Infant and Children Pain Tips

Ask A Pharmacist

Infant and Children Pain Tips

Self medication is not recommended. Always discuss medication changes with your physician and pharmacist.

Dispelling some Myths:

YES! Infants and children feel pain. Research is showing that the number and degree of painful events as a newborn can impact their pain perception in childhood and adulthood.

YES! Be honest with a child about to have a painful procedure, explain why it is needed, what it will feel like (pressure, pinch), and how long the pain will last. If the child is old enough give them some control (child count to three, pick out a sticker, type of bandaid).

Immunizations, Gain with less Pain:

Immunizations are extremely important in preventing serious infections and their complications which can have fatal outcomes. Prevention is key and the benefits outweigh the risks. Discuss this with your physician.

To decrease pain and mild effects of the immunization give acetaminophen for 24hours regularly scheduled every 4 hours starting with a dose 30-60 minutes before the poke.

Research has shown that infants have less pain if the DPTP-Hib vaccine is given first, followed by the pneumococcal vaccine (Prevnar®) rather than the reverse order. (Routine immunizations in infancy).

Dosing of Acetaminophen:

Caution : to avoid underdosing and OVERdosing inadvertently ALWAYS check the STRENGTH of the product (mg/mL) and use an accurate measuring devise with the bottle or from the pharmacy.

Acetaminophen is available in drops, syrup, chew tablets, regular, extra strength tablets and suppositories. It is an analgesic and decreases fever.

Check other product labels for acetaminophen content, it is often in cough and cold products, muscle pain relievers and others.

The dose to give is calculated by mg per kg per dose (10-15mg/kg/dose every 4-6 hours NOT TO EXCEED 65mg/kg/DAY). 

In an older child do NOT EXCEED a normal adult dose (≤ 4000mg per day).

Example: 11 lb baby, convert to kg is 11 ÷ 2.2 = 5 kg. Calculate 10mg/kg every 4 hours is 50mg every 4 hours, or alternatively 15mg/kg every 6 hours is 75mg every 6 hours. May give regularly for short periods or when required.

Suppositories are available in different strengths. The DOSE is the same as the oral dose. If you need to give a portion of the suppository cut the suppository in half length-wise (tip to stern) to provide a more accurate dose. After removing the foil, insert the suppository gently with baby on their side then hold the buttock cheeks together.

When and when not to consider ibuprofen:

Ibuprofen has advantages and disadvantages. It is available as a liquid and different strengths of solid dosage forms. Read the label strength carefully.

Advantages include a longer action than acetaminophen so it does not need to be given as frequently. It is a non-steroidal anti-inflammatory (NSAID) acting as an analgesic and also relieving inflammation, and decreases fever.

Disadvantages include the risk of serious kidney damage especially in patients with underlying kidney disease. It may also cause stomach upset.

NOTE: There is no proven advantage to the child of giving an acetaminophen dose then an ibuprofen dose alternating and repeating this regimen. It leads to confusion and risk of overdose. Some reports show the two drugs may interact with serious side effects.

Dosing of ibuprofen:

Ibuprofen is dosed mg per kg . Infant’s weight is converted from pounds to kilograms (calculation above). Dose of ibuprofen is 5-10mg/kg per dose given every 6-8 hours NOT TO EXCEED 40mg/kg/day.

In the case of older children do NOT EXCEED a normal adult dose. (≤ 1200-3200mg per day).

Example: 10 kg child, 10 kg at 5mg/kg is 50mg and give every 6 hours. May give regularly or when required.

Janice Sumpton RPh., BScPhm.   July 23, 2009