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Paediatric Pain and Fever

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What is pain?

  • Pain is an unpleasant sensation signalling an injury to some part of the body.1
  • Pain may be sharp or dull, intermittent or constant, or throbbing or steady.
  • Sometimes pain is very difficult to describe. The intensity of pain can vary from mild to intolerable.1
  • Pain in children is often under-treated.2
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What causes mild to moderate pain and fever in children?

  • Viral or bacterial infections can cause mild-to-moderate pain and fever in children, such as the common cold, a sore throat or common childhood illnesses such as chickenpox.4
  • Teething in young children is often a cause of discomfort as the tooth erupts through the gums. Cavities may also cause toothache in older children.5
  • Headaches are common in children, occurring in up to 75 percent of school-aged children.6
  • There are many causes of headaches in children, but some of the more common causes include an upper respiratory tract infection (an ear infection, a throat
    infection, a sinus infection or an allergy), a minor bump on the head, or a tension headache.6
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What is fever?

  • Fever is a normal response of the body to illness that facilitates and accelerates recovery.3
  • Fever is defined as a body temperature ≥38 degrees C.3
  • Fever is frequently a cause for concern among parents and healthcare providers.3
  • In children, it is more accurate to measure body temperature in the ear, or in the axilla (armpit).3 Fever causes discomfort, which is often associated with pain due to the underlying condition such as a sore throat or headache.3
  • Fever is not harmful in itself. However, fever in a child younger than 3 months of age should be further investigated by your health care provider.3
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Treatment of pain and fever in children

  • Medicines to relieve pain and fever are mostly given to relieve the discomfort of the child. This enables the child to eat better, to prevent dehydration and to
    reduce irritability.3,4
  • Paracetamol and ibuprofen may be given to children to relieve pain and fever. Aspirin should not be given to children or adolescents, as it increases the risk of a rare but serious condition called Reye syndrome.4
  • Due to anxiety or fear of fever, parents or caregivers may give more medicine than is needed to adequately treat a fever. On the flip-side, pain, especially in young children, is often under-treated.2
  • For pain and fever medicine to work most effectively, it is very important to give it to the child at the correct prescribed dose, at the correct scheduled time.2
  • For example, for effective control of pain, paracetamol should be given as a scheduled dose over time, and not “as needed”.2
  • Giving too much medicine may result in unwanted side effects or toxicity, and giving too little will hamper the effect of the medicine.2
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Paracetamol in the treatment of pain and fever in children

Paracetamol has a dual action, which means it relieves both mild-to-moderate pain and fever in children.7 It is the number one prescribed reliever of pain and fever in children by South African paediatricians8 and is endorsed by expert bodies around the world, including the World Health Organisation.2 Paracetamol may be given to children younger than 3 months of age, and children with chickenpox.2

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Tips on the correct administration of medication for pain and fever

  • Doses should be measured carefully to avoid over- or under-dosing.
  • If the temperature does not come down after one dose, do not administer another dose immediately. Wait for the appropriate dosing interval to pass and only give another dose at the correct time.
  • If the child vomits immediately after taking a dose of medicine, another dose may be given.
  • Avoid combination products and ‘cough and cold medicines’, which complicate dosing and may increase the risk of overdose and side-effects.
  • Medication should not be administered for longer than two days without consulting a doctor.
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Home care tips for a fever

  • Do not over-dress or under-dress the child, or wrap the child in heavy blankets.
    Encourage the child to drink fluids regularly (breast milk is best for breastfeeding children).
  • To ensure that you are using the correct medication at the correct dose, speak to your doctor or pharmacist before administering medication for fever.
  • Check the child during the night, but do not wake the child just to administer medication for a fever.
  • Seek further medical advice if the fever does not get better within 48 hours, or if the child’s condition worsens.
  • Sponging with tepid water is not recommended.

Panado® paediatric syrup – Alcohol and sugar free

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Recommended dose – Children

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Fast, effective relief of pain and fever from:

  • Teething Pain
  • Toothache
  • Sore Throats
  • Headaches

Works in 15 minutes10

Gentle on tummies13

Medical References

1. Watson JC. Overview of Pain [online] October 2018 [cited 19 November 2019]; Available from URL: https://www.merckmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/pain/overview-of-pain. 2. De Martino M,
Chiarugi A. Recent Advances in Pediatric Use of Oral Paracetamol in Fever and Pain Management. Pain Ther 2015;4:149–168. DOI 10.1007/s40122-015-0040-z. 3. Green R, Jeena P, Kotze S, et al. Management of acute fever in children: Guideline for
community healthcare providers and pharmacists. S Afr Med J 2013;103(12):948-954. DOI:10.7196/SAMJ.7207. 4. Tesini BL. Overview of Viral Infections in Children. Merck Manual Consumer Version [online] September 2019 [cited 19 November 2019];
Available from URL: https://www.merckmanuals.com/home/children-s-health-issues/viral-infections-in-infants-and-children/overview-of-viral-infections-in-children?query=tonsillopharingytis%20in%20children. 5. Hennessy BJ. Toothache. Merck Manual Consumer Version [online] September 2018 [cited 19 November 2019]; Available from URL: https://www.merckmanuals.com/home/mouth-and-dental-disorders/symptoms-of-oral-and-dental-disorders/toothache?query=toothache%20in%20children. 6. Bonthius DJ, Hershey AD. Headache in children. Beyond the basics [online] October 2019 [cited 19 November 2019]; Available from URL: https://www.uptodate.com/contents/headache-in-children-beyond-the-basics. 7. Adcock Ingram Data on File. Reference available on request. 8. Impact Rx February 2019. 9. Panado® Paediatric Syrup Alcohol and Sugar Free & Panado® Paediatric Syrup package insert. April 2010. 10. Wilcock A, Twycross R. Therapeutic reviews: Acetaminophen
(Paracetamol). J. Pain Symptom Manag. 2013,46(5):747-757. 11. Panado Paediatric Syrup Strawberry Approved package insert March 2002. 12. Van den Anker JN. Optimising the management of fever and pain in children. Int J Clin Pract 2013;67(178):26–32.
13. Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 13th ed. Acetaminophen. p696.

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