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Managing pain and fever in children
This module will help keep you up to date on how to manage pain and fever in children.
Follow the module down the page and note the instructions as you go.
Completing this module will:
Refresh your knowledge on the management of pain and fever in children
Check your understanding of appropriate paracetamol doses for various ages and indications
Compare the various CALPOL® product formats available for older children (over 6 years)
Recap the warning signs for urgent onward referral
Understanding childhood pain
At various points in their life a child will feel pain, whether from everyday bumps and scrapes or from common childhood illnesses. When a child is unwell it can be concerning for parents and carers and they will want to help their child to feel better quickly.
You can support and reassure them as well as recommend advice or treatment options or refer them when appropriate.
Treating pain in children
Acute pain is like an alarm from the body telling us something is wrong.1 It is a very personal experience1,2 and children of the same age can vary widely in their perception and tolerance of pain.2 Paracetamol or ibuprofen can be recommended as first-line treatment for mild-to-moderate pain in children.3
Paracetamol is thought to block chemical messengers in the brain that tell your body you have pain.4 Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) that works by reducing hormones that cause pain and swelling.5 Because paracetamol (the active ingredient in CALPOL®) and ibuprofen (the active ingredient in CALPROFEN®) work in different ways, they have different side-effect profiles, e.g. paracetamol causes less gastric irritation than NSAIDs6 such as ibuprofen.
Ibuprofen should not be used in those with chickenpox, if dehydration is suspected, or in those with asthma which has previously been triggered by ibuprofen or similar medicines.7,8 Aspirin (another NSAID) must not be given to children under 16 years of age.7
In children under 16, paracetamol (CALPOL®) or ibuprofen (CALPROFEN®) should be given alone initially for pain relief.3 If the chosen product does not bring pain relief, check whether an appropriate dose has been taken. If the dosing instructions has been adhered to, you can recommend a switch to the other analgesic, e.g. if paracetamol has been used, ibuprofen should be tried, and vice versa.3
If the child does not respond sufficiently to either drug alone, alternating paracetamol and ibuprofen can be considered.3 They should not be given at the same time7,8 and it is recommended to leave at least one hour between the two.7 Advise parents/caregivers to keep a diary of the time and dose of each medicine given to ensure they don’t give more than the maximum daily dose of either drug.7,8 If the child is still in pain after trying this, referral is required.3
A body temperature above 38°C is considered a fever.9,10 It is very common in young children and while temperatures usually return to normal within a few days,10 it can be worrying for parents/caregivers. Many are so concerned they seek out medical help; in fact, fever is probably the most common reason for a child to be taken to the doctor and is the second most common reason for a child to be admitted to hospital.9 However, most fevers in children over 6 months are not serious9 and can be managed at home.10
Did you know after the age of 6 months the actual temperature of a fever is not a good indication of whether the child is seriously unwell?9
This can be helpful to explain when trying to reassure an anxious parent/caregiver.
You can provide reassurance to worried parents/caregivers by explaining signs that indicate that the child is not seriously unwell. These include:9
- Normal-coloured skin, lips or tongue
- Normal response
- Content and willing to smile
- Stays awake, or wakes up quickly and easily when you wake them
- A strong, normal cry or is not crying
- Moist lips and tongue
Ensure the child is comfortable, drinking regularly to prevent dehydration and is dressed appropriately (not under dressed or over wrapped). Avoid sponging them down to try to make them cooler as it may make the fever worse by reducing heat loss from the skin, thereby trapping heat in deeper parts of the body. It may also be uncomfortable for the child. Parents/caregivers should check on the child regularly, including during the night.
If the child is uncomfortable or distressed, paracetamol (CALPOL®) or ibuprofen (CALPROFEN®) can be given.7,8 These can be alternated in line with the recommendations mentioned previously, if the child's distress persists or recurs before the next dose is due.
CALPOL® dose recommendations
Paracetamol (CALPOL®) rarely causes adverse effects when given at the correct dosage.11
Children need a lower dose than adults, depending on their age and sometimes their weight.12
Care must be taken as too much paracetamol can cause permanent liver damage.11
What is the correct dose/recommendation(s) for CALPOL® suspension in the following situations?
