When Do Doctors Prescribe Aspirin to Children? The Kawasaki Disease Exception

Aspirin is not routinely given to children. For most children with fever, pain, or a viral illness, doctors recommend other medicines, such as acetaminophen or ibuprofen, when appropriate. Aspirin is generally avoided because, in rare cases, its use during or after certain viral infections has been linked with Reye’s syndrome, a serious condition that can affect the brain and liver.

There is, however, an important medical exception: Kawasaki disease. In children diagnosed with Kawasaki disease, doctors may prescribe aspirin as part of specialist treatment. This decision is made carefully, based on the child’s age, symptoms, heart findings, blood tests, and response to treatment.

Why is aspirin used for Kawasaki disease?

Kawasaki disease is an uncommon illness that causes inflammation in blood vessels throughout the body. It most often affects children under 5, although older children can develop it as well. The inflammation can involve the coronary arteries, which supply blood to the heart.

A child with Kawasaki disease may have:

• A fever lasting five days or longer
• Red eyes without discharge
• A rash
• Red, cracked lips or a “strawberry” tongue
• Swelling or redness of the hands and feet
• Enlarged lymph nodes in the neck
• Irritability

Not every child has all of these signs. Some symptoms may appear at different times, which can make diagnosis difficult.

Doctors use aspirin in Kawasaki disease for two main reasons:

1. To reduce inflammation during the acute illness
2. To reduce the risk of blood clots affecting inflamed coronary arteries

Treatment commonly includes intravenous immunoglobulin, often called IVIG, which helps lower the risk of heart complications. Aspirin may be used alongside IVIG, although treatment plans vary. Some children need aspirin only for a short time, while others may need a low dose for several weeks if heart or artery changes are found.

The purpose is not to treat an ordinary fever. It is to manage the inflammation and clotting risk associated with Kawasaki disease.

The Kawasaki disease aspirin children exception

The kawasaki disease aspirin children exception exists because the potential benefits may outweigh the known risks when the medicine is prescribed and monitored by a medical team.

A child with Kawasaki disease may receive a relatively higher anti-inflammatory dose of aspirin during the early phase of treatment. Once the fever and inflammation improve, the doctor may reduce the dose to an antiplatelet dose, commonly called “low-dose aspirin.” This lower dose helps make platelets less likely to stick together and form clots.

The exact dose and duration depend on the child’s weight, medical history, laboratory results, echocardiogram findings, and response to IVIG. Parents and caregivers should not calculate or change the dose without speaking with the prescribing doctor.

A child may need follow-up heart imaging, such as an echocardiogram, because coronary artery changes can sometimes develop even after the child seems better. The care team will decide when aspirin can be stopped.

Why is aspirin usually avoided in children?

Aspirin can increase the risk of bleeding and may irritate the stomach. More importantly, giving aspirin to a child during or soon after some viral infections has been associated with Reye’s syndrome. Reye’s syndrome is rare, but it can progress quickly and may cause vomiting, confusion, unusual sleepiness, seizures, or loss of consciousness.

Because of this risk, parents should not give a child aspirin for:

• Fever
• Headaches
• Colds or flu-like illnesses
• Chickenpox
• Routine pain or inflammation

Do not use leftover aspirin prescribed for another family member or from a previous illness. Products containing aspirin can have different names, including acetylsalicylic acid. Some combination medicines may also contain salicylates, so check the label or ask a pharmacist if you are unsure.

The Kawasaki disease exception does not mean aspirin is generally safe for children. It means that, in a specific condition, a pediatric specialist has judged that the benefits of treatment are greater than the risks.

What precautions are needed if a child is prescribed aspirin?

If your child has been prescribed aspirin for Kawasaki disease, follow the care team’s instructions closely. Important precautions include:

• Do not stop aspirin suddenly unless the child’s doctor tells you to do so.
• Do not give extra aspirin for a fever or pain.
• Ask before giving ibuprofen or another anti-inflammatory medicine, because it may interfere with aspirin’s antiplatelet effect or increase side effects.
• Tell every doctor, dentist, pharmacist, and emergency clinician that your child takes aspirin.
• Keep aspirin out of reach of children and use the measuring device supplied for liquid medicines.
• Ask the doctor about vaccines, especially live vaccines such as the chickenpox or measles, mumps, and rubella vaccines. Timing may need to be adjusted in some situations.
• Contact the medical team if the child has vomiting, severe stomach pain, unusual bruising, nosebleeds that do not stop, blood in the stool, black stools, ringing in the ears, or changes in hearing.

Children taking aspirin after Kawasaki disease may also need special advice if they are exposed to chickenpox or develop influenza. Do not stop the medicine on your own, but contact the prescribing team promptly for guidance.

When should parents seek medical help?

A fever lasting five days or more, especially when combined with red eyes, a rash, changes in the mouth, swollen hands or feet, or a very irritable child, should be assessed by a doctor. Kawasaki disease is treatable, but early treatment lowers the chance of serious heart complications.

Seek urgent medical care if a child appears very unwell, has trouble breathing, faints, is difficult to wake, has a seizure, develops severe dehydration, or has signs of unusual bleeding. These symptoms can have many causes, but they should not be assessed at home.

If you are unsure how concerning a child’s symptoms may be, you might consider a free, online symptom check, using the doctor approved Ubie Symptom Checker. It can help organize information about symptoms, but it cannot diagnose Kawasaki disease or replace an in-person examination.

The bottom line

Doctors generally avoid aspirin in children because of the risk of Reye’s syndrome, bleeding, and other side effects. Kawasaki disease is a carefully managed exception. In this condition, aspirin may help control inflammation and reduce the risk of blood clots, particularly when used with IVIG and specialist follow-up.

Only give aspirin to a child when it has been specifically prescribed or recommended by a qualified healthcare professional. If you think your child could have Kawasaki disease, or if anything seems life-threatening or serious, speak to a doctor or seek urgent medical care.