Assessment of Knowledge and Practices Regarding Pediatric Paracetamol and Ibuprofen Use Among Syrian Parents: A Cross-Sectional Survey

International Journal of Advanced Pharmaceutical Sciences and Research (IJAPSR) ISSN: 2582-7618 (Online), Volume-5 Issue-6, October 2025 15 Published By: Lattice Science Publication (LSP) © Copyright: All rights reserved. Retrieval Number: 100.1/ijapsr.E408805050825 DOI:10.54105/ijapsr.E4088.05061025 Journal Website: www.ijapsr.latticescipub.com Abstract: Paracetamol (acetaminophen) and ibuprofen are widely used for pediatric fever and pain management in Syria, but improper dosing and limited safety awareness pose significant risks. This study assessed Syrian parents' knowledge, attitudes, and practices regarding these medications. An online survey was distributed via social media (March–July 2025), targeting Syrian parents. Data from 112 respondents were analyzed, focusing on demographics, medication usage patterns, dosing knowledge, awareness of side effects/contraindications, and information sources. 85 % used paracetamol for fever; 71% used ibuprofen for pain/inflammation. Critical knowledge gaps existed: 67% lacked awareness of correct paracetamol dosing, and 87% were uninformed about ibuprofen's side effects. Only 13% knew ibuprofen's minimum age restrictions, and 48% were unaware of its contraindication in asthma. Non-professional sources (internet: 16%; family/friends: 14%) contributed to the dissemination of misinformation, although pharmacists were highly trusted (82%). 79% expressed interest in educational interventions. Syrian parents rely heavily on paracetamol/ibuprofen but lack essential safety knowledge, particularly for ibuprofen. Urgent, culturally tailored educational initiatives that leverage trusted pharmacists and digital tools are needed to mitigate the risks of medication errors in children. Keywords: Paracetamol, Ibuprofen, Survey, Awareness, Syrians. Abbreviations: COX: Cyclooxygenase OTC: Over-The-Counter NSAIDs: Non-Steroidal Anti-Inflammatory Drugs Manuscript received on 25 July 2025 | First Revised Manuscript received on 06 August 2025 | Second Revised Manuscript received on 19 September 2025 | Manuscript Accepted on 15 October 2025 | Manuscript published on 30 October 2025. *Correspondence Author(s) Ali Fadel, Student, Faculty of Pharmacy, University of Tishreen, Latakia, Syria. Email ID: [email protected], ORCID ID: 0009-0003-4863-6868. Abeer Zrika, Student, Faculty of Pharmacy, University of Tishreen, Latakia, Syria. Email ID: [email protected], ORCID ID: 0009-0004-7067-6302. Maya Hmede, Student, Faculty of Pharmacy, University of Tishreen, Latakia, Syria. Email ID: [email protected], ORCID ID: 0009-0003-0278-1891 Prof. Ayat Abbood*, Department of Medicinal Chemistry and Quality Control, Faculty of Pharmacy, University of Tishreen, Latakia, Syria. Email ID: [email protected], ORCID ID: 0000-0001-8387-3875 © The Authors. Published by Lattice Science Publication (LSP). This is an open-access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/) I. INTRODUCTION Fever and pain are among the most common symptoms experienced by children [1], leading parents to frequently rely on over-the-counter (OTC) medications such as ibuprofen (a nonsteroidal anti-inflammatory drug, NSAID) [2]and acetaminophen (paracetamol) [3]. These medications are widely used for their antipyretic (fever-reducing) [4] and analgesic (pain-relieving) properties [5]. However, despite their accessibility [6] and general safety [7] when used correctly [8], improper dosing [9], incorrect indications [10], and lack of awareness of potential side effects can pose significant health risks to children [11]. In Syria, where the healthcare system has been severely impacted by years of conflict [12], economic instability [13], and limited access to medical professionals [14], parents often self-medicate their children based on personal experience [15], advice from relatives [16], or incomplete information [17]. Studies from other low-resource settings suggest that misconceptions about fever management [18], such as the belief that all fevers must be aggressively treated or that alternating ibuprofen and acetaminophen is always safe [19], are common [20]. Additionally, dosing errors [21], whether due to confusion between infant and adult formulations or inaccurate measuring devices [22], can lead to acetaminophen-induced hepatotoxicity [23] or ibuprofen-related gastrointestinal or renal complications [24]. Understanding Syrian parents' knowledge [25], attitudes [26], and practices regarding these medications are crucial for several reasons [27]: 1. Preventing medication errors [28]: Overdosing [29], underdosing [30], or inappropriate use can result in avoidable adverse effects [31], 2. Addressing misconceptions [32]: Some parents may not