What the NHS and NICE Say About Alternating Paracetamol and Ibuprofen
Parents often ask whether it is a good idea to alternate paracetamol and ibuprofen when a child has a fever. It is a reasonable question, and the answer in the UK is more cautious than a lot of what is written online.
The NICE position
NICE guideline NG143, Fever in under 5s: assessment and initial management, is the reference point for fever in young children in the UK. In summary, it advises that:
- antipyretics should not be used with the sole aim of bringing a temperature down — the question is whether the child appears distressed, not what the thermometer says;
- either paracetamol or ibuprofen may be considered for a child with fever who appears distressed;
- the two should not be given at the same time;
- alternating them should only be considered if distress persists or comes back before the next dose is due;
- antipyretics do not prevent febrile convulsions and should not be used for that purpose.
Read the guidance yourself rather than relying on this summary: NICE NG143, and the NHS pages on paracetamol for children and ibuprofen for children.
Why we do not publish an alternating schedule
You will find fixed alternating timetables on plenty of websites — one medicine every three hours, rotating. We used to publish one on this page, and we have taken it down. Alternating is something to consider with advice for a particular child, not a routine schedule to follow from a web page. The right answer depends on the child, the medicines, the doses on the packaging and what else is going on, and none of that is something a website can know.
If a pharmacist, GP or 111 has told you to alternate, follow what they told you, and use the packaging for the dose amounts.
When to get medical help
Contact a GP, or call NHS 111, if your child is under 3 months and has any fever; is 3–6 months with a temperature of 38°C or above; has a fever lasting more than five days; is unusually drowsy, irritable, or difficult to wake; shows signs of dehydration; or if you are simply worried. Call 999 or go to A&E if your child has a rash that does not fade when you press a glass against it, has difficulty breathing, or is having a fit for the first time.
Where MediTime fits in
MediTime does not decide anything about medicines. It keeps a record of the doses you have given, shows how long it has been since the last one, and counts how many have been recorded in the past 24 hours — using the intervals and daily maximums printed on the packaging. If you have been advised to alternate two medicines, having an accurate record of what went in and when is useful. The decision about what to give, and when, stays with you and whoever advised you.