Select a situation then match it to the correct dosage
An 11-year-old with headache
Baby, under 2 months, distressed with fever
A 7-year-old with earache
A 7-month-old, 8kg, with teething pain
A 4-year-old with chickenpox, who has a fever
5ml up to four times a day of CALPOL® Infant Suspension (120mg paracetamol in 5ml)
10ml up to four times a day of CALPOL® Infant Suspension (120mg paracetamol in 5ml)
5ml up to four times a day of CALPOL® SixPlus™ Suspension (250mg paracetamol in 5ml)
10ml up to four times a day of CALPOL® SixPlus™ Suspension (250mg paracetamol in 5ml)
Unable to recommend, referral required
CALPOL® for older children
By the age of 6 years, children may take a much more active role in their healthcare. School-age children are more accurate in communicating and as they get older, many can reliably describe the location and severity of their pain.2
They may also be more engaged with, and informed about, their health choices. They could even have developed their own product preferences, particularly in certain circumstances, e.g. at home or on-the-go. To help meet these needs, there is a range of CALPOL® products for children 6 years and older, to choose from. They are formulated with over twice the strength of infant paracetamol suspension.
- 250mg paracetamol in 5ml
- Quickly soothes symptoms, starting to work on fever in just 15 minutes
- Available in 80ml (GSL), 100ml (GSL) or 200ml (P) bottles with strawberry flavour
- Supplied with an oral syringe and flow restrictor in the neck of the bottle for easy and accurate dosing
- Colour and sugar free
- 250mg paracetamol packed into 5ml sachets (GSL)
- More portable format than bottles, for pain and fever relief on the go
- 12 sachets in each pack, available in strawberry flavour
- Supplied with a double ended spoon for accurate dosing
- Colour and sugar free
- 250mg paracetamol in each melt-in-the-mouth (orodispersible) tablet
- Quickly melts on the tongue with no need for water, providing fast relief from pain and fever on the go13
- Available in strawberry flavour in packs of 12 (GSL) and 24 (P)
- Colour free
Customers may not always be aware of the full CALPOL® SixPlus™ product range so do mention these in your 6 years + pain and fever relief conversations and highlight the unique format differences which may benefit them.
CALPOL® SixPlus™ FastMelts
Watch the video explaining the mode of action of CALPOL® SixPlus™ FastMelts.
When to refer
It can be difficult for parents or carers to tell when a child is seriously ill. As previously highlighted, reassuring signs to look for are that the child is a normal colour, active, breathing normally and responsive.15 Most children with a fever do get better very quickly but some may get worse16 and need urgent referral.
Urgent referral required:
Is under 3 months old and has a temperature of 38°C or higher, or parents/carers think they have a high temperature
Is 3 to 6 months old and has a temperature of 39°C or higher, or parents/carers think they have a high temperature
Has other signs of illness, such as a rash, as well as a high temperature
Has a high temperature that’s lasted for 5 days or more
Does not want to eat, or is not their usual self and parents/carers are worried
Has a high temperature that does not come down with paracetamol
Is dehydrated, e.g., nappies that are not very wet, sunken eyes, and no tears when they’re crying
Immediate action required:
Has a stiff neck
Has a rash that does not fade when a glass pressed against it
Is bothered by light
Has a fit (febrile seizure) for the first time (they cannot stop shaking)
Has unusually cold hands and feet
Has blue, pale or blotchy skin, lips or tongue
Has a weak, high-pitched cry that’s not like their normal cry
Is drowsy and hard to wake
Is extremely agitated (does not stop crying) or is confused
Finds it hard to breathe and sucks their stomach in under their ribs
Is not responding like they normally do, or is not interested in feeding or normal activities
Pain and fever are possible symptoms of many infections, both viral and bacterial.9
If any serious infection or illness is suspected, GP referral is required.
Trusted by parents and carers for over 50 years, CALPOL® has developed a wide range of gentle and effective products to help take care of children when they’re unwell, from babies all the way through to little grown-ups.14 Remember to mention the CALPOL® product range, including the unique product formats for those over 6 years of age, in your customer conversations.
*J&J Survey 2023, 291 out of 302 parents with children aged 6 months to 12 years would recommend CALPOL® for fast effective pain relief
For more information about when to recommend the wider CALPOL® range, complete the e-moduleSTART LEARNING