recognize when a fever requires medical attention versus when symptomatic treatment is sufficient [33]. Improving health literacy [34]: In crisis-affected settings [35], targeted educational interventions can empower caregivers to make safer and more informed decisions [36]. This article examines how Syrian parents perceive and use ibuprofen and acetaminophen in children, assessing their awareness of correct dosages, potential side effects, and when to seek medical help. By identifying knowledge gaps and common misconceptions, this study aims to inform public health strategies that promote safer pediatric medication practices in Syria and similar contexts. Ali Fadel, Abeer Zrika, Maya Hmede, Ayat Abbood Assessment of Knowledge and Practices Regarding Pediatric Paracetamol and Ibuprofen Use Among Syrian Parents: A Cross-Sectional Survey Assessment of Knowledge and Practices Regarding Pediatric Paracetamol and Ibuprofen Use Among Syrian Parents: A Cross-Sectional Survey 16 Published By: Lattice Science Publication (LSP) © Copyright: All rights reserved. Retrieval Number: 100.1/ijapsr.E408805050825 DOI:10.54105/ijapsr.E4088.05061025 Journal Website: www.ijapsr.latticescipub.com II. METHODS The study was conducted from March 2025 to July 2025 through an online survey on PollMil Forms. Its purpose was to assess the knowledge and practices of parents in Syria regarding the administration of paracetamol and ibuprofen to their children. This questionnaire was part of our efforts to raise health awareness and fill knowledge gaps in this area. The survey was distributed via social networks (Facebook and WhatsApp). The questions included participants' demographic information, employment status, previous experiences with paracetamol and ibuprofen, and their scientific understanding and awareness of using these medications, as well as their benefits for children. III. RESULTS A. Demographic Data of Participants 112 responses were collected in this research. Table 1 shows the demographic characteristics of the participants. Table I: Demographic Characteristics of Participants Demographic Data Characteristics Percentages % Gender Female 60% Male 36% Children Yes 77% No 18% Age (Years) 20-30 26% 30-40 18% 40-50 31% Average Age of Children 1 month – 1 year 34% 1-5 years 12% 5-10 years 27% 10 - 15 years 11.6% 15 – 18 years 16% Study High school 15% College graduated 56% Post graduated 14% Works in Healthcare Categories Yes 6% No 94% 60% of the participants were female, while 36% were male. The 40–50 age group represented the highest portion (31%), followed by the 30–40 age group (18%). Regarding education level, about half (56%) held university degrees. 34% of participants have children between one month and one year old, followed by parents having children of five to 10 years old (27%). Only 6% worked in healthcare, indicating most respondents lacked professional medical information. B. General Knowledge about Paracetamol and Ibuprofen 71% of parents are familiar with acetaminophen, while 8% have no prior knowledge (Table 2). Only 33% know the correct pediatric dosages, indicating a possible knowledge gap about paracetamol. 85% report using acetaminophen for fever in children. 71% use ibuprofen for pain/inflammation in their children, but most parents (87%) were unaware of its side effects. These results show high usage of both medications among parents [37], highlighting the need to improve parental awareness of proper dosing [38], especially for acetaminophen [39]. Table II: Data of General Concepts of Participants About Paracetamol and Ibuprofen Options Percentages % Have you ever heard of paracetamol? Yes 91% No 8% N/A 1% How well do you know the correct dosage for paracetamol for children? I know 33% I do not know 67% When your child has a fever, do you use paracetamol? Yes 85% No 13% N/A 2% Do you use ibuprofen to relieve pain or inflammation in children? Yes 71% No 27% N/A 2% How well do you know the side effects of ibuprofen? I know 13% I do not know 87% How often do you prescribe paracetamol to your children during the year? 10 – 20 times during one year Most of the answers How often do you prescribe ibuprofen to your children during the year? 10 times during one year Most of the answers Where do you get your information about medications? Doctors 30% Pharmacist 30% Internet 16% Family 7% Friends 7% Personal experiments 11% Most participants often (31%) or always (53%) adhere to the dosages prescribed by physicians when using paracetamol and ibuprofen, while 13% deviate from instructions (Table 3). 