Although doctors recommend that kids get either one or the other for broken bones, the two have not been compared in a clinical study, note the paper's authors, Dr. Amy L. Drendel, from the Medical College of Wisconsin, Milwaukee, and colleagues. Each choice has some theoretical risks: Codeine is a potent opiate, although it is only given for a short period of time for such injuries, and some doctors have concerns that some of the action of ibuprofen could interfere with the body's ability to repair broken bones.

Drendel's study, reported in the Annals of Emergency Medicine, began with 336 children, 4 to 18 years of age, treated in the emergency department for a broken arm. Half were given ibuprofen, and half were given or acetaminophen with codeine.

Researchers judged how well a drug worked by seeing how many children needed other pain medications. There was no appreciable difference between the two groups in that regard.

However, playing and eating were less likely to be affected by pain in children treated with ibuprofen. By contrast, the analgesic used made little difference regarding the effect of pain on school or sleep.

During the 3-day study period, about half of those children treated with acetaminophen/codeine reported a significant side effect, compared with about 30 percent of those given ibuprofen. Nausea and vomiting were also significantly higher in the acetaminophen/codeine group.

On day 1, more parents of children in the ibuprofen group were satisfied or very satisfied with their child's treatment - 86 percent vs. 68 percent. Children also seemed more satisfied with ibuprofen, because they tasted better.

Based on the results, "Ibuprofen is preferable to acetaminophen with codeine for outpatient treatment of children with uncomplicated arm fractures," the authors conclude.