With the fall flu season underway, health experts are issuing a clear reminder: children and teenagers under 18 should never be given aspirin. Confusion over fever-reducing medicines like Tylenol has left some families reaching for old standbys in the medicine cabinet, but doctors caution that aspirin is not a safe substitute.
When taken during viral illnesses such as flu or chickenpox, doctors warn that giving aspirin during viral illnesses such as the flu or chickenpox can have dangerous consequences in kids.
Reye’s syndrome, a rare but severe illness linked to aspirin use in people under 18 years old, causes swelling in the brain and serious liver damage that can become deadly.
Arundel News turned to two local physicians to help provide families with clear guidance about the rare condition, including the risks and how to recognize the symptoms.
“Reye’s syndrome is an acute encephalopathy (brain disease) caused by liver failure,” said Dr. Lauren Fitzpatrick, M.D., Medical Director of Pediatrics at Luminis Health Anne Arundel Medical Center. “It is typically associated with a preceding viral infection, and use of aspirin during this illness can increase risk for Reye’s syndrome.”
 |
Why Aspirin Poses a Risk
Children and adolescents are more vulnerable because their livers are still developing. When combined with a viral infection, aspirin can overwhelm the liver's ability to function properly.
“Viral infections such as chickenpox or flu stress the liver’s mitochondria, the part of the liver responsible for break down of fatty acids,” explained Poonum Korpe, M.D., Medical Director at Anne Arundel County Department of Health and an Associate Professor at John's Hopkins Bloomberg School of Health. “Aspirin can further stress the liver. Therefore, a child’s liver is dealing with a ‘double whammy,’ and this can lead to disruption in the liver’s normal function… which leads to swelling in the brain and fatty deposits in the liver.”
Symptoms Parents Should Watch For
The first signs of Reye’s syndrome can look deceptively ordinary. A child may begin vomiting, seem unusually sleepy, or act confused. But symptoms can worsen quickly.
“The first symptoms of Reye’s syndrome include vomiting and confusion, changes in personality, and a decreased level of consciousness,” Dr. Korpe said. “As the condition progresses, children can develop worsening confusion, agitation, and eventually can fall into a coma.”
Is Aspirin Ever Safe for Kids?
Both doctors agreed that aspirin should almost never be used without a doctor’s direction.
“Aspirin use is not recommended in children under the age of 18,” Dr. Korpe stressed. “In some instances, it can be recommended by a physician for the treatment of certain inflammatory disorders. But this should only be done under close medical supervision.”
Dr. Fitzpatrick noted one specific exception: “One example of when aspirin is prescribed is for the treatment of Kawasaki disease. Kawasaki disease is a vasculitis that can cause aneurysms in the blood vessels to the heart, and thus aspirin is given to thin the blood.”
Safer Alternatives Families Can Trust
While aspirin use poses serious risks for children, Dr. Fitzpatrick emphasized that families still have safe and effective options for managing fever and pain in children, “Both ibuprofen and acetaminophen are safe and optimal choices for treating fever and pain in children.”
Dr. Korpe also recommends ibuprofen or acetaminophen as the best over the counter options adding, “These medications should be given based on the weight-based dosage recommendations written on the product label. Always check with your pediatrician first before giving a child any new medications.”
 |
Beyond Aspirin: Hidden Medication Risks Parents Need to Know
Dr. Fitzpatrick cautions that aspirin isn’t the only ingredient families need to watch out for when treating children.
“Salicylates are definitely something that should be avoided,” Fitzpatrick said, noting they are compounds related to aspirin and sometimes appear in over-the-counter products or herbal remedies.
Check labels to avoid other common medicines that can be risky if misused, “Cough and cold medications, like Robitussin or dextromethorphan, should be avoided in kids under age 6,” Dr. Fitzpatrick explained. “Benzocaine, which used to be found in Orajel, can cause a condition called methemoglobinemia, where the body produces a red blood cell that cannot carry oxygen, thus causing anemia and poor tissue perfusion of oxygen."
Dr. Fitzpatrick added that parents should be especially cautious about anti-diarrheal drugs. “Antidiarrheals like loperamide (Imodium) should not be used in young children. They can be associated with decreased bowel movement, lethargy, and in rare cases, even death.”
Children with Underlying Conditions May Face Greater Risk
“Any child experiencing symptoms like those described above, should have extensive medical investigations performed to look for other medical conditions that could mimic Reye’s syndrome, including inborn metabolic conditions,” said Dr. Korpe.
While aspirin is the most well-known trigger, certain metabolic conditions can make some children more vulnerable to developing Reye's Syndrome .
"Conditions that cause the body to have problems with processing fatty acids, and those that cause the body to not be able to process ammonia, increase the risk of Reye’s syndrome or Reye-like illnesses,” said Dr. Fitzpatrick.
Environmental Toxins That Can Cause Reye's-Like Symptoms
Reye’s syndrome is rare, but Dr. Fitzpatrick points out that other environmental toxins can mimic its dangerous effects.
“There are toxins that can trigger Reye's-like symptoms,” she explained. “These can include insecticides, herbicides, aflatoxins, and even solvents like isopropyl alcohol and certain mushroom toxins.”
Get Emergency Care Right Away
If a child begins showing possible signs of Reye’s syndrome — such as persistent vomiting, sudden confusion, unusual behavior, or extreme sleepiness — parents should not wait to seek care. Immediate medical care is essential, as the condition can progress quickly, leading to seizures, coma, or even death if untreated. Any child with these warning signs, particularly after a recent viral illness like flu or chickenpox, should be taken to the emergency department right away for evaluation. Acting quickly can make the difference between recovery and long-term complications.
With early medical intervention, symptoms may improve within a few weeks, but in severe cases Dr. Fitzpatrick says "permanent brain damage" with lasting "neurological deficits" is possible.
While there is no single cure for Reye's Syndrome, Dr. Fitzpatrick says treatments focus on stabilizing the child while the body recovers, "All treatment is supportive, giving fluids with sugar and electrolytes, replacing Vitamin K or platelets if needed if bleeding complications, giving diuretics to help with brain swelling, and respiratory support if not breathing well on their own."
 |
This article originally appeared in Arundel News.
