Fort Worth, Texas,
09:43 AM

4 Reasons Why This Pediatrician Doesn't Alternate Tylenol and Motrin for His Kids

It’s a classic bit of advice when you child is running fever: Alternate Tylenol and Motrin around the clock to keep their fever down.

But, does it help? Is it necessary?

I personally don’t think so…and here are 4 reasons why:

1. I don’t treat numbers, neither temperatures nor times.

When your child has fever, sometimes it’s not such a bad idea to let it be. If the child isn’t too uncomfortable and they are drinking well, it’s reasonable not to treat even if their temperature is high. If you’d like more information, read this great post from Dr. Paul Offit called, “The Case for Letting Fever Run It’s Course.” The bottom line is that treating fever may in fact cause the symptoms to last longer and the child to be contagious longer than just letting it run it’s course.

Bottom line: If treating the thermometer is not the best idea, should we be treating a child every three hours, around the clock, just in case? Maybe not.

2. It might keep the temperature lower, but it doesn’t make kids feel better.

There have been a few studies that suggest treating fever on a scheduled basis might keep the child’s temperature lower. So, it probably does work to do that. The interesting thing with those studies is that when you ask the parent how well they thought the fever was controlled, both groups reported that their fever control was adequate.

Bottom line: Even if the temperature was lower, the parents couldn’t tell the difference in how the child felt.

3. It increases the risk of extra doses.

When your child is sick, you are tired and stressed, things are complicated enough. The risk of extra doses is significantly higher when you are alternating medications. While the risk of an extra dose here and there probably isn’t high, if there is little to no benefit, I choose not to risk it.

Bottom line: If you are going to do alternating doses, write them down somewhere to keep track.

4. I’m lazy and it’s too much trouble for me.

This is not one of those issues that I’m willing pick a big fight with another doctor or patient over…but given the three points above combined with my desire to keep everything as simple as possible, I don’t personally alternate fever reducers for my kids and I don’t routinely recommend it for my patients.

Get to know Justin Smith, M.D.

Justin Smith, M.D., is a pediatrician in Trophy Club  and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. Dr. Smith is an experienced keynote speaker for a variety of topics including pediatric/parenting topics, healthcare social media and physician leadership. If you are interested in having Dr. Smith present to your conference or meeting, please contact him at

He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” open now. Click to learn more. To make an appointment, call 817-347-8100.


Comments 1 - 7 (7)
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Hi, I have a question. Maybe several lol. My baby is 10 months old and always gets high fevers when sick with a virus or ear infection etc. rarely is it below 103 and a lot of the time it goes up to 105
Justin Smith, M.D.
Thank you Katrina for your question. It doesn't because treating fever aggressively has not been shown to decrease the incidence of febrile seizures:
Does your advice change if the patient has a history of febrile seizures?
Cook Children's
Thank you Jen for your question.If you would like to alternate that is fine, depending on the advice of your pediatrician and their preference. Consult with your pediatrician on this topic. Thank you.
What about if they have tested positive for the flu and you are worried about chills/aches? I hate using meds if they aren’t necessary but my almost 7 month old has it and she seems pretty miserable. Thank you!
Kim E
Thank you for great info. I am an ED APRN and I also do not promote alternating between acetaminophen and ibuprofen for the reasons already stated. In addition, if the febrile illness has a GI component, giving ibuprofen on an already irritated belly as well as often underhydrated child is not a good idea. Just wanted to add that to your already sound advice. Thanks so much!
Paul Smolen
Justin, I am a fellow pediatrician and i agree with your feelings about alternating ibuprofen and acetaminophen but there are few other reasons that parents need to be careful with these medications. Reason #5-With viral illness, kids get better faster if their fever is not treated. The fever is accelerating their recovery. Reason #6- I have seen many children who have become hypothermic at the end of a alternating regime of these meds that has gone on for days. This can't be good for them. Thanks for the nice post and keep up the good work. Doc Smo