Earlier this year there was a massive Tylenol recall. The recall included Infant Tylenol drops, Children’s Tylenol, as well as many other children’s medications. I’m not exaggerating when I say massive, but generic medications (liquid acetaminophen made by Walgreens or CVS, for example) were not included. The recall was a great reminder that generics are just as good as brand-name medications.
The recall also serves as a great reminder that giving medications to children is never risk-free. Recalls like this remind us to use medications only when absolutely necessary. There is always risk when you intervene.
Tylenol (acetaminophen) is a great medication. It has a place in our medicine cabinets and in keeping children comfortable in the face of fever or pain. Teething, viral infections, ear infections, and minor injuries are great times to use Tylenol. But prior to shots is not. Or afterward, as it turns out. After shots, Tylenol will help prevent fever, but may also prevent the desired immune response. There is new data to support this that has changed the way I think and counsel families about Tylenol. Now when parents ask, I say,“If it were my child, no Tylenol before shots.”
Fever is a “normal” immune response to a trigger (medical school and residency taught me this). But being a mom has certainly shown me that fevers in my babies don’t feel “normal.” When we pediatricians say it’s “normal,”we neglect to connect with the experience of parenting a feverish child. I understand why so many parents reach for the Tylenol. I did; after F’s 2 month shots, he developed a low-grade fever and cried his little face off. I gave him Tylenol twice that night. I wouldn’t have, had I known this:
Fever is a part of the body’s natural inflammatory response to infectious triggers (viruses or bacteria). And to shots. Scientifically speaking, post-shot fevers demonstrate the immunization given is working!
So what if giving Tylenol (a fever-reducer) reduces the immune system’s response? Some Czech Republic doctors wanted to find out.
They published their findings in The Lancet. They wanted to evaluate a baby’s immune response after the standard 2 month-old immunizations. Researchers sorted babies into two groups, one in which the babies received the 2 month shots, and another in which the babies received the 2 month shots and then received Tylenol every 6-8 hours afterward for 24 hours. They looked at the outcomes of fever in both groups and observed the desired immune response (blood tests) in all babies. Since shots are given to trigger the immune system to remember a particular insult, if the baby’s immune system doesn’t respond and develop antibodies to the vaccine, the shot isn’t as effective. They wanted to know if Tylenol dulled the effect of the shots.
The Study Results:
- High fever over 39.5ºC (103ºF) was uncommon in both groups (≤1% of all infants).
- Low-grade fever around 38 ºC (100 ºF) was very common (in 42% of infants receiving Tylenol, and in 66% of kids without Tylenol).
- Babies who received Tylenol had a reduced immune response. The study found antibody concentrations were significantly lower in babies who received the Tylenol compared with those who didn’t. This was true to all vaccine types tested. Even after booster shots later on (at 4 and 6 months, for example), the lower antibody concentrations existed in the group that originally got the Tylenol for 3 different vaccines.
Powerful stuff. The fact is, fever is a common and expected response after immunizations and shots. Tylenol will help prevent fever in some, but may also prevent the desired immune response. This study found that around 1/2 of all 2 month-old infants (42-66%) had temperature elevation in the first 24 hours. Most babies tolerate temperature elevation without complaint. Others may be sleepy, cranky, or decrease their feeding. Although Tylenol will reduce the likelihood that your infant has a mild temperature, this reduction in inflammation may reduce the effectiveness of the shot.
Mama Doc Tips: How To use Tylenol After Shots:
- Never give Tylenol before shots. You may decrease your baby’s (or child’s) immune response to the shot for no reason. It’s okay for your baby to have a fever. It’s a safe and normal response to immunization.
- Think about using Tylenol only when necessary. If your baby seems remarkably fussy, uncomfortable or has a high fever (over 103ºF) after shots, consider using Tylenol. If your baby or child has a low-grade temperature (100-101 ºF) after shots, avoid using Tylenol as it may interfere with the immune response.
- Fever is “normal” but unsettling. Talk with your child’s pediatrician about ways to support your child when they have a fever.
HereWeGoAJen says
We’ve only done Tylenol after one set of shots (the first ones), when she ended up with a huge knot in her leg at the injection site and was very uncomfortable. I had read about this study (or a similar one) before we started shots.