38% of respondents reported encountering errors or drug interactions related to these medications, whereas 58% did not. 49% of participants demand more education on the proper use of these medications [40]. The participants showed high confidence [41]. Most surveyed parents followed the pharmacist's advice about these medications [42]. The most preferred pharmaceutical dosage form of ibuprofen was Syrup (44%), followed by tablets (34%) (Table 4). For paracetamol, the most preferred pharmaceutical dosage form was tablets (44%), followed by syrup (29%) and suppositories (27%). The survey results demonstrated variability in parents' knowledge regarding the appropriate dosages of paracetamol and ibuprofen for their children’s ages [43]. Specifically, 65% of respondents rated their knowledge as good to excellent. Additionally, 43% reported not knowing the appropriate age to initiate ibuprofen use [44]. International Journal of Advanced Pharmaceutical Sciences and Research (IJAPSR) ISSN: 2582-7618 (Online), Volume-5 Issue-6, October 2025 17 Published By: Lattice Science Publication (LSP) © Copyright: All rights reserved. Retrieval Number: 100.1/ijapsr.E408805050825 DOI:10.54105/ijapsr.E4088.05061025 Journal Website: www.ijapsr.latticescipub.com Table III: Data of Concepts of Participants about Trust and Safety in Use of Paracetamol and Ibuprofen Options Percentages % Do you follow the dosages prescribed by your doctor when using paracetamol and ibuprofen? Always 53% often 31% rarely 10% never 3% Have you noticed any errors or drug interactions with these medications? Yes 38% No 58% N/A 4% Do you think there is a need for additional awareness about the proper use of these medications? Yes 49% No 31% Maybe 16% How much do you trust the information provided by pharmacists about these medications? Average 82.10% Table IV: Survey Data on Participants' Information About Dosage and Intake Methods Options Percentage % If you give ibuprofen to one of your children, what is the most common way to give it to you? Syrup • 44% Compressed tablets • 34% Suppositories • 14% Others • 5% If you give paracetamol to one of your children, what is the most common way to give it to you? Syrup • 27% Compressed tablets • 40% Suppositories • 29% Others • 3% How much do you know about the dosages of paracetamol and ibuprofen when giving them to your children according to their ages? Excellent • 19% Good • 46% intermediate • 23% none • 10% What is the average age to give ibuprofen? 1 year • 21% 3 years • 34% No information • 43% What do you know about the contraindications for using ibuprofen in patients with asthma? I have knowledge 49% I do not have any knowledge • 48% Yes • 79% No • 19% IV. DISCUSSION The present study offers valuable insights into Syrian parental knowledge and practices regarding the use of paracetamol and ibuprofen [45]. High usage rates (paracetamol: 85%; ibuprofen: 71%) suggest trust in these medications for managing common pediatric symptoms such as fever and pain [46]. Lack of knowledge about side effects (87% for ibuprofen) indicates potential risks from uninformed use. Reliance on doctors/pharmacists is positive [47], but the 16% who use the internet highlights a need for verified educational resources [48] . Additionally, 43% of respondents were unaware of the minimum age at which ibuprofen can be given [49], and 48% lacked knowledge about its contraindications in asthma [50], a well-known risk factor for NSAID-induced bronchospasm [50]. These findings align with previous studies that highlight parental misconceptions about pediatric drug safety [51], emphasising the need to incorporate medication literacy into primary healthcare education [52]. The strong interest (79%) among participants to learn more about the proper use of these medications presents a key opportunity [53]. Health authorities [54], community pharmacies [55], and primary care providers should collaborate to develop culturally relevant educational materials [56] and campaigns that address these knowledge gaps [57]. Interventions could include digital content [58], simplified dosing charts [59], awareness sessions, and pharmacist-led counselling programs [60]. V. CONCLUSION The findings highlight a high prevalence of use of paracetamol and ibuprofen among Syrian parents, but also reveal significant gaps in knowledge related to dosing, safety, and contraindications. These results underscore the need for targeted health education initiatives to promote safer use of these medications in pediatric care. DECLARATION STATEMENT After aggregating input from all authors, I must verify the accuracy of the following information as the article's author. ▪ Conflicts of Interest/ Competing Interests: Based on my understanding, this article has no conflicts of interest. ▪ Funding Support: This article has not been funded by any organizations or agencies. 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(2025). Extraction of Methylparaben and Propylparaben using Magnetic Nanoparticles. Clinical Medicine and Health Research Journal, Volume 5, Number 1, Pages 1145-1167. DOI: https://doi.org/10.18535/cmhrj.v5i1.450. 