What is the appropriate ibuprofen (Advil) dosing for children ≥6 months old based on weight, including dose per kilogram, dosing interval, maximum daily amount, contraindications, and alternative medication?

Pediatric Ibuprofen (Advil) Dosing

For children ≥6 months old, administer ibuprofen at 10 mg/kg per dose every 6-8 hours, with a maximum daily dose of 40 mg/kg/day (not exceeding 30-40 mg/kg/day depending on frequency), and never use in dehydrated children or those with vomiting/diarrhea. 1, 2

Weight-Based Dosing

• Standard dose: 10 mg/kg per dose, administered every 6-8 hours 1
• Dose range: 5-10 mg/kg per dose is acceptable, with clinical trials showing 7.5-10 mg/kg as the effective range 2, 3
• Maximum frequency: 3-4 times daily 2
• Maximum daily dose: 30-40 mg/kg/day total 2

Age and Weight Restrictions

• Minimum age: 6 months 1, 2
• Minimum weight: Body weight must be above 5-6 kg 2
• Children >40 kg: Use adult dosing 1

Critical Age Consideration

• Ibuprofen is not recommended for infants under 6 months of age 1
• For infants 3-6 months, short-term use may be considered safe only if weight >5-6 kg and with special attention to hydration, though this is off-label 2

Dosing Interval and Timing

• Standard interval: Every 6-8 hours 1, 2
• Peak effect: Maximum temperature reduction occurs 3-4 hours after administration 3
• Duration of action: Longer than acetaminophen, allowing less frequent dosing 3

Absolute Contraindications

• Dehydration: Never administer to dehydrated patients 4
• Vomiting and diarrhea: Contraindicated in children with gastroenteritis, with or without fever, due to risk of renal damage 4
• Neonates: Contraindicated in the neonatal period 4
• Wheezing/persistent asthma: Contraindicated during active wheezing or in children with persistent asthma 4
• Varicella (chickenpox): Contraindicated during active varicella infection 4
• Known hypersensitivity: Never use in patients sensitive to ibuprofen or other NSAIDs 4

Route of Administration

• Preferred route: Oral liquid formulation 2
• Avoid rectal route: Rectal administration shows erratic absorption, especially in young infants, and is less reliable 2

Alternative Medication

Acetaminophen is the alternative antipyretic/analgesic for children:

• Dose: 10-15 mg/kg per dose 1
• Interval: Every 4-6 hours 1
• Maximum daily dose: 60 mg/kg/day or 5 doses in 24 hours 1
• Age advantage: Can be used in infants <6 months (acetaminophen is the only recommended analgesic for infants <3 months) 1

When to Alternate Medications

If both medications are needed, stagger timing: give acetaminophen every 4-6 hours and ibuprofen every 6-8 hours, so medications are administered every 3-4 hours 1

Clinical Use Guidance

Appropriate Indications

• First-line use: Inflammatory pain in children 4
• Acceptable use: Acute pain management 3
• Limited use: Fever control—should not be used routinely as an antipyretic except in rare cases 4

Common Pitfalls to Avoid

Dosing errors are extremely common:

• 51% of parents give inaccurate doses overall, with 62% misdosing acetaminophen and 26% misdosing ibuprofen 5
• Infants <1 year are at highest risk for receiving inaccurate doses 5
• Prevention strategy: Always dose based on weight in kilograms, not age, as weight-based dosing significantly reduces errors 5

Hydration Assessment is Critical

Before prescribing ibuprofen, ensure the child:

• Is adequately hydrated 2
• Does not have vomiting or diarrhea 4
• Has no signs of dehydration (dry mucous membranes, decreased urine output, poor skin turgor) 4

Safety Profile

• Gastrointestinal events are rare but can affect both upper and lower digestive tract 4
• Ibuprofen is better tolerated by children than adults 3
• Safer in overdose than acetaminophen and aspirin 3
• Adverse effects are similar to other NSAIDs but less frequent in pediatric populations 3