Ibuprofen Use in Children During COVID-19 Pandemic

There has been much alarm raised about the use of ibuprofen in children during the current COVID-19 pandemic and lots of fake news. This issue is particularly important in children who use ibuprofen to control their disease symptoms (eg in children with PANDAS/PANS).

We are aware of stories circulating about four children in Cork but there is nothing official that we have been notified of. If this changes we will put a post here at The Children’s e-Hospital so keep a look out and check this website regularly.

The first thing to say is that COVID-19 is a new virus and our knowledge about it is limited.We do however have information coming from China about their experience in the paediatric population. Based on 45,000 cases the death rate in the 0-9 year age group was zero and in the 10-18 year age group it was very low (0.2%). Children do not appear to be significantly affected by this virus but they do act as vectors (i.e. they carry the virus and pass it on without having symptoms). Therefore the advice from the government regarding social isolation is particularly important.

Can you use ibuprofen?
Ibuprofen is an anti-inflammatory and in conditions such as chicken pox we recommend that it is not used because of the potential risk of secondary infections such as necrotising fasciitis. With COVID-19 there is NO published evidence or even anecdotal evidence that ibuprofen should be avoided in children. I am only going to talk about children.

In managing patients with PANS/PANDAS, The Children’s e-Hospital PANS/PANDAS service has always advocated short term blocks of treatment (maximum of 5 days) and then taking a break when managing flares in symptoms. After this the treatment needs to be individualised to the child and may include the use of antibiotics. What we need to ensure is that there is nothing else that needs treating in children who show a flare. So, we need to be prepared. Make sure you have a thermometer and ideally get hold of a saturation monitor. If you can, consider buying a HOTPOD child health monitoring kit but note that supplies for all of these is likely to be low. If another member of the household exhibits signs consistent with COVID-19 then it is likely that your child will get the infection but might not show a flare. If they do exhibit a flare we need to discuss each case individually but initial steps will be to use paracetamol and monitor their condition (and if possible vital signs). The early use of antibiotics may be a better option than ibuprofen until we get more information but if a child is suffering significantly the use of ibuprofen should not be completely discounted – but only for a maximum of 5 days. This will need to be discussed with your GP or paediatrician.

The Children’s e-Hospital will start a surveillance program for PANS/PANDAS patients so that we can gather data on how this population behaves and publish the output on that regularly.

Please feel free to leave comments and questions below and I will try my best to answer them.

Dr Tim Ubhi