Should you use ibuprofen to treat your child’s fever during COVID-19?

Doctors are cautioning against using anti-inflammatories like ibuprofen to treat children’s fevers during the COVID-19 pandemic. But why? We asked a paediatrician for answers.

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While many parents reach for anti-inflammatories such as ibuprofen to treat pain, fevers and teething problems, recent research has shown that anti-inflammatories could aggravate the novel coronavirus, also known as COVID-19. This has sparked global concern amongst parents who are being advised to use acetaminophen (also known as paracetamol) instead, but why?

We spoke to specialist paediatrician at Life Fourways Hospital, Dr Natasha Padayachee-Govender about COVID-19, as well as how to treat your sick child during the pandemic.

How many children have been infected with COVID-19 worldwide?

As of 24 March 2020, COVID-19 has been responsible for more than 450 000 infections and over 18 000 deaths worldwide, but data regarding infected children is limited, says Dr Padayachee-Govender. However, a recent review of 72 314 cases by the Chinese Center for Disease Control and Prevention showed that less than 1% of the cases were in children younger than 10 years of age.

Should you use ibuprofen to treat fevers during this time or not?

“The information about COVID-19 is dynamic,” says Dr Padayachee-Govender. “This means it’s always changing, and daily recommendations are being adapted and changed based on new evidence that emerges about the virus.

“The jury is still out on the exact reason why ibuprofen shouldn’t be used at this time. It’s speculated that there’s a type of runaway immune response known as a ‘cytokine storm’ which may be responsible for the high mortality rate in severe flu pandemics. Emerging information about how SARS-CoV-2 virus infects cells has led to speculation that NSAIDS (anti-inflammatories like ibuprofen) may worsen clinical disease,” she explains.

But there’s conflicting views…

The World Health Organisation (WHO) recently confirmed that they’re not aware of reports of any negative side-effects of ibuprofen besides the usual side effects that limits its use in some people.

Also, the European Medicines Agency (EMA) has confirmed that “There is currently no scientific evidence establishing a link between ibuprofen and worsening of COVID-19 (18 March 2020).

In their report, they suggest that people should look at all options for treating fevers including paracetamol and ibuprofen.

ALSO SEE: Coronavirus and pregnancy: should you be concerned?

What’s the best way to treat your child’s fever?

Dr Padayachee-Govender has the following suggestions:

Increase fluids

Encourage your child to drink plenty of fluids such as water. If your little one has a fever, she may not feel hungry, but the good news is, it’s not necessary to force her to eat. However, fluids such as breastmilk, formula, and water should be offered frequently. Older children may eat jelly, soup, or frozen lollies. If your child is unwilling or unable to drink fluids for more than 6 hours, you should consult your doctor.

ALSO SEE: Make your own ice pops

Encourage rest

Most children feel tired and achy with a fever. During this time, you should encourage your little one to rest as much as possible. It’s not necessary to force your child to sleep or rest if she begins to feel better. She can resume normal activities when her fever has subsided for 24 hours or more.

Try sponging and baths

Sponging involves placing your little one in a bathtub and using a damp washcloth to apply comfortably warm (30°C) water to her entire body. Cooling occurs as water evaporates from the skin surface, which will help bring down your child’s fever. Therefore, your little one doesn’t need to be wrapped in a towel after a bath or submerged in cold water. If you sponge your child down, it’s a good idea to give her anti-fever medications straight afterwards.

Use the right medications

The most effective way to treat a fever is to use a medication such as paracetamol (Calpol, Panado, Empaped), especially if your child contracts the coronavirus. It’s important that children are given the correct dose per weight. The dosing times also need to be accurate. If you’re unsure, check with your doctor.

Here is a rough estimate:

Paracetamol: 15mg/kg per dose 6 hourly

A word of warning… hold off on elderberry

Elderberry syrup and gummies have always been popular during flu season. However, the very reason some hoped elderberry would help with influenza is the reason to avoid it during the COVID-19 pandemic, warns Dr Padayachee-Govender. Elderberry (Sambucol) extract has been shown to increase the body’s production of inflammatory cytokines, which is thought to be helpful against influenza. Unfortunately, right now doctors believe that its high levels of cytokines, or specifically cytokine storm, is contributing towards the mortality rate with COVID-19.

If your child’s temperature is not coming down and your child is feeling worse – call your doctor to discuss further treatment options.

How serious is COVID-19 for kids?

While most children recover from COVID-19, there are still critical cases, says Dr Padayachee-Govender. “According to the American Academy of Paediatrics, a new study on 2 143 children with suspected cases of COVID-19 in China showed that 6% of children had severe or critical illness. Of those children with confirmed cases of COVID-19, about 3% had severe or critical symptoms.

“That’s much better than adults, where it’s 18.5%, but that’s definitely a higher number than I’d like,” she explains. “And infants had a higher rate of serious illness than children. Just under 11% of infants had severe or critical cases. That means 1 in 10 infants had serious illness,” she adds.

“We all need to work together to slow the spread of COVID-19 so that our hospitals are not too full to care for those who need us. We can find meaning and community in our shared purpose.

Together we can protect the vulnerable by staying away from each other. We need to take social distancing seriously.”

Tips to keep your family safe:

Protect grandma and grandpa

“Keep your kids away from grandma and grandpa unless you live together. Adults over the age of 60 are the group we are most worried about,” says Dr Padayachee-Govender. “We really don’t know yet how contagious kids are with COVID-19. And while there’s speculation that they may not be as contagious as adults, we need more information before we take chances with a disease that’s deadly to so many older adults.”

Prioritise your child’s health

Paediatricians are taking stringent measures to make sure their offices are safe and you’re advised to continue with your kids’ regular check-ups, especially if they’re under age 2 and need their vaccines. This is one of the best ways to help your children develop a stronger immune system.

It’s also important that you and loved ones get the flu vaccine. “We recommended this for infants over 6 months old,” says Dr Padayachee-Govender. There’s an overlap of symptoms with COVID-19 and influenza. The flu vaccine will help to keep you and your family protected from flu season which is starting.

ALSO SEE: The flu vaccine – everything you need to know

Call your doctor first

If you’re concerned that you or your loved one has contracted COVID-19, don’t walk into a clinic. Call your GP or paediatrician so they can direct your care and make sure you get the help you need.

Wash those hands well and cough into that elbow!

It’s so easy to forget how powerful hand washing can really be to stop the spread of contagious illness.

About the expert

Dr Natasha Padayachee-Govender has been a specialist paediatrician at Life Fourways Hospital since 2015. Her special interests are in allergies and asthma, neonatal intensive care and early childhood development. She has published and contributed to articles about children’s health and medical conditions. She is always researching and keeping up to date with the latest literature to provide the best evidence-based care for her patients. She often posts valuable resources and information on her Facebook page “Prana Kids Paediatrics”. It’s a great resource for you and your family. Learn more about Dr Natasha Padayachee-Govender here.

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