In reviewing the pros and cons of acetaminophen (Tylenol) vs. ibuprofen (Advil, Motrin), pediatrician Jennifer Trachtenberg hits all the right notes that parents typically hear ad nauseam from their board-certified pediatrician:

Mainly, it is not necessary to treat the number on the thermometer, nor is it always necessary to bring the temperature down.


Don’t let “fever phobia” get to you, says Dr.Trachtenberg:

What is important is to address how the child is feeling and behaving regardless of their temperature. Are they happy, playful drinking fluids or are they cranky, irritable and uncomfortable?

If the former, then no fever-reducing medicine is even necessary. What pediatricians want parents to know is not to be scared of fever, it’s the body‘s way of fighting off the infection. The goal of a fever reducer is to make a kid feel better so they can rest and recover. Over-the-counter medicine doesn’t treat the illness or make them better or less contagious any faster. The take-home message is to use fever reducers for added comfort not just because your child has an elevated temperature documented on the thermometer.


What about giving both fever-reducers in an alternating fashion? Won’t that bring the temperature down and keep it down?

An all-too-common practice, in my opinion, is alternating Tylenol and Motrin. Parents often do this to keep the fever “down” or suppressed. In most cases, this is not needed especially if you remember treatment is for comfort and not trying to get the thermometer to read 98.6F. In addition, alternating medication every three to four hours often leads to medication errors and overdoses which can potentially be severe.

So if you are giving both (a practice I rarely recommend), please make sure to write down which medicine, the dosage and what time it was given, so all caregivers are aware to avoid errors.


One of our very first posts on The PediaBlog dealt with fever phobia and when to worry about your child’s fever:

Without a doubt, fever is a major cause of concern for parents. For pediatricians, not so much. Parents frequently ask: “When should I worry?” and  “How high can I let the fever go before I go to the emergency room?”


These were the warning signs and symptoms we advised parents to be on the lookout for in their otherwise-healthy-but-febrile child six years ago. The advice hasn’t changed:

  • Fever in a child two months of age or younger
  • A child who still appears lethargic after the fever has gone away
  • Fever lasting longer than five days
  • Fever in a child with a lowered immune system or a chronic disease
  • Fever after spending prolonged time in the heat
  • A febrile child who is vomiting non-stop or not drinking fluids
  • Fever with a stiff neck and headache
  • Fever with rash.  (A rash that occurs once the fever has gone is most frequently viral and, therefore, not concerning. A rash and a fever occuring at the same time IS concerning.)
  • Fever associated with severe pain (anywhere — head, belly, extremity, etc.)
  • Fever and a bad cough or difficulty breathing.
  • Fever in a child who is not immunized or under-immunized.


Read the rest of Dr. Jennifer Trachtenberg’s article, “Motrin vs. Tylenol for children: A pediatrician explains,” at KevinMD here.


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