In a recent blog, I wrote about the use of acetaminophen and ibuprofen for the treatment of fever in children. It has been shown that giving both together, or alternating them every two hours, lowers high fevers more effectively than either drug alone. In that article, no mention was made of the use of aspirin, acetylsalicylic acid, in the same setting. Aspirin for children age 16 years and under is contraindicated because it’s related to serious problems.
The first of these “problems” is bleeding. This comes in the form of nosebleeds, bruising, and gastrointestinal bleeding. Nosebleeds and bruises are apparent immediately because they can be seen easily. GI bleeding is more deceptive because it takes awhile for the patient to know it’s happening. Stomach bleeding is hidden until enough blood collects in the stomach to cause the patient to vomit. That may take hours. Lower intestinal bleeding is hidden until the patient has a bowel movement. Bleeding is a serious consequence of aspirin, but is less problematic than the second “problem,” Reye’s syndrome.
Pronounced “rye” like the bread, Reye’s syndrome occurs as a result of a child under age 16 taking aspirin during a viral illness, especially chicken pox and the flu. By some unknown mechanism, probably within the body’s cells, the child develops vomiting, rapid breathing, diarrhea, and fatigue that progresses to confusion, seizures, coma, and potentially death. Swelling of the brain and damage to the liver are the events that place the child in the greatest danger. There is no specific treatment for Reye’s, but focusing on reversing brain swelling, hydration, and vascular support can be life-saving measures.
I never saw a case of Reye’s syndrome, but those physicians who did were strong advocates for prevention. And prevention meant not prescribing aspirin for fever associated with chicken pox and other viral illnesses for children 16 and under. Reye’s syndrome is a proven entity, and physicians were repeatedly warned not to combine aspirin with chicken pox in young children. The message was delivered widely and successfully, and physicians changed their treatment patterns as a result. With Varivax, chicken pox vaccine, being given as part of the childhood immunization schedule, the incidence of chicken pox and consequently Reye’s syndrome, should continue to decrease.
Why avoid aspirin for childhood fever? Because it has very serious consequences in toddlers and teens with viral syndromes, especially chicken pox.
Reference: Google.com/reyesyndrome
