Everything You Need to Know About Pain Relievers for Babies

There is nothing is more heart wrenching as a parent than thinking your precious baby is in pain. You will want to give her something that provides relief. Know the effects and risks of giving painkillers. Learn about the different types of painkillers, how they work and potential side effects.

What are analgesics?

Analgesics are pain reducing drugs. There are a number of different classes of analgesics:

Narcotics (e.g. Codeine) are chemically based on morphine molecules (opioids). These are used therapeutically to treat moderate to severe pain, suppress cough, alleviate diarrhea and induce anaesthesia.
Non-steroid anti-inflammatory drugs (NSAIDs) e.g. Ibuprofen (Motrin®, Advil®, Nurofen®) are used to treat mild to moderate pain, reduce fever and provide an anti-inflammatory action.
Acetaminophen (also know as paracetamol in some countries); e.g. (Tylenol®, Panado®). Acetaminophen/paracetamol is safer compared to other analgesics, but like other medications it is not free from risk of unintended, harmful effects.

In addition to being analgesics (pain relievers), NSAIDs and acetaminophen/ paracetamol are also antipyretics (fever reducers). While analgesics can relieve the symptoms of pain and fever, they have no effect on the length or severity of an illness or condition. In other words, they mask the symptom of pain and/or fever associated with a physical ailment but do nothing to treat the underlying cause.

Analgesics suitable for babies and children

The most commonly used analgesics for infants and children for the treatment of pain and fever today include:

Ibuprofen

Ibuprofen has a similar effect to acetylsalicylic acid (aspirin), but is more potent and better tolerated. Ibuprofen is not recommended for children who suffer with asthma, reflux, tummy, kidney, liver or heart problems, or pregnant women, but can be taken by nursing mothers.

The peak effect of Ibuprofen occurs in 1 to 2 hours. The effects can last up to 8 hours. It is generally recommended that ibuprofen is taken with milk or food to reduce the risk of gasto-intestinal side effects.

Acetominophen/ Paracetamol

Acetominophen/ paracetamol is the most widely used pain relieving and fever reducing drug in the world. It is found in more than 100 products. It can be taken by babies, children, pregnant women and nursing mothers.

Acetominophen/ paracetamol can be taken on an empty stomach or with food or milk. It takes approx 30 to 60 minutes to reach peak effect. The effects last up to 4 hours.

IMPORTANT: Acetominophen/ paracetamol and ibuprofen are not recommended for use by babies under the age of 1 month unless advised to do so by a doctor.

These analgesics can be purchased over-the-counter and come in drops or elixirs (syrup) for babies and young children, and tablets or capsules for older children and adults. Strength varies between drops and elixirs and may also vary from manufacturer to manufacturer. Read labels carefully to minimize the risk of overdose.

Analgesics to avoid

Many over-the-counter (OTC) analgesics medications are not suitable for use by infants and children and can be dangerous. Children are not mini adults. Their growing and developing organs, particularly liver and kidneys, are not capable of metabolizing (breaking down) drugs as efficiently as an adult's liver and kidneys can.

Acetylsalicylic acid (aspirin)

Aspirin was once the most popular drugs world-wide used to relieve mild to moderate pain and lower fever. Aspirin is no longer recommended for use by babies and children due to the risk of Reye's Syndrome.

Other analgesics

Medications containing narcotic drugs (opioids) such as codeine are often combined with acetaminophen/paracetamol for a more potent effect. Codeine is also included in many OTC cough mixtures to suppress cough. Other opioid derivative drugs are included in many anti-diarrheal medications. Medications containing narcotic drugs can have potentially serious effects for babies and children because they produce a sedative effect that may impair breathing function.

NEVER give any OTC drugs to babies or children without first checking with your doctor.

How they work

Ibuprofen blocks the production of prostaglandins in a similar way to acetaminophen/paracetamol. Prostaglandins are local hormones which are released by damaged tissues. Prostaglandins promote inflammation, sensitize nerve endings to pain, and are involved in the transmission of pain messages to the brain.

Although ibuprofen and other NSAIDs also have anti-inflammatory properties, it can takes days or weeks of continued use to achieve this effect.

Acetaminophen/ paracetamol works in a similar way to ibuprofen by blocking the production of prostaglandins and therefore blocking pain messages. In other words the source of the pain is still present, it's just not noticed as much. Unlike ibuprofen, acetaminophen/ paracetamol has virtually no anti-inflammatory properties, but is better tolerated and has fewer side-effects compared to ibuprofen.

Acetaminophen/paracetamol and ibuprofen also have antipyretic (fever reducing) properties by affecting the part of the brain that regulates the temperature of the body. Because acetaminophen/paracetamol has few adverse reactions with other drugs, it is included in many cough, cold and flu medications. This means it's possible that a parent could accidentally give their baby additional doses of acetaminophen/paracetamol through different types of medications.

For common childhood illnesses that require the use of an analgesic, there is no evidence to support that one of these analgesics is better than the other in the relief of pain or fever.

