Although both acetaminophen and ibuprofen are widely used to manage fever and pain in children, treatment recommendations for very young children vary. Researchers conducted a systematic review and meta-analysis to compare the antipyretic, analgesic, and safety profiles of acetaminophen and ibuprofen for the short-term treatment of fever or pain in children younger than two years of age.

Included in the analysis were 19 randomized and nonrandomized studies that had a total of 241,138 participants. The studies were conducted in seven countries and various settings, including both hospital- and community-based health care settings.

Compared with acetaminophen, ibuprofen was associated with a reduced temperature within four hours of treatment onset and from four to 24 hours after treatment. Ibuprofen was also associated with less pain at four to 24 hours after treatment onset. No data were available regarding pain outcomes in the first four hours after treatment. The incidence of adverse events was low with both treatments. The safety profile of acetaminophen and ibuprofen was similar with respect to kidney impairment, gastrointestinal bleeding, hepatotoxicity, and asthma and/or wheezing at 28 days or less after treatment.

A major limitation of the study is the small number of participants included in the analgesic analysis, the authors write. Only four studies included pain outcomes, none of which reported on pain within four hours of treatment. Comparison of adverse events was also difficult because of the small sample size of many of the studies included in this analysis.