57. Hasan, B., & Asaad, R. (2023). White Blood Cell and Platelet Counts as Simple and Inexpensive Markers for Determination of the Metabolic Syndrome among Patients with Type 2 Diabetes Mellitus. Research Journal of Pharmacy and Technology, 16(2): p. 786-790. DOI: http://doi:10.5958/0974-360X.2023.00135. 58. Ghassan, A., Asaad, R., & Abedallah, N. (2024). Impact of Letrozole treatment on lipid profile in postmenopausal women with hormone receptor-positive early Breast Cancer: A prospective study. Bulletin of Pharmaceutical Sciences. Assiut University, 47 (1): 363-374. DOI:http://doi:10.21608/BFSA.2023.230365.1874. 59. Al Khleif, M., Alzoubi, N. A., Shannan, G., Malek, Z., & Thallaj, N. (2025). Exploring Circadian Rhythms: A Comprehensive Study on Sleep Patterns and Disorders in Syrian Society. Am J Biomed Sci & Res. 2025 26(2). DOI: https://doi.org/10.34297/AJBSR.2025.26.003416. 60. Shannan, G., Malek, Z., & Thallaj, N. (2025). Advancements in Monomolecular Multimodal Platforms for Cancer Theragnostics. Am J Biomed Sci & Res. 27(3). DOI: https://doi.org/10.34297/AJBSR.2025.27.003569. AUTHOR’S PROFILE Ali Fadel, Undergraduate Student, Fifth year in Pharmaceutical Chemistry and Quality Control Department at the Faculty of Pharmacy, Tishreen University, Latakia, Syria. Pharmacy student at Tishreen University. registered dates at the university between 2020 and 2025. ICDL certificate in 2025. Highlights: Board theoretical experience in analytical methods, synthesis of organic compounds, pharmaceutical preparations, medicinal chemistry principles, TLC methods, high liquid performance methods, Gc methods, UV/visible spectrophotometer principles, electrochemical techniques, IR and NMR specters, extraction methods, gel electrophoresis methods, capillary electrophoresis methods, quality control of solid dosage forms, quality control of liquid dosage forms, quality control of semi-solid dosage forms, GMP, GLP, sampling, Food chemistry. Abeer Zrika, Undergraduate Student, Fifth year in Pharmaceutical Chemistry and Quality Control Department at the Faculty of Pharmacy, Tishreen University, Latakia, Syria. Pharmacy student at Tishreen University and registered at the university between 2020 and 2025. ICDL certificate in 2025. Highlights: Board theoretical experience in analytical methods, synthesis of organic compounds, pharmaceutical preparations, medicinal chemistry principles, TLC methods, high liquid performance methods, Gc methods, UV/visible spectrophotometer principles, electrochemical techniques, IR and NMR specters, extraction methods, gel electrophoresis methods, capillary electrophoresis methods, quality control of solid dosage forms, quality control of liquid dosage forms, quality control of semi-solid dosage forms, GMP, GLP, sampling, Food chemistry. Maya Hmede, Undergraduate Student, Fifth year in Pharmaceutical Chemistry and Quality Control Department at the Faculty of Pharmacy, Tishreen University, Latakia, Syria. Pharmacy student at Tishreen University and registered at the university between 2020 and 2025. ICDL certificate in 2025. Highlights: Board theoretical experience in analytical methods, synthesis of organic compounds, pharmaceutical preparations, medicinal chemistry principles, TLC methods, high liquid performance methods, Gc methods, UV/visible spectrophotometer principles, electrochemical techniques, IR and NMR specters, extraction methods, gel electrophoresis methods, capillary electrophoresis methods, quality control of solid dosage forms, quality control of liquid dosage forms, quality control of semi-solid dosage forms, GMP, GLP, sampling, Food chemistry. Assessment of Knowledge and Practices Regarding Pediatric Paracetamol and Ibuprofen Use Among Syrian Parents: A Cross-Sectional Survey 20 Published By: Lattice Science Publication (LSP) © Copyright: All rights reserved. Retrieval Number: 100.1/ijapsr.E408805050825 DOI:10.54105/ijapsr.E4088.05061025 Journal Website: www.ijapsr.latticescipub.com Prof. Ayat Abbood, pharmaceutical chemistry and quality control department, Tishreen University - Ph.D. in pharmacy in the field of drug control (20062010, University of Paris-11, France) - Master 2 Research: Research and Analytical Development (2005-2006, University of Paris-11, France) - Professional Master 1: Quality Control of Medicines and Other Health Products (2004-2005, University of Paris-11, France) - Bachelor's degree in Pharmacy and Medicinal Chemistry (1996-2000, Tishreen University, Latakia) lead of Medicinal Chemistry and Quality Control -Faculty of Pharmacy -Tishreen University (2021 until now) - Head of Pharmacy Department - College of Pharmacy and Health Sciences - Al-Manara University (3 years) - Dean of Pharmacy Faculty –Al-Jazeera University (one year). 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