Use of Acetaminophen in Children

Acetaminophen has been used to manage pain and fever in pediatric patients for over 50 years (Temple, Temple, and Kuffner, 2013). Most, if not all, of the children I see for physical therapy has used acetaminophen at one point for its indicated use. It is common practice in the out-patient clinic I work for to obtain medical clearance from the resident physician prior to therapy if a child has a fever or is exhibiting symptoms of pain. The most common reason children are seen by a doctor or admitted in a hospital is because of a fever (“Use”, 2014). Wang et al. (2014) reported that an intravenous form of acetaminophen or paracetamol has been recently approved for use in full-term neonates, children, and adults in Europe; although its use in the United States is limited to patients 2 years and older. In my clinical experience, the families of children with disabilities that I’ve seen for physical therapy have not reported the use of intravenous acetaminophen. It would be interesting to know in the future if parents would notice a difference in a child’s response between oral and intravenous forms of acetaminophen administration.

Gallelli et al. (2014) reported that headaches are common in children, with a prevalence of 4-11% between the ages of 7-11 years, and that acetaminophen is a drug used to manage its symptoms. The study concluded that the use of magnesium salt in treating children with tension type headaches increased the efficacy of acetaminophen. This finding is interesting because some of the children who I see for physical therapy with cervical dystonia may be prone to tension type headaches because of tonal increase in the head and neck region. Gallelli et al. (2014) indicated that unmanaged headaches may decrease a child’s quality of life, including performance in school and participation in social interactions. I believe that a study specific to this pediatric population will be of value to pediatric physical therapists.

Seeing patients who use multiple drugs to help manage their illness is not uncommon for physical therapists. Children who underwent tonsillectomy, for example, may be prescribed acetaminophen with other post-operative analgesia in the hope that multimodal analgesia may produce greater pain relief with fewer side effects (Merry et al., 2013). Polypharmacy becomes an issue in rehabilitation when the side effects outweigh the benefits that the medications bring into the table. The families of children with disabilities must discuss medication management with their child’s physician and physical therapists must be cognizant of the side effects that medications may exert on the child. How a child responds to therapeutic intervention may be facilitated or limited by pharmacotherapy.

References

Gallelli, L., Avenoso, T., Falcone, D., Palleria, C., Peltrone, F., Esposito, M., & … Guidetti, V. (2014). Effects of acetaminophen and ibuprofen in children with migraine receiving preventive treatment with magnesium. Headache: The Journal of Head & Face Pain, 54(2), 313-324. doi:10.1111/head.12162

Merry, A. F., Edwards, K., Ahmad, Z., Barber, C., Mahadevan, M., & Frampton, C. (2013). Randomized comparison between the combination of acetaminophen and ibuprofen and each constituent alone for analgesia following tonsillectomy in children. Canadian Journal of Anaesthesia, 60(12), 1180-1189. doi:10.1007/s12630-013-0043-3

Temple, A. R., Temple, B. R., & Kuffner, E. K. (2013). Dosing and antipyretic efficacy of oral acetaminophen in children. Clinical Therapeutics, 35(9), 1361-1375e45. doi:10.1016/j.clinthera.2013.06.022

Use antipyretics for at-home management of children with low-risk fever and distress. (2014). Drugs & Therapy Perspectives, 30(12), 422-425. doi:10.1007/s40267-014-0166-9

Wang, C., Allegaert, K., Tibboel, D., Danhof, M., van der Marel, C. D., Mathot, R. A., & Knibbe, C. A. (2014). Population pharmacokinetics of paracetamol across the human age-range from (pre)term neonates, infants, children to adults. Journal of Clinical Pharmacology, 54(6), 619-629. doi:10.1002/jcph.259