Demystifying Pain Relief for Kids: A Parent's Guide

It’s the middle of the night, your child is beside you in bed with a mystery illness and she is burning up. She is sweaty, listless and unhappy. You reach for the trusty bottle of paracetamol, hoping to soothe her discomfort, only to watch in dismay as she promptly vomits it back up. Cue the worry. Or maybe your tween suffers from headaches, needing both paracetamol and ibuprofen to eliminate his pain completely. Again, the worry sets in. As parents, we worry. We worry when the medication won’t go down. We worry what it is doing to them when it does. Understanding how these painkillers work might just ease some of those concerns.

Let’s start with ibuprofen, the non-steroidal anti-inflammatory drug (NSAID) superhero in your medicine cabinet. Picture this: a tiny army of enzymes and fatty acids spring into action when cells get damaged. They produce the Cyclooxygenase (COX) enzymes—one group act as the cell's housekeeper, producing prostaglandins to maintain order in our cardiovascular, renal, and gastrointestinal systems. The other group are the defenders protecting the body against invaders, triggering prostaglandins that create swelling, fever and contribute to an inflammatory soup that all leads to pain.

Ibuprofen stops the beginning of this cascade. It prevents the precursor to these cyclo oxygenase enzymes from being formed. So neither group is produced. So even though the anti inflammatory targets the prostaglandins that cause inflammation and pain, they also take out the housekeepers, who make the prostaglandins that keep our stomachs happy. That's why upset tummies are a common side effect. To minimise this, try pairing ibuprofen with food, and if appetite is lacking, co medicating with vitamin C or E might help. And keep taking small, regular sips of water to support the kidneys, they also need extra care after taking ibuprofen.

And this is super important: if your little one has chickenpox or respiratory symptoms, steer clear of ibuprofen. It might actually suppress the fever and immune response that fights off other viral and bacterial infections such as pneumonia or necrotising soft tissue infection.

And, children under 16 cannot be given aspirin because of the risk of developing Reye's syndrome. This is an awful and thankfully rare illness that affects children and teenagers after viral infections. Aspirin inhibits fatty acid metabolism in the liver. In the case of Reye’s syndrome, liver cells have difficulties metabolising and eliminating waste. This leads to a build up of ammonia in the liver that that then enters the central nervous system causing swelling in the brain.

So why do we still reach for ibuprofen? Well, it's got a lower NNT (number needed to treat) score than paracetamol. This means that it takes fewer people to feel better using ibuprofen than paracetamol. The image below comes from here The bars show the 95% confidence interval, and the line where light blue turn to dark is the point estimate.

When it comes to understanding how paracetamol works, scientists are still piecing together the puzzle. What is known is that it triggers many inhibitory pathways in the central nervous system. These pathways start with the formation of N-arachidonoylphenolamine (AM404) in the brain. This illustration shows one of these paths. It shows paracetamol being transformed in the liver into a chemical that is able to cross the blood brain barrier. From here it interacts with an enzyme (fatty acid amide hydrolase) to create AM404. AM404 opens doors on the surface of cells that send calming (seratonergic) messages through the central nervous system. These messages reduce pain signal transmission in the spinal cord. They turn down defence mechanisms and send messages of safety around the body.

When my children were very young I was afraid that high fever could lead to seizures or brain damage. But I have learned through experience and the expertise of doctors and pharmacists that fever helps the body fight infection. By reducing fever, you can actually prolong your child’s illness. So if your child is miserable, irritable or in pain then paracetamol or ibuprofen will help them feel more comfortable. In some case though cuddles; fluids; home remedies such as honey and lemon or humidified air; rest; and nutrition, turn out to be the best medicine of all. Good luck my friend, I hope your child gets better soon.

xx

P