Kim B. says
Thank you for this post. I follow your blog and always learn a lot. Regarding Tylenol and immunizations, I agree with the advice here. As a new mother and an epidemiologist, I read the Lancet study very carefully when it was first published. Before the article came out, I gave Tylenol to my baby prophylacticly before immunizations. Now I avoid it, unless my son develops symptoms that suggest his low-grade fever is bothering him (e.g. crankiness, crying).
I do want to make one point, however, about the Lancet results. Although the difference in antibody titers was statistically significantly different between the two groups of kids, we do not know whether that difference is *clinically* significant. That is, unless we follow these kids up for a longer time, we actually don’t know whether a lower antibody titer means that the kids are not protected against infection. Maybe both groups achieved the threshold level of immunity to confer protection. To know this, a new study would need to be conducted.
Wendy Sue Swanson, MD says
Great point, Kim. Thanks for your careful read and your comment. I agree that we don’t know if those reduced antibody titers mean that those children won’t be protected from infection years from now. Only follow up studies will tell us that.
Jessica says
HI there, I just came across your blog while searching for information about the risks of Tylenol. I have always given my (now 2 1/2 year old) son Tylenol before and after his shots, and also whenver he’s shown even the littlest amount of discomfort from fever. I have been especially concerned about fever ever since he had a febrile seizure at 18 months. Now I have been reading about the possible link between Tylenol and childhood asthma….a new study has just come out: https://www.msnbc.msn.com/id/38690295/ns/health-kids_and_parenting
My son tends to get wheezing and asthma symptoms when he gets a cold..now I am wondering if this could be related toimmismi my pretty liberal use of Tylenol. If it were your child, would you still give Tylenol at all? What alternatives are there?
Wendy Sue Swanson, MD says
Jessica,
I like this summary of the same findings: https://consumer.healthday.com/Article.asp?AID=642092
Like the article points out, there is no proof that Tylenol use CAUSES asthma. Kids who use more Tylenol (who ended up being more likely to be wheezers) may simply use more medication than other kids, without asthma. This study just found a correlation, not an explanation.
Tylenol is a safe medication, but like any medication, should only be used when absolutely necessary. So as the summary I copied above states, I still think Tylenol may be the safest choice for minor aches and fever. Ibuprofen is an okay alternative but doesn’t have the same safety profile.
Claire says
What about antibiotics? If my own Sweet O has yet another ear infection and is on antibiotics, should I wait to get his flu shot? I guess I could post this on the flu shot post as well! You’ve covered so much already, I am surprised I have another question!
Wendy Sue Swanson, MD says
I answered this exact question twice in clinic today so clearly I should have mentioned it! It’s okay to have your child get their flu shot while on antibiotics for an infection. Only if your child had a fever would we really encourage waiting (to ensure immunization effectiveness).
S says
I know this is an older post (came across it in a google search). I am looking for information to help me figure out what to do with my fussy, just-vaccinated son. I don’t understand why the study of one thing (giving before the vaccination) led to the recommendation against a different thing (giving after a fever has already developed from the shots). My kid’s been feverish all day. My husband tells me that it really makes no difference whether you give the Tylenol before or after, based on the immune response time course. (I obviously have zero understanding of immunology.) If you read this comment, would you mind explaining? Thanks.
Wendy Sue Swanson, MD says
You ask a good question, S. I would suggest that giving acetaminophen any time around the time of injection (before or after) may have a similar effect on the immune system. When you give shots, you provide particles or tiny pieces of bacteria/virus. This stimulate the human body to react by making an army of immunoglobulins (antibodies or immune fighters) to form. These immunoglobulins then stick around for LIFE (most of the time) to protect a baby,child,or adult from potential infections.
This study isn’t conclusive that acetaminophen at the time of, or before/after shots, causes a decreased ability to fight off infection….rather just a decreased amount of antibodies. Potentially it might diminish that, but no one knows that yet.
So, don’t over-think this. If you feel your baby would benefit greatly from a dose of acetaminophen you may consider it.
Consult your child’s doc if you’re concerned about how he/she is doing. But what you feel is best for your child. Acetaminophen to ease discomfort can sometimes provide great comfort and symptom improvement.
Christine says
Thank you for this post! I had heard about the study when it came out, but I realized after leaving the doctor’s office that I’d forgotten to ask about when I should give acetaminophen. When I did a search online, all the results were saying that it shouldn’t be routine, but this is really the only place that said what the actual triggers to give acetaminophen should be.
hayley says
this is great advice. im all pro let the fever run its course if you can. i just had a 2month old get shots and i just wanted to check to make sure that i wasnt being a bad mom for not giving him tyelonal at 99.7
Wendy Sue Swanson, MD, MBE says
I don’t think you need to give Tylenol, Hayley, unless you feel your baby is very uncomfortable.
Don’t treat the number on the thermometer, treat your baby.
Kai G says
My son got ibuprofen with his 2nd set of shots – given it also works as a fever reducer, would it also potentially reduce the vaccination effects like acetaminophen? Also, based on an earlier comment it was stated that ibuprofen doesn’t have as good a safety profile (eek!) – what exactly does that mean, what additional risks are incurred?
Erin says
My 12 month old baby received the six recommended shots on Friday as part of her well child check up. She was just a little warm on Friday night as well as Saturday and Sunday but today is Monday (72 hours later) and she just started running a 101-ish degree fever today. Everything I’ve read as well as my pediatricians office says a fever from shots should only last up to 48 hours. Is there any way today’s fever could still be related to that or should I start looking for another source? She has no other symptoms just the fever. Would love another perspective. Thanks.
Wendy Sue Swanson, MD, MBE says
Timing of fever response after immunization varies with what immunizations are given. For example, MMR immunization tends to give a fever between 7-12 days after injection (because of the way that the immunization stimulates the immune system) where other immunizations can provoke a fever response within a few days.
Check out this reference for more or call your pediatrician’s office to review if you have any concerns about your child:
https://www.chop.edu/service/vaccine-education-center/vaccine-considerations.html?id=75765#fevers
Sasha says
Hi, I just came across this article. My 8 weeks old got her shots today. And has been really fussy and uncomfortable ever since the injections. No fever. I was going to give Tylenol to help her with her pain (she cries when she moves her legs) but I don’t want to interfere with her immune response. Are they any recommendations on how to help comfort her and make her feel better without giving Tylenol?
Wendy Sue Swanson, MD, MBE says
I think acetaminophen can help with routine fussiness after immunizations but I’m unsure it’s the best first step (bc of info in the post). Of course you know this but cuddling, holding, nursing, and other comfort measures are also a great way to support her. Consider little ice packs (wrapped in thin towel) for those sweet little legs?
Chris P says
How many days after flu shot is it safe to use Tylenol? I have a LO who’s cutting molars and cannot sleep. I will wait to give flu shot until this passes, but just curious as to how many days/weeks after vaccinations we should wait to use pain relievers.
Wendy Sue Swanson, MD, MBE says
there are no official recommendations on timing after immunization in using acetaminophen — I would use it if your child needs it for pain control and/or try other teething soothing techniques (cool wash cloths, etc).
Kaitlyn says
So my son lukas was two months four days ago and is getting his two month old shots
My dr told me to get acetamidiphine and give him 0.5-1.0 aday depending on his weight.
Is this okay? What should i do?? Ive been giving him 0.5 for the majority of the last week snd the last few days realized hes 11 pounds so i gave him 1.0
Makes me feel like SUCH a bad mom if all i did was ruin his chances of figting off the shots!!!!
Ashoolah says
My son is 4 months, he just received his 4 months shots yesterday. When he received his 2 months shots be was just a little cranky fussy aND it was hard to put him down to sleep. but this time when he received his 4 months shot they had given him Tylenol before his shots i agreed because i thought it was okay for him. later that night he got really warm at bedtime and was really fussy I didn’t think much about it till when we woke up he was still warm so I ended up giving him Tylenol which didn’t help much since he still warm & not feeling to good:( he is my first baby so I am new to all of this:( I just want him better.
Emily says
People have been giving babies tylenol to babies after vaccinations for the last 40 years. If what the article says is true, then NOBODY (millions) are fully innoculated