Managing pain and fever in children is one of the most common concerns for parents. Whether it’s a mild fever, teething discomfort, sore throat, or post-vaccination pain, knowing which medicines are safe—and how to use them correctly—is essential.

In South Africa, healthcare professionals recommend a limited number of safe, effective, and evidence-based painkillers for children. This guide explains everything in detail, including types of medicines, proper dosing, safety precautions, and practical tips for parents.

---

Understanding Pain and Fever in Children

Pain and fever are not illnesses themselves—they are symptoms of underlying conditions such as infections, injuries, or inflammation.

Common Causes of Pain in Children

• Fever due to viral or bacterial infections
• Teething pain (especially in infants)
• Ear infections
• Sore throat or tonsillitis
• Headaches
• Minor injuries or sprains
• Post-immunisation discomfort

Fever, in particular, is the body’s natural defence mechanism. However, when it causes discomfort or rises too high, pain relief medication may be needed.

---

Commonly Recommended Painkillers in South Africa

In South Africa, only two main over-the-counter (OTC) painkillers are widely recommended for children:

• Paracetamol (first-line treatment)
• Ibuprofen (second-line or stronger option)

These medicines are available in pharmacies, supermarkets, and clinics, usually in syrup, drops, or chewable tablet forms.

---

1. Paracetamol for Children

What is Paracetamol?

Paracetamol (also known as acetaminophen) is the most commonly used painkiller and fever reducer for children. It is considered the safest option when used correctly.

Why Paracetamol is First Choice

• Safe for most age groups, including infants (with medical advice)
• Effective for mild to moderate pain
• Minimal stomach irritation compared to other painkillers
• Widely available and affordable in South Africa

Uses of Paracetamol

Paracetamol is used to treat:

• Fever
• Headaches
• Toothache
• Teething pain
• Earache
• Sore throat
• General body pain

Recommended Dosage

The correct dosage depends on the child’s weight, not just age.

• 10–15 mg per kg body weight
• Given every 4 to 6 hours
• Maximum: 4 doses in 24 hours

Example:

If a child weighs 10 kg:

• Dose = 100–150 mg per dose

Forms Available in South Africa

• Infant drops
• Syrup/suspension
• Chewable tablets (for older children)

Popular options include Panado Paediatric Syrup and Calpol.

Safety Tips

• Always use a measuring syringe or spoon
• Never exceed the recommended dose
• Avoid combining with other medicines containing paracetamol
• Overdose can cause serious liver damage

---

2. Ibuprofen for Children

What is Ibuprofen?

Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that reduces pain, fever, and inflammation.

When to Use Ibuprofen

Ibuprofen is often used when:

• Paracetamol is not effective
• Pain involves inflammation (e.g., injury or swelling)
• Fever is persistent

Benefits of Ibuprofen

• Stronger pain relief than paracetamol in some cases
• Reduces inflammation and swelling
• Longer-lasting effect

Recommended Dosage

• 5–10 mg per kg body weight
• Every 6 to 8 hours
• Maximum: 3–4 doses per day

Age Restrictions

• Generally safe for children older than 3–6 months
• For younger infants, consult a doctor

Forms Available

• Syrup/suspension
• Chewable tablets

Common brand: Nurofen for Children.

Safety Tips

• Give after food to prevent stomach irritation
• Avoid if the child is dehydrated or vomiting
• Do not use in children with certain kidney or stomach conditions
• Do not combine with other NSAIDs

---

Medicines to Avoid in Children

Aspirin (Strictly Avoid)

Aspirin should never be given to children.

Why is Aspirin Dangerous?

It is linked to a rare but serious condition called Reye’s syndrome, which can cause:

• Brain swelling
• Liver damage
• Death in severe cases

---

Choosing the Right Painkiller

Choosing between paracetamol and ibuprofen depends on the child’s condition.

When to Use Paracetamol

• Mild fever
• Headache
• Teething pain
• General discomfort

When to Use Ibuprofen

• Swelling or inflammation
• Muscle injury
• Severe pain
• Fever not responding to paracetamol

Can They Be Used Together?

In some cases, doctors may recommend alternating paracetamol and ibuprofen. However:

• This should only be done under medical guidance
• Incorrect use increases risk of dosing errors

---

Dosage Guide Table

Weight (kg)	Paracetamol Dose	Ibuprofen Dose
5 kg	50–75 mg	Not recommended
10 kg	100–150 mg	50–100 mg
15 kg	150–225 mg	75–150 mg
20 kg	200–300 mg	100–200 mg
25 kg	250–375 mg	125–250 mg

Always confirm dosing with a healthcare professional.

---

How to Give Medicine Safely

1. Use Correct Measuring Tools

Avoid kitchen spoons. Use:

• Oral syringes
• Measuring cups

2. Check Labels Carefully

Look for:

• Strength (mg per ml)
• Expiry date
• Active ingredients

3. Stick to the Schedule

• Do not give doses too close together
• Keep track of time and amount

4. Store Medicines Safely

• Keep out of reach of children
• Store at recommended temperature

---

Common Mistakes Parents Make

• Guessing doses instead of using weight
• Using household spoons
• Giving adult medication to children
• Combining multiple medicines unknowingly
• Overdosing during high fever

Avoiding these mistakes can prevent serious health risks.

---

Side Effects to Watch For

Paracetamol

• Generally safe
• Overdose can cause liver damage

Ibuprofen

• Stomach pain
• Nausea
• Risk of kidney issues if dehydrated

Seek medical help if you notice:

• Vomiting
• Rash
• Breathing difficulty
• Unusual sleepiness

---

When to See a Doctor

You should consult a doctor if:

• Baby is under 3 months with fever
• Fever lasts more than 2–3 days
• Child has severe pain
• Symptoms worsen
• Child is not eating or drinking
• Signs of dehydration appear

---

Special Considerations in South Africa

Access to Medicines

Painkillers like paracetamol and ibuprofen are widely available:

• Pharmacies
• Clinics
• Supermarkets

Public Healthcare Advice

South African health guidelines recommend:

• Paracetamol as first-line treatment
• Careful dosing based on weight
• Avoid unnecessary medication

---

Natural Alternatives for Mild Pain

Sometimes, medication may not be necessary. You can try:

• Lukewarm sponge bath for fever
• Hydration (fluids)
• Rest and comfort
• Cold compress for injuries
• Teething rings for babies

These methods can support recovery alongside medication.

---

Pain Management for Different Age Groups

Infants (0–12 months)

• Use paracetamol with doctor guidance
• Avoid ibuprofen under 3–6 months

Toddlers (1–3 years)

• Both medicines may be used carefully
• Teething pain is common

Children (4–12 years)

• Wider range of dosage options
• Can use chewable tablets

---

Importance of Weight-Based Dosing

Weight-based dosing ensures:

• Effective pain relief
• Reduced risk of overdose
• Safer treatment

Always weigh your child or use recent weight records.

---

Frequently Asked Questions

Can I give painkillers on an empty stomach?

• Paracetamol: Yes
• Ibuprofen: No (give with food)

How long do they take to work?

• Usually 30–60 minutes

Can I wake a child for medicine?

• Only if necessary (e.g., high fever)

What if a dose is missed?

• Give when remembered, but do not double dose

---

Final Thoughts

Painkillers for children in South Africa are safe and effective when used correctly. The key points every parent should remember:

• Paracetamol is the first choice
• Ibuprofen is useful for stronger or inflammatory pain
• Always use weight-based dosing
• Avoid aspirin completely
• Consult a doctor when in doubt

By understanding how these medicines work and following proper guidelines, parents can confidently manage their child’s pain and fever while ensuring safety.

---