Ibuprofen dosage in children
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Here is a thorough summary of pediatric ibuprofen dosing from authoritative sources (Harriet Lane Handbook, Rosen's Emergency Medicine, and current pediatric guidelines):
Ibuprofen Dosing in Children
Key Principle
Always dose by weight, not age. Weight-based dosing is more accurate and safer.
Eligibility
- Minimum age: 6 months (do not use in infants younger than 6 months)
- Minimum weight: approximately 5-6 kg
Standard Oral Dosing (PO)
Analgesic / Antipyretic:
| Parameter | Dose |
|---|---|
| Dose per administration | 5-10 mg/kg/dose |
| Frequency | Every 6-8 hours as needed |
| Max single dose | 400 mg |
| Max daily dose (analgesic) | Lesser of 40 mg/kg/day or 3200 mg/day |
| Max daily dose (antipyretic) | Lesser of 40 mg/kg/day or 2400 mg/day |
- Harriet Lane Handbook (23rd ed.), p. 3119-3120
- Rosen's Emergency Medicine, Table 157.5
Weight-Based Dosing Chart (Oral Suspension 100 mg/5 mL)
| Weight | Approx. Age | Dose | Suspension (100 mg/5 mL) |
|---|---|---|---|
| 5.4-8.1 kg (12-17 lb) | 6-11 months | 50 mg | 2.5 mL |
| 8.2-10.8 kg (18-23 lb) | 12-23 months | 75 mg | 3.75 mL |
| 10.9-16.3 kg (24-35 lb) | 2-3 years | 100 mg | 5 mL (1 tsp) |
| 16.4-21.7 kg (36-47 lb) | 4-5 years | 150 mg | 7.5 mL (1.5 tsp) |
| 21.8-27.2 kg (48-59 lb) | 6-8 years | 200 mg | 10 mL (2 tsp) |
| 27.3-32.6 kg (60-71 lb) | 9-10 years | 250 mg | 12.5 mL (2.5 tsp) |
| 32.7-43.2 kg (72-95 lb) | 11 years | 300 mg | 15 mL (3 tsp) |
| >43.6 kg (96+ lb) | 12+ years | 400 mg | 20 mL (4 tsp) |
IV Dosing (Hospital Use)
| Age | Dose | Frequency |
|---|---|---|
| 6 months to <12 years | 10 mg/kg/dose (max 400 mg) | Every 4-6 hours PRN |
| 12-17 years | 400 mg/dose | Every 4-6 hours PRN |
| Max daily (children) | Lesser of 40 mg/kg/day or 2400 mg/day | - |
Infuse over at least 10 minutes in children; hydrate well before IV use.
Special Indication: Juvenile Rheumatoid Arthritis (JRA)
- Ages 8 months-12 years: 30-50 mg/kg/day divided every 6 hours orally
- Maximum: 800 mg/dose or 2400 mg/day
- Harriet Lane Handbook (23rd ed.), p. 3121
Available Formulations
| Formulation | Concentration |
|---|---|
| Infant drops | 50 mg/1.25 mL |
| Oral suspension | 100 mg/5 mL (most common) |
| Chewable tablets | 100 mg |
| Junior strength tablets/caplets | 100 mg |
| Adult tablets | 200 mg (use only if weight-appropriate) |
Contraindications & Cautions in Children
- Do not use in infants under 6 months
- Avoid in dehydration (risk of acute kidney injury)
- Caution with renal or hepatic insufficiency
- Caution with known aspirin hypersensitivity (cross-reactivity)
- Do not use with active GI bleeding or peptic ulcer disease
- Inhibits platelet aggregation - use with caution pre-surgery
- At >30 weeks gestation in pregnant patients: contraindicated (premature ductus arteriosus closure)
- Avoid in varicella (chickenpox) - associated with increased risk of invasive group A streptococcal infection
Practical Tips
- Always use the measuring syringe or cup that comes with the medication - household spoons are inaccurate
- Give with food or milk to reduce stomach upset
- Do not give more than 4 doses in 24 hours
- If fever/pain is not controlled after 24-48 hours, seek medical evaluation
- Can be alternated with acetaminophen every 3-4 hours if needed for refractory fever, though evidence for this practice is mixed
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