Conditions such as headache, myalgia, chest pain, pharyngitis, otitis media, arthralgia, sunburn, strains, and sprains often produce minor pain in children. For treatment of this mild pain, aspirin, acetaminophen, ibuprofen (nonnarcotics), and codeine (narcotic) are excellent oral analgesic medications. Aspirin is one of the oldest analgesic medications, but its use has recently declined. It has the advantage of being inexpensive, and it has anti-inflammatory effects. Sustained high dosages are needed, however, for the anti-inflammatory effect. Thus, in most instances, aspirin is not much better than non–anti-inflammatory drugs.

Aspirin may be given every 4 hours at a dosage of 10 to 15 mg/kg per dose. Higher dosages increase only the anti-inflammatory effect—not the analgesic effect. Buffered aspirin may be tolerated better and absorbed faster, but there is no evidence to show that it acts more rapidly or lasts longer than the nonbuffered variety.

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Likewise, enteric-coated aspirin is better tolerated but has variable absorption. There are some definite disadvantages to using aspirin for pain management. It has many side effects, particularly gastrointestinal irritation in some patients, which can lead to nausea and vomiting. Aspirin also inhibits platelet function, which can lead to bleeding with overdosage, and it may cause reversible liver toxicity and central nervous system (CNS) problems (tinnitus, dizziness). Moreover, it may induce bronchospasm in asthmatic patients. Reye syndrome has been associated with the use of aspirin for varicella and flulike illness, but not for control of pain from trauma.

Acetaminophen acts centrally on nonopioid receptors in the brain to inhibit prostaglandin synthetase. Acetaminophen is more expensive than aspirin but is probably a better choice for pain associated with minor trauma or otitis media because it is tolerated better and it comes in liquid form, making it easier to give to young children. In some studies, acetaminophen has been shown to be a less potent analgesic than aspirin, but most claim it is equipotent.

One study showed that 1000 mg of acetaminophen equals to 60 mg of codeine for postpartum pain. In addition, acetaminophen does not cause bleeding and is less likely than aspirin to cause bronchospasm in asthmatics. It is dosed at 15 mg/kg per dose every 4 hours and takes effect in 20 to 40 minutes, with a peak effect in 2 hours. High dosages are usually well tolerated, but therapy should not exceed 4 to 6 g/day. Acetaminophen has no anti-inflammatory effects, and therapeutic doses rarely are associated with side effects; overdose, however, can cause liver toxicity.