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Cited by 5Pharmaceutical studies and practicesThermal Regulation in MedicinePediatric Pain Management Techniques

Efficacy and Safety of Paracetamol and NSAIDs for Fever and Pain Management in Children with Chronic Diseases: A Narrative Review

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Milani, Gregorio Paolo, Nicolini, Giangiacomo, Cananzi, Mara, Spiezia, Luca, Vidal, Enrico·2026·Children
DOI 10.3390/children13010071PMC PMC12839990
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Abstract

Background/Objectives: Fever and pain are among the most common symptoms in pediatric infections and chronic diseases, causing significant discomfort for children and concern for caregivers. Effective management is essential to relieve distress while avoiding overtreatment or undertreatment. Paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs), particularly ibuprofen, are the primary antipyretic and analgesic agents in pediatric care, but their use in children with chronic conditions might be challenging. Methods: A narrative review and clinical expert judgment were used to synthesize current evidence on the use of paracetamol and NSAIDs (especially ibuprofen) in children with some common chronic diseases. Results: Paracetamol is often considered a first-line option in several chronic conditions. Caution is warranted in children with pre-existing malnutrition, obesity, and neuromuscular disorders as these factors might increase the risk of hepatotoxicity. NSAIDs provide additional anti-inflammatory effects and comparable analgesic efficacy but should be used cautiously in some high-risk populations due to potential gastrointestinal, renal, and bleeding complications. Their use is contraindicated in children with dehydration, renal impairment, nephrotic syndrome relapses, while careful risk-benefit assessment is required in small and vulnerable neonates. Some data also suggests NSAIDs may worsen outcomes in certain acute bacterial and viral infections. Data on chronic infections such as tuberculosis, HIV, and viral hepatitis are limited, highlighting the need for further research. Combination therapy with paracetamol and ibuprofen may enhance analgesia in postoperative settings without significantly increasing adverse events. Overall, available evidence is limited and largely observational. Conclusions: This narrative review synthesizes current evidence and clinical expertise to provide practical guidance on the rational use of paracetamol and NSAIDs in children, emphasizing individualized therapy according to comorbidities, risk factors, and clinical context, particularly in vulnerable populations. A risk-adapted, evidence-based approach ensures optimal symptom control while minimizing harm, supporting safer, more effective, and family-centered care for children with fever and pain.

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  • For short-term treatment of acute pain and fever, robust evidence continues to support both the efficacy and comparative safety of paracetamol.

    “For short-term treatment of acute pain and fever robust evidence continues to support both its efficacy and comparative safety [ 1 , 2 , 20 ].”

    From Paracetamol: A History of Assumptions, Errors, and Evidence Reversals in Pain Management (2026) · cites this paper as [20]

    Section 4.1 (page unavailable) says numerous trials demonstrate paracetamol’s efficacy for fever and mild-to-moderate pain in children. Sections 1 and 4.2 (pages unavailable) describe a favorable safety profile and generally comparable safety to ibuprofen at recommended doses. The citing sentence does not limit its claim to children or acknowledge the review’s cautions for children with particular comorbidities. (LLM, conf=0.82)

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Cited by

Sorted by citations

Authors
Milani, G. P., Nicolini, G., Cananzi, M., Spiezia, L., & Vidal, E.
Affiliations
  • University of Milan (IT)
  • Pediatric Care Unit, Conegliano Hospital, 31015 Conegliano, Italy
  • University of Padua (IT)
  • University of Udine (IT)
Corresponding author
Vidal, Enrico
ORCID
Venue
Children
Publisher
MDPI AG
Published
2026-01-01
Volume
13
Issue
1
Pages
71
ISSN
2227-9067 (ISSN-L)
DOI
10.3390/children13010071
PMC
PMC12839990
OpenAlex
W7117987093
Cited by
5
References
7
Citations by year
2026: 5
FWCI
9.84
Type
journal article
Language
en
Open access
Licence
Locations
  • Children (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • Institutional Research Information System (University of Udine) (submittedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Archive of Doctoral Theses and Digital Collections (University of Calabria) (submittedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion, cc-by)
Funders
Angelini
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Thermal Regulation in Medicine
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
paracetamol, ibuprofen, nonsteroidal anti-inflammatory drugs, fever management, pediatric pain management, children with chronic illness, antipyretics, analgesics, hepatotoxicity, gastrointestinal adverse effects, renal adverse effects, bleeding risk, malnutrition, obesity, neuromuscular disorders, nephrotic syndrome, neonates, combination therapy, postoperative analgesia, tuberculosis, HIV, viral hepatitis, pediatric infection

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