Is It Time to Toss the Tylenol?

This common medication may be hurting our kids

When I started training as a midwife in the 1990s, standard medical guidance said acetaminophen (commonly known as Tylenol) was completely safe during pregnancy. This advice did not change over the next two decades. As long as women did not exceed the approved dose, acetaminophen was recommended for treatment of headache, back pain, fever, cold symptoms, and just about any other discomfort a pregnant woman might be experiencing. “Tylenol is safe and effective during pregnancy” was a prenatal care mantra.

Now close to 300 law firms representing thousands of families are suing the manufacturers and distributors of acetaminophen, claiming the drug neurologically injured their children. While the American Academy of Obstetrics and Gynecology still insists that Tylenol is perfectly safe during pregnancy, mounting evidence suggests otherwise. If we value the health of our children, it may be time to reevaluate our relationship with Tylenol.

Before the 1980s, most Americans (including pregnant women) took aspirin when they wanted pharmaceutical relief from aches and pains. Aspirin was also given to children to treat fever and pain. Although acetaminophen was brought to the market in the 1950s, few consumers had even heard of it before 1975 when Johnson and Johnson lobbied the FDA to make the drug available without a prescription. The drug manufacturer then implemented a large advertising campaign aimed at convincing the public that Tylenol was superior to aspirin in treating both pain and fever. At the same time the FDA had issued a warning that children should no longer be given aspirin during viral illnesses due to a very small risk of developing a serious and potentially deadly condition called Reye syndrome. Parents stopped giving aspirin and started giving Tylenol.

People associate the remedies their parents gave them during childhood illnesses with love and nurturing and safety. Just ask any of us whose mothers caringly slathered Vick’s vaporub on our chests every time we had a cough how we feel about the smell of the stuff. We now have two generations of people raised on Tylenol, and American allegiance to the drug runs deep. When we feel uncomfortable, we reach for the Tylenol. Sixty five percent of pregnant women report taking the drug. Most American parents give the drug to their children every time a new tooth is emerging or the number on thermometer rises above 98.9 F.

And all of that Tylelol may be messing us up.

It is well known that acetaminophen can damage the liver. Tylenol overdose, intentional or accidental, is the most common cause of liver injury and liver failure in children and adults. A single bottle of sweetened, flavored liquid acetaminophen can easily kill a child, yet nearly every American family has a stash of this drug in the house.

Tylenol is metabolized in the liver, and even small amounts can damage the organ. While most medical authorities insist that standard doses of Tylenol cannot harm us, studies show that over one third of people taking the recommended dose of acetaminophen for pain or fever experience liver injury. These liver injuries usually heal when the patients stop taking acetaminophen. While pediatricians and other primary health care providers continue to recommend Tylenol for fevers and discomforts, the peer-reviewed site MedicineNet states that “Tylenol should be used cautiously under a doctor's supervision with monitoring of liver enzyme levels.”

Outside of the liver, Tylenol primarily affects the nervous system. Which is why people take it. Acetaminophen inhibits the production of prostaglandins within the brain and spinal cord. This makes a person less likely to perceive pain. Prostaglandins in the central nervous system play a role in the fever response, so Tylenol also suppresses fever. In addition to reducing pain and fever, Tylenol might be creating some unintended effects in the central nervous system.

A 2019 study conducted by Johns Hopkins University and funded by the National Institute of Health found that children exposed to acetaminophen in the the womb were three times more likely to develop autism and/or attention deficit hyperactivity disorder (ADHD) than children whose mothers never took the drug while the pregnant. In 2021, the European Journal of Epidemiology published a meta-analysis showing a 19% increase in autism and a 21% increase in ADHD diagnoses in children exposed to Tylenol prenatally.

In 1985, the year that Americans started routinely taking Tylenol for minor health complaints, 1 in 2500 American children were diagnosed with autism. Today the number is 1 in 36. Pediatric ADHD diagnoses have seen a similar exponential rise. Many aspects of pregnancy and childhood have changed dramatically since 1985 (children started being exposed to prenatal ultrasound, the cesarean rate more than doubled, use of synthetic oxytocin in labor rose dramatically, additives in food increased, the pediatric immunization schedule grew from a handful of shots to over 30 doses of vaccines by age one, time spent in front of screens skyrocketed, etc.) so we cannot isolate a single variable that may be causing the epidemic of nervous system disorders in our children. But the evidence suggests Tylenol may be playing a role.

Studies also show that Tylenol blunts empathy, making users less compassionate and responsive to the pain of others around them. Reduction in empathic behavior after taking acetaminophen has been found in both human and rat studies. Tylenol decreases levels of oxytocin, the chemical thought to be responsible for human love and bonding. Every week at 25% of Americans, including 11% of children, take at least one dose of acetaminophen. The social consequences of this routine drug use could be much more significant than many people assume.

Like ADHD and autism, asthma diagnoses have increased greatly since the early 1980s. A large body of research shows that Tylenol may be playing a role. Exposure to acetaminophen in utero increases a child’s risk of having asthma. Tylenol use is also associated with adult onset asthma. Among people who already have asthma, acetaminophen can cause bronchospasm, a potentially life-threatening constriction of the breathing passages. Up to 1/3 of patients with asthma who take Tylenol may experience bronchospasm.

Researchers believe Tylenol can cause asthma symptoms because the drug depletes the body’s store of glutathione, a powerful antioxidant produced in the liver. When the liver breaks down acetaminophen, a very toxic byproduct called NAPQI (N-acetyl-p-benzoquinone imine) is produced. Glutathione in the liver quickly binds to the NAPQI to neutralize this poison. The bound compound is then eliminated through the kidneys.

Processing Tylenol uses a large amount of glutahione, leaving less of the chemical available for other important functions. These functions include neutralizing toxins other than Tylenol, destroying free radicals, maintaining Vitamin C levels, repairing damaged cells, encouraging cell death in precancerous cells, and maintaining the function of our mitochondria. In the lungs, glutathione protects cells from the damaging effects of oxygen. When levels of glutathione are low, inflammation in the lungs increases. Glutathione is integral to our health and well being. And acetaminophen leaves our bodies in short supply of this vital chemical.

If increased rates of ADHD, autism, and asthma don’t scare you, maybe the next fact will. Prenatal exposure to Tylenol is associated with abnormal genital development in male offspring. Male babies exposed to acetaminophen in the first and second trimester of pregnancy are more likely to be born with undescended testicles and other malformations of the uro-genital tract. Tylenol exposure lowers prenatal testosterone levels in male fetuses. Adult males who take Tylenol also experience decreases in serum testosterone.

Tylenol is never a life-saving medication. No one will die without it. The drug is most commonly used for treating minor to moderate pain and discomfort. A 2106 Cochrane review found that Tylelnol isn’t even very effective for treating pain, showing no significant difference in pain relief between those taking acetaminophen and those taking a placebo. I would argue that we should implement the precautionary priniciple and stop using Tylenol altogether. At the very least, we should stop giving this drug to children and pregnant women.

So what are the alternatives? First, we can stop believing that we need to drug minor and moderate discomfort in our children. Getting sick is part of the work of childhood, and kids do it a lot. When we reach for drugs every time our children are sick, we are teaching them to reach for drugs every time they feel uncomfortable. Tylenol does not reduce the duration of childhood illness. In fact, evidence shows acetaminophen may worsen nasal congestion during colds and prolong viral shedding. By trying to make our children feel better, we may be inadvertantly making them feel worse by giving them Tylenol.

Childhood illnesses can be managed with rest, warm baths, chicken soup and other warm and easily digestible foods, loving care and time. Fever is a natural immune response which benefits the body and does not need to be suppressed. Many herbal remedies can help sick children rest and recover without the risks of acetaminophen. Our calm presence with our children when they are sick lets them know we trust they are not fragile, they can handle adversity, and they possess a powerful innate ability to heal. These lessons will serve them far more than teaching them to take drugs every time they don’t feel well.