Put Down the Aspirin: Reye's Syndrome

You wake in the middle of the night to the sound of crying. Stumbling bleary-eyed through the house, you make your way to your child's room to find him hot, itchy, and inconsolable. Groaning, you realize your little one has chicken pox. Didn't you vaccinate for that? Guess it didn't take.

Rifling through the medicine cabinet for something to bring down the fever, you come up with only a bottle of Aspirin. The warning on the back says not to give it to children, and even in your sleep-deprived state, you remember hearing something about this before. Looks like someone will have to make a late-night trip to the 24-hour pharmacy.  But what's the big deal anyway? Don't they make children's Aspirin? Didn't you have Aspirin as a child all the time? Maybe if you broke the pill in half...

What is Reye's Syndrome?

Reye's Syndrome is a serious condition that is characterized by sudden brain dysfunction and damage to the liver due to fat deposits. This damage can also occur in other organs, such as the pancreas, heart, kidney, and spleen. Reye's Syndrome is diagnosed exclusively in children under the age of 15 and always after a viral infection like varicella (chicken pox) or influenza.  The child's outcome is dependent on how harshly his central nervous system is affected, but the mortality rate for the syndrome approached a shocking 80 percent at one time.

What Causes Reye's Syndrome?

The exact cause of Reye's Syndrome is unknown. The syndrome was named for an Australian pathologist, R. D. K. Reye, who first reported on it in 1963. The strange condition was found to occur after viral infections, mainly chicken pox and flu, but also after other like measles, pertussis, and salmonella.  

While less than 0.1% of children who were given Aspirin developed Reye's Syndrome, over 80 percent of those with Reye's Syndrome had been given Aspirin at some point in the three weeks prior.

While researchers were not able to determine a direct link between Aspirin and Reye's Syndrome, enough evidence was present for health organizations to warn against the use of Aspirin in children beginning in 1980. Since 1994, a maximum of two cases have been reported each year in the United States. The dramatic decrease from a peak of 555 cases reported in the winter season of 1979-1980 is largely due to the warnings against Aspirin use. Growing awareness of the dangers of Aspirin in children has also helped bring the number of cases down.

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The Symptoms of Reye's Syndrome

Less than a week after a viral infection of some kind, the child is suddenly stricken with a period of intense nausea and vomiting.  This can last for hours.  When the vomiting finally subsides, the child immediately begins a period of aggressive behavior with high irritability.  As the brain damage progresses, the child begins to exhibit lethargy and has trouble staying awake. He may become extremely confused. He may experience seizures and even loss of consciousness. The brain swelling can produce what is called a decerebrate posture due to the loss of control over the spinal reflexes.  The arms and legs are held stiff and straight, while the forearms turn in toward the center of the body and the toes point downward.

How Is Reye's Syndrome Diagnosed?

There is no specific test for Reye's Syndrome, one of the factors that makes this condition so dangerous. Many of its symptoms are also the symptoms of other conditions, so doctors will usually simply include it as a possible diagnosis for any child who shows up at the hospital with vomiting and mental changes. The process of diagnosing will be more dependent on ruling out other conditions as opposed to testing for Reye's. Blood tests are performed, as well as CT or MRI scans of the head. Spinal taps and liver biopsies may be performed also.

Treatment of Reye's Syndrome

Just as there is no specific diagnostic test for Reye's Syndrome, there is no specific treatment. Doctors will treat the symptoms of the syndrome and monitor brain pressure and blood gas and pH levels. Steroids are administered in order to reduce brain swelling. IV fluids are given to keep the child hydrated and increase