Side effects

Mild side effects associated with ibuprofen include: heartburn, abdominal discomfort or fullness, nausea, vomiting, diarrhea, constipation, dizziness, drowsiness, fatigue, headache, ringing in the ears, blurred vision, sweating, fluid retention, mild allergic reaction such as skin rashes, itching and hives.

Mild side effects associated with acetaminophen/ paracetamol include: drowsiness, fatigue, rashes or itching.

More serious side effects associated with both ibuprofen and acetaminophen/ paracetamol (with the recommended dosage) although rare can occur. These include: severe allergic reaction, swelling of the lips, tongue, around the eyes and face, wheezing or obstructed breathing, collapse, severe skin eruption, itching or hives, decreased urine volume, blood stained urine, fever, sore throat, abdominal bleeding or bruising due the effects on blood cells, jaundice (yellow coloration of the skin or eyes) due to liver reaction.

In recent years concerns have been raised about the possible link between over use of acetaminophen/ paracetamol and autism, ADHD and asthma. Clinical studies are currently being undertaken.

Toxic effect due to overdose may include vomiting, abdominal pain, sweating, convulsions, drowsiness, decreased breathing and coma. In extreme cases, overdose may lead to serious and permanent damage to the liver and kidneys or death.

A serious complication associated with the use of aspirin is the higher than normal incidence of Reye's Syndrome in children who have received aspirin while feverish with a viral infection of the upper respiratory tract or chickenpox. Reye's Syndrome affects the brain and liver and although extremely rare, can be fatal. As a result aspirin is no longer recommended for children under 16 years of age except on the advice of a doctor.

Using analgesics wisely

Use only for clearly defined symptoms of illness or suspected source of pain.
Do not give more than the recommended dose unless advised to do so by your baby's doctor.
Do not give more than one type of analgesic to your baby, either together or alternating, unless advised to do so by your doctor.
Do not give your baby analgesics for longer than 24 hours unless advised to do so by your baby's doctor.
Check labels carefully. Caution needs to be taken with the wide variety of different strengths of oral preparations available.
Monitor the effectiveness of treatment.
Reseal the container properly after use. Store in a cool safe place, out of the reach of children.

When to see a doctor

Have your child seen by a doctor if your child...

is less than 6 months old and has a fever;
if over 6 months of age and has a fever over 100º F (39.8º C);
has a fever which lasts more than 24 hours;
seems unwell, unusually sleepy or irritable;
has pain symptoms which persist for longer than 24 hours;
is vomiting;
is refusing to drink;
has convulsions (fits);
has breathing difficulties such as a cough or wheeze;
has unusual rashes; or
if you are concerned.

What else could it be?

As a health professional who specializes in providing solutions to well baby care problems, I would say virtually all parents of distressed, wakeful babies will at some point become concerned or convinced that their baby is suffering from pain of some description.

A baby can become distressed, wakeful, or refuse to feed for many reasons - pain is only one.

Below are some examples of what I find to be common reasons for babies to display troubled behavior.

Physical/medical problems

A physical or medical problem is the least likely cause of a physically well baby's distress, but it’s the first thing that needs to be assessed. The first step to finding a solution to your baby's distress is to have your baby thoroughly examined by a medical doctor. If he/she is unable to provide an effective solution, extend your search to other possible causes. The next step will be to review your infant feeding and settling practices.

A physical problem does not exclude a baby from experiencing other problems. Distressed behavior displayed by a baby is not necessarily related to a diagnosed problem/condition.

Feeding problems

Gastro-intestinal discomfort/pain: In the case of physically well, thriving newborn babies, I find lactose overload to be a common cause of abdominal discomfort/pain in the early weeks of life. While painkillers might briefly relieve a baby's discomfort/pain this is only a temporary measure. Unless you address the underlying cause, you are likely to find that once effects of the painkiller wears off your baby's pain will return. Lactose overload can be effectively managed (without the need for painkillers) by making appropriate adjustments to your infant feeding practices.

Fussy feeding behavior: Both breastfed and bottle fed babies can develop feeding aversions, which presents as a physically-well baby resisting feeding so fiercely that parents become convinced the baby is experiencing pain as a result of swallowing.

Sleeping problems

It is often assumed that pain is the cause when a baby appears to fight falling asleep despite obvious signs of tiredness; also when a baby wakes prematurely from sleep still tired. While pain is a possible cause of this behavior, it’s the least likely cause in the case of physically well babies. I find that is most cases the baby is distressed owing to lack of sleep rather than suffering from pain. Lack of sleep causes the release of stress hormones that make it difficult for the baby to fall asleep. Parents in general are unaware of how their infant settling practices influence their baby’s ability to sleep… for better or worse, and in some case may need to change their settling practices in order to better support their baby to get the amount of sleep he/she needs.

The many physical, developmental and behavioral reasons for sleep disturbance. The most common being baby's learned dependence on negative sleep associations.