Children's Liquid Pain Reliever Shortage: What Parents Need to Know

It has been a challenging winter for families and pediatricians everywhere. First came the ‘tripledemic’ with COVID-19, influenza (flu), and respiratory syncytial virus (RSV) which, along with other infections, caused sickness in children nationwide. Then came a local measles outbreak and a liquid antibiotic shortage.

Now, families are having difficulties finding the liquid forms of acetaminophen and ibuprofen.

What Are Acetaminophen and Ibuprofen?

Acetaminophen (generic name for Tylenol™) and ibuprofen (generic name for Motrin™ and Advil™) are the only two medications recommended for children to reduce fevers. Acetaminophen is used to reduce fevers and pain in children of all ages. Ibuprofen is used for the same, but also has anti-inflammatory properties and is used in children older than 6 months. Both are available in liquid, chewable tablet, tablet, and capsule forms, and dosages depend on the child’s weight. Acetaminophen is also available as a suppository (a small, smooth pill inserted into the rectum).

The liquid forms are sold as two separate products: for infants and for children.

• For acetaminophen, both infant’s and children’s products are the same. They are the same strength, and the dosing is the same for both.
• For ibuprofen, the infant’s product is a different strength than the children’s product: it’s more concentrated. Make sure you know which strength you are using, to ensure correct dosing and to avoid overdosing.

If you cannot find brand name acetaminophen or ibuprofen, you can use generic and store brands as they are safe and effective. You may also check with your local pharmacy to see if they are compounding/making acetaminophen or ibuprofen liquid formulations.

Frequently Asked Questions

Can I give chewable tablets instead of the liquid form?

If your child is able to chew foods, you may give chewable tablets at appropriate doses based on weight. Chewables can also be dissolved in liquid and given.

Can I crush tablets or open capsules and give them in applesauce or yogurt?

If your child is able to chew foods AND their dose is equal to or greater than one tablet, then it is okay to crush up the tablet into tiny pieces to give to the child in applesauce, pudding, or yogurt.

However, if their dose is under one tablet, do not crush up the pill and guess the dose to give. Crushing pills should be a last resort, if you cannot find liquid or chewable medication.

The same applies for capsules. Please refer to the chart below for general dosing.

Home herbal recipes or natural remedies such as colloidal silver should be avoided, as they may be more harmful than helpful.

NOTE: If you’re reading this on a mobile device, you may need to rotate it to see these tables in full. The blog post continues after the tables.

ACETAMINOPHEN

IBUPROFEN

Are rectal suppositories safe to give?

Yes, they are safe to give in healthy children as long as you feel comfortable giving it and the dose is correct. If your child has any medical conditions or is immunosuppressed, ask your doctor first before you give a suppository. Do not ever give a suppository orally (by mouth).

Can I give both acetaminophen and ibuprofen to help reduce fevers?

Yes, you can use both, but ibuprofen should ONLY be given if your child is older than 6 months.

Some prefer to give these medications on an alternating schedule.

It is also okay to give both acetaminophen and ibuprofen at the same time as they work differently. Read more about alternating schedules and the differences between acetaminophen and ibuprofen.

How often can I give fever medications?

Acetaminophen may be given every 4-6 hours. Do not give more than five doses in 24 hours.

Ibuprofen may be given every 6-8 hours. Do not give more than four doses in 24 hours.

Can I give medicines that contain other ingredients, such as cold and flu medications?

The American Academy of Pediatrics (AAP) does not recommend any cough or cold/flu combination medications in children under 6 years old. The other ingredients in these medications can be more harmful than helpful, especially in young children.

What else can I do if my child has a fever?

• Encourage extra fluids. It is important your child stays hydrated.
• Dress your child in light clothing or fewer layers. Do not cover them with heavy blankets.
• Give your child a lukewarm (NOT hot or cold) sponge bath to help cool them down.
• Place lukewarm washcloths on your child's stomach, under the arms, and behind the neck for 15-20 minutes at a time. Do NOT use cold water or rubbing alcohol.

Do not give ibuprofen if your child has a bleeding disorder, ulcers, or kidney disease.

Do not give acetaminophen if your child has a liver disorder, phenylketornuria (PKU), or Glucose 6 phosphate dehydrogenase (G6PD) deficiency.

Never give aspirin to any child under 18 unless it is prescribed by their doctor.

Always contact your pediatrician if you have questions or concerns about your child’s illness or medications.

Learn more about fever. Learn more about acetaminophen.