1, 2
• Fever itself is a beneficial physiologic mechanism and does not worsen illness course or cause long-term neurologic complications 2

Monitoring and Follow-Up

Expected Response

• Clinical improvement should occur within 48-72 hours 1
• If no improvement or condition worsens, further investigation is warranted 1

Hydration and Supportive Care

• Encourage adequate fluid intake as crucial for the child's well-being 1
• Monitor for signs of dehydration, particularly if fever persists 9

When to Reassess

• Observe for signs of serious illness beyond fever 2
• Monitor activity level and overall well-being 2

Practical Dosing Guidance

Weight-Based Calculation

For a typical 5-year-old (approximately 18-20 kg):

• Acetaminophen: 180-300 mg per dose every 4-6 hours 1, 3
• Ibuprofen: 90-200 mg per dose every 6-8 hours 4, 5

Safety Storage

• Emphasize safe storage of antipyretics to prevent accidental poisoning 1
• Parents should use measuring devices provided with medications to ensure accurate dosing 2