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One of the most common medications parents in my practice give is ibuprofen. Known also by its brand names Advil and Motrin, it does a great job of bringing down high fevers and can be really helpful with pain, too. It's so helpful, in fact, that it's easy to think of it as completely safe.
Now, no medication is completely safe. All medications can have side effects, and any medication can possibly cause an allergic reaction. And since acetaminophen (the other medication parents give for fever and pain) can cause serious liver damage if too much is given, it's easy to think that ibuprofen is the safer choice.
But there is a difference between "safer" and "safe". That's what a study just out in the Journal of Pediatrics reminds us of. Researchers from Riley Hospital for Children in Indianapolis looked at medical records of children admitted to the hospital, and found that of those who had kidney damage, a significant number had been taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen (Aleve). Some of the kidney damage was serious.
This isn't news to doctors; we've known that along with possible bleeding problems, NSAIDs can damage kidneys. But we think of it as rare and we don't always mention it to parents. Which is our bad. But since medications like ibuprofen and naproxen are readily available without a prescription, we don't always get a chance to talk with parents about it either.
So here's what you need to know: while it's not common, NSAIDs can hurt the kidneys. It's more likely to happen when there is dehydration, as this concentrates the medication in the blood and the kidneys are already a bit stressed out dealing with the dehydration.
What this means in practical terms:
- Think twice before giving your child any over-the-counter medication. This is a good general rule of thumb. Ask yourself: is this really necessary?
- Don't freak out over fevers. Fever is one of the ways the body fights infection, as germs don't like high temperatures. If your child has a fever but is basically comfortable and drinking, leave the fever alone. You'll avoid the risk of side effects from medication--and your child might even get better faster.
- Don't give ibuprofen or other medications "just in case," to prevent a fever. I actually see this often; parents give it when their child has a cold, whether or not there actually is a fever. This is rarely a good plan--better to save the medication for when your child really needs it.
- The other reason that parents give these medicines is for pain. While I am certainly not saying that you should let your child be in pain, if the pain is mild it's always good to think about other remedies, like massage or rest, and only give medications if they don't work.
- Since dehydration can make NSAIDs more dangerous, don't give them if your child isn't drinking well. If they are drinking fine and you give them, make sure they keep up with the fluids.
- If ever you're thinking about giving an over-the-counter medication and you aren't sure if it's a good idea, call your doctor. That's what we are here for!
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