Balancing the risks and benefits of the use of over-the-counter pain medications in children.

Paracetamol (acetaminophen) and ibuprofen are the most frequently purchased over-the-counter (OTC) medicines for children. Parents purchase these medicines for the treatment of fever and pain. In some countries other NSAIDs such as aspirin (acetylsalicylic acid) and dipyrone are available. We aimed to perform a narrative review of the efficacy and toxicity of OTC analgesic medicines for children in order to give guidance to health professionals and parents regarding the treatment of pain in a child. Neither aspirin nor dipyrone are recommended for OTC use because of the association with Reye's syndrome for the former and the risk of agranulocytosis for the latter. Both paracetamol and ibuprofen are effective for the treatment of mild pain in children. Adverse effects with both medicines are infrequent. Ibuprofen is an NSAID and therefore there is a greater risk of gastrointestinal adverse effects and hypersensitivity. Aspirin and dipyrone should be avoided. Paracetamol is the drug of first choice for mild pain in children because of its favourable safety profile. For the treatment of significant musculoskeletal pain, ibuprofen is the drug of first choice.