Managing pain and fever in children

This module will help keep you up to date on how to manage pain and fever in children.
Follow the module down the page and note the instructions as you go.

Product information can be found at the end of the module

Treating pain in children

Acute pain is like an alarm from the body telling us something is wrong.¹ It is a very personal experience^1,2 and children of the same age can vary widely in their perception and tolerance of pain.² Paracetamol or ibuprofen can be recommended as first-line treatment for mild-to-moderate pain in children.³

Paracetamol is thought to block chemical messengers in the brain that tell your body you have pain.⁴ Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that works by reducing hormones that cause pain and swelling.⁵ Because paracetamol (the active ingredient in CALPOL^®) and ibuprofen (the active ingredient in CALPROFEN^®) work in different ways, they have different side-effect profiles, e.g. paracetamol causes less gastric irritation than NSAIDs⁶ such as ibuprofen.

Ibuprofen should not be used in those with chickenpox, if dehydration is suspected, or in those with asthma which has previously been triggered by ibuprofen or similar medicines.^7,8 Aspirin (another NSAID) must not be given to children under 16 years of age.⁷

In children under 16, paracetamol (CALPOL^®) or ibuprofen (CALPROFEN^®) should be given alone initially for pain relief.³ If the chosen product does not bring pain relief, check whether an appropriate dose has been taken. If the dosing instructions has been adhered to, you can recommend a switch to the other analgesic, e.g. if paracetamol has been used, ibuprofen should be tried, and vice versa.³

If the child does not respond sufficiently to either drug alone, alternating paracetamol and ibuprofen can be considered.³ They should not be given at the same time^7,8 and it is recommended to leave at least one hour between the two.⁷ Advise parents/caregivers to keep a diary of the time and dose of each medicine given to ensure they don’t give more than the maximum daily dose of either drug.^7,8 If the child is still in pain after trying this, referral is required.³

Managing fever

A body temperature above 38^°C is considered a fever.^9,10 It is very common in young children and while temperatures usually return to normal within a few days,¹⁰ it can be worrying for parents/caregivers. Many are so concerned they seek out medical help; in fact, fever is probably the most common reason for a child to be taken to the doctor and is the second most common reason for a child to be admitted to hospital.⁹ However, most fevers in children over 6 months are not serious⁹ and can be managed at home.¹⁰

Did you know after the age of 6 months the actual temperature of a fever is not a good indication of whether the child is seriously unwell?⁹

This can be helpful to explain when trying to reassure an anxious parent/caregiver.

CALPOL^® dose recommendations

Paracetamol (CALPOL^®) rarely causes adverse effects when given at the correct dosage.¹¹
Children need a lower dose than adults, depending on their age and sometimes their weight.¹²
Care must be taken as too much paracetamol can cause permanent liver damage.¹¹

CALPOL^® for older children

By the age of 6 years, children may take a much more active role in their healthcare. School-age children are more accurate in communicating and as they get older, many can reliably describe the location and severity of their pain.²

They may also be more engaged with, and informed about, their health choices. They could even have developed their own product preferences, particularly in certain circumstances, e.g. at home or on-the-go. To help meet these needs, there is a range of CALPOL^® products for children 6 years and older, to choose from. They are formulated with over twice the strength of infant paracetamol suspension.

• 250mg paracetamol in 5ml
• Quickly soothes symptoms, starting to work on fever in just 15 minutes
• Available in 80ml (GSL), 100ml (GSL) or 200ml (P) bottles with strawberry flavour
• Supplied with an oral syringe and flow restrictor in the neck of the bottle for easy and accurate dosing
• Colour and sugar free

• 250mg paracetamol packed into 5ml sachets (GSL)
• More portable format than bottles, for pain and fever relief on the go
• 12 sachets in each pack, available in strawberry flavour
• Supplied with a double ended spoon for accurate dosing
• Colour and sugar free

• 250mg paracetamol in each melt-in-the-mouth (orodispersible) tablet
• Quickly melts on the tongue with no need for water, providing fast relief from pain and fever on the go¹³
• Available in strawberry flavour in packs of 12 (GSL) and 24 (P)
• Colour free

Customers may not always be aware of the full CALPOL^® SixPlus^™ product range so do mention these in your 6 years + pain and fever relief conversations and highlight the unique format differences which may benefit them.

CALPOL^® SixPlus^™ FastMelts

Watch the video explaining the mode of action of CALPOL^® SixPlus^™ FastMelts.

When to refer

It can be difficult for parents or carers to tell when a child is seriously ill. As previously highlighted, reassuring signs to look for are that the child is a normal colour, active, breathing normally and responsive.¹⁵ Most children with a fever do get better very quickly but some may get worse¹⁶ and need urgent referral.

Urgent referral required:

Immediate action required: