I held the bottle by the bathroom sink, the sticky thick red liquid dripping slowly over my hands as panic oozed within me. How much liquid acetaminophen — the active ingredient in Tylenol — had my toddler drank from this bottle?
As a pediatrician, my biggest fear was the risk of liver failure that can come with ingesting more than the recommended dose of this medication. It remains the most common cause of liver failure in the United States. I decided to call poison control. They reassured me, and my daughter has no issues with her liver.
Never in this conversation with poison control was autism ever mentioned.
The news about acetaminophen and autism has been confusing. First, we were told pregnant women should not take the medicine, instead toughing out fevers and pain. Next, an announcement went out that children should not take it for any reason.
However, experts agree acetaminophen is not the cause of autism, and it is safe to use in children. The brain is extremely complex, and while the exact cause of autism is not known, we know that there are a variety of genetic and environmental factors at play. Pinning autism on acetaminophen is unfair and not supported by the research.
Still, this unfounded claim has stoked guilt and anger in families. We see it in the entries parents are putting on our Pediatric Health Chat, and pediatricians hear your frustration.
This call to avoid acetaminophen has brought up new challenges for families trying to navigate how to treat fever and pain in their children. Untreated fever and pain don’t only make children feel awful; they also can hinder their recovery.
There are two other medication types we can use for pain and fever in children — opioids and nonsteroidal anti-inflammatories (NSAIDs) — but both carry serious downsides.
Opioids like fentanyl or morphine can slow and stop breathing, put patients at risk for addiction, and do nothing to address fever. NSAIDs, including Motrin and ibuprofen, can be harsh on the stomach, increase risk of bleeding, and can be dangerous for patients with conditions such as kidney disease. Additionally, ibuprofen is not recommended for infants under 6 months of age, so acetaminophen is generally considered the only option for babies with pain or fever.
All these medications, when taken in recommended doses to treat specific symptoms or conditions, can be used safely in most children. Pediatric healthcare professionals recommend them only when necessary, and that’s the point. They become essential when a child is ill or in pain. Completely avoiding well-studied and frequently used medications is rarely the answer for families trying to do the best for their children.
Anyone who tells you to avoid potentially helpful medications for your child is misleading you. They should be telling you to talk to your pediatric clinician about what’s right for your family. We are happy to help explain the research and science and listen to your concerns.
When considering whether to give a medication like acetaminophen to your child, consider:
Treatment plans for your child should be devised using science. When the science is confusing and the headlines are scary, talk to your clinician to understand what is right for your child. Each child and situation is different and the pediatric clinician who knows your child best is a person trained to help guide you.