What To Do for Tots Getting Shots

Acetaminophen after vaccination okay to treat fever

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) It's not easy to watch your baby get their shots. Parents often ask whether it's helpful to give a child acetaminophen to reduce some of the pain and swelling that can result.

Acetaminophen is the generic name for Tylenol. A recent study found that it might help reduce the risk of a fever in babies, but not enough for doctors to recommend it.

In toddlers, the acetaminophen doesn't seem to make a difference in preventing fevers after vaccinations.

These researchers concluded it was best to wait and only give acetaminophen to babies if they develop a fever or other symptoms after their shots.

"Talk to your pediatrician about the CDC recommended immunization schedule."

The study, led by Markus A. Rose, of the Department of Pediatric Pulmonology/Allergy/Infectious Diseases at Goethe University Children’s Hospital in Germany, looked at the effectiveness and safety of giving children acetaminophen at the same time as their scheduled vaccines.

The researchers included 301 healthy babies in the study. The babies received the recommended vaccinations in Germany at 2 months, 3 months, 4 months and 11-14 months.

The vaccines administered included the 7-valent pnuemococcal conjugate vaccine for pneumonia, the hepatitis B vaccine, the inactivated polio virus, the Haemophilus influenza type b (Hib) vaccine and the DTaP for diphtheria, tetanus and pertussis (whooping cough).

These are the same vaccines recommended at well-child visits for infants in the US.

The babies were randomly divided into two groups. One group of 148 babies was given acetaminophen each time they received their vaccinations.

They received their first dose immediately after getting their vaccinations and two more doses six to eight hours between each one.

Each dose was either 125 mg or 250 mg each, depending on the child's weight.

The other group of babies did not receive any acetaminophen following vaccinations.

The babies' temperatures were measured and any other possible reactions were assessed for four days after vaccination.

The most common reactions were tenderness, swelling and redness at the injection site.

When the children were toddlers, there was not much difference in fevers between those who had the acetaminophen and those who did not.

Following the infant doses, however, fewer of the babies that received acetaminophen experienced a low grade fever (between 100.4 and 102.2 degrees Fahrenheit) compared to those that did not get the acetaminophen.

For example, after the first dose, 9 percent of the babies getting acetaminophen experienced a low grade fever compared to 36 percent of those without acetaminophen.

Among the babies getting acetaminophen, 19 to 20 percent had a low fever after their second and third doses, compared to 44 to 46 percent of babies without acetaminophen.

High fevers were too rare among the babies to determine how much the acetaminophen might have helped.

The researchers concluded the acetaminophen did prevent fever and other reactions mostly for the infants, with about 43 percent effectiveness.

However, the reactions and fevers were mild, and the overall effectiveness was less than 50 percent.

The researchers concluded that the data is not strong enough to support changing the current recommendation, which is to give children acetaminophen only if they develop a fever and not immediately after vaccinations to prevent a fever.

Tracie Newman, MD, a pediatrician with Sanford Health in Fargo, North Dakota, and a dailyRx expert, said she talks to a lot of her patient families about whether to take acetaminophen for immunizations.

She said for many years, it was recommended that children receive acetaminophen at the time of vaccination to prevent fevers. But times have changed.

"There is pretty good data now that we should probably not be doing this," Dr. Newman said. "Fever can be a natural reaction to an immune trigger. It means the body is responding and building the protection we want."

A fever therefore usually means the vaccine is working.

"It makes intuitive sense that we would not want to suppress the very immune system from which we are trying to elicit a reaction," Dr. Newman said. "I recommend my families watch and wait."

She said an alternative for pain relief is to give babies sugar water during shots, which another study recommends.

"We already do this during circumcisions and babies love it," she said. "Many clinics around the country are doing this with vaccine administration."

The study was published June 21 in the journal BMC Pediatrics. The research was funded by the pharmaceutical company Wyeth, now owned by Pfizer Inc.

Two authors are consultants for Wyeth/Pfizer and have received travel funds from the company. Three authors are current employees of Pfizer Inc., and one author was an employee of Wyeth.

Review Date: 
June 25, 2013
Last Updated:
September 6, 2013