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If one medication does not seem to work sufficiently to reduce fever or pain in children age 12 and under, the key is to alternate between acetaminophen and ibuprofen: administer one medication at 10 a.m., 2 p.m., and 6 p.m., and the other at 12 p.m., 4 p.m., and 8 p.m.
To prevent an upset stomach, your child should take medicine with food when possible. Your child may get acetaminophen (Tylenol) and ibuprofen (Motrin or Advil). ― Acetaminophen and ibuprofen will be switched back and forth (alternate) every 3 hours. They should not be taken at the same hour (Picture 1).
If youre not sure how much to give a child, ask your pharmacist or doctor. If you give it: 3 times in 24 hours, leave at least 6 hours between doses. 4 times in 24 hours, leave at least 4 hours between doses.
Katherine Kazmier, M.D., a pediatrician with Seattle Childrens Hospital, says its generally safe to give both medications at the same time every six hours (always following dosing instructions on the bottle). Your child can also alternate between them, taking one every three hours.
In studies of antipyretic effects, acetaminophen has a peak effect at approximately 2 hours and ibuprofen at 3 hours. The recommended dosing intervals are every 6 and every 8 hours for acetaminophen and ibuprofen respectively10; thus, theoretically they might be alternated every 3 hours.
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You can alternate Tylenol and ibuprofen (Advil) every 3 hours or every 4 hours, following the schedules outlined above. You could also alternate them on different days, for example, on a Monday you take ibuprofen, on a Tuesday you take Tylenol, on a Wednesday you take ibuprofen and so on.
In studies of antipyretic effects, acetaminophen has a peak effect at approximately 2 hours and ibuprofen at 3 hours. The recommended dosing intervals are every 6 and every 8 hours for acetaminophen and ibuprofen respectively10; thus, theoretically they might be alternated every 3 hours.
If using only one medication is not making your child more comfortable then you can try giving acetaminophen and ibuprofen together. When giving acetaminophen and ibuprofen together make sure you do not give acetaminophen more often than once every four hours, and ibuprofen more often than once every six hours.

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