Why Is Aspirin Dangerous for Children? Reye’s Syndrome Symptoms and Risks

Aspirin can be dangerous for children and teenagers because, in rare cases, it has been linked to Reye’s syndrome, a serious condition that can cause sudden swelling in the brain and severe liver problems. The risk is greatest when aspirin is given during or shortly after a viral infection, such as influenza (flu) or chickenpox.

Because of this risk, the U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and the American Academy of Pediatrics generally advise against giving aspirin or aspirin-containing medicines to anyone under 18 unless a doctor specifically recommends it.

Reye’s syndrome is uncommon, but it can become life-threatening quickly. Understanding which medicines contain aspirin, what symptoms to watch for, and when to seek medical care can help parents and caregivers respond safely without unnecessary worry.

Why is aspirin dangerous for children?

The exact cause of Reye’s syndrome is not fully understood. It appears to involve an abnormal response in the body’s cells, particularly in the liver and brain, after a viral illness. Aspirin exposure during this period may increase the risk in susceptible children.

Aspirin is also called acetylsalicylic acid or salicylate. It is found in some prescription and over-the-counter products. Giving a child aspirin for a fever, headache, cold, or flu can therefore carry a risk that many caregivers may not realize.

The concern is not that every child who takes aspirin will develop Reye’s syndrome. The condition is rare. However, because it can progress rapidly and may cause permanent brain injury or death, health authorities recommend avoiding aspirin in children and teenagers unless it is being used under direct medical supervision.

Aspirin should be avoided especially when a child:

• Has flu, chickenpox, or another suspected viral infection
• Is recovering from a viral illness
• Is being treated for fever or pain without advice from a healthcare professional
• May have taken more than the recommended amount
• Is taking multiple medicines whose ingredients are not fully known

Which products may contain aspirin?

Aspirin is not always clearly recognized by its brand name. Some combination products for pain, fever, colds, upset stomach, or flu may contain aspirin or another salicylate.

Check the active ingredients on every medicine label. Look for terms such as:

• Aspirin
• Acetylsalicylic acid
• Salicylic acid
• Acetylsalicylate
• Salicylate
• Bismuth subsalicylate

Bismuth subsalicylate is found in some medicines used for diarrhea, nausea, heartburn, and upset stomach. It is not the same as aspirin, but it contains a salicylate and may not be appropriate for children or teenagers with a viral illness. Some products marketed for adults should never be shared with children.

If you are uncertain whether a medicine contains aspirin or is suitable for a child, ask a pharmacist or speak to a doctor before giving it.

What is Reye’s syndrome?

Reye’s syndrome is a rare illness that can affect the liver and brain. It often begins while a child is recovering from a viral infection, when the initial fever or other symptoms may already seem to be improving.

The illness may first look like a stomach bug. It can then progress to changes in alertness or behavior caused by swelling in the brain. Symptoms may worsen over hours, which is why prompt medical assessment is important.

Reye’s syndrome does not spread from person to person. It is also not simply a severe case of flu or chickenpox. It is a separate medical emergency that requires hospital care.

Reye’s syndrome symptoms

Early symptoms can include:

• Repeated or persistent vomiting
• Unusual sleepiness, tiredness, or lack of energy
• Irritability or unusual changes in behavior
• Confusion or difficulty paying attention
• Loss of interest in normal activities
• Weakness or clumsiness

As the condition progresses, more serious symptoms may develop:

• Increasing confusion or disorientation
• Agitation, aggression, or unusual behavior
• Trouble staying awake or responding normally
• Slurred speech
• Seizures
• Loss of consciousness
• Abnormal breathing, including very fast or irregular breathing
• Coma

A child who has repeated vomiting and unusual sleepiness, confusion, or behavior changes after a viral illness needs urgent medical evaluation. Do not wait to see whether the symptoms disappear, particularly if aspirin or a salicylate-containing medicine may have been taken.

What are the risks?

Reye’s syndrome can cause swelling and pressure inside the brain. It may also interfere with how the liver processes fats and how the body maintains normal blood chemistry.

Possible complications include:

• Seizures
• Breathing problems
• Coma
• Permanent brain damage
• Liver dysfunction
• Death

Early diagnosis and intensive hospital treatment improve the chances of recovery. Some children recover fully, while others may have lasting neurological problems. The condition is rare, but its potential severity is the reason prevention is taken seriously.

What should parents use instead?

For fever or pain, healthcare professionals commonly recommend acetaminophen or ibuprofen, depending on the child’s age, health, symptoms, and other medicines. These medicines are not interchangeable, and the correct dose depends on the child’s weight and the product’s concentration.

Always:

• Read the label carefully
• Use the measuring device supplied with the medicine
• Follow age and weight directions
• Avoid giving two products with the same active ingredient
• Ask a pharmacist or doctor if the child has liver disease, kidney disease, dehydration, stomach ulcers, or other medical conditions
• Never give adult-strength medicine unless a healthcare professional specifically instructs you to do so

Ibuprofen is generally not recommended for infants under six months unless a doctor advises it. Acetaminophen can also be dangerous in excessive amounts, so “aspirin-free” does not mean a medicine is risk-free.

Children with fever do not always need medicine. Fluids, rest, light clothing, and monitoring may be enough, depending on the child’s condition. Fever is a symptom, not a diagnosis, and the child’s overall behavior and breathing are important signs to watch.

When to speak to a doctor

Speak to a doctor before giving aspirin or any salicylate-containing medicine to a child or teenager. A doctor may prescribe aspirin in specific situations, such as Kawasaki disease, certain heart conditions, or other uncommon medical circumstances. In those cases, the benefits are carefully weighed against the risks, and the child is monitored.

Seek urgent medical care for:

• Repeated vomiting
• Confusion, unusual sleepiness, or major behavior changes
• Trouble breathing
• A seizure
• Fainting or difficulty waking
• Severe dehydration
• A child who appears seriously ill
• Any suspected overdose or accidental ingestion of aspirin

If an overdose may have occurred, contact emergency services or your local poison information service immediately. Do not make the child vomit unless a medical professional tells you to do so, and keep the medicine container available for healthcare workers.

You might also consider a free, online symptom check, using the doctor approved Ubie Symptom Checker to help organize symptoms and decide what questions to ask. An online checker cannot diagnose Reye’s syndrome, assess a poisoning, or replace urgent medical care. If anything could be life-threatening or serious, speak to a doctor or seek emergency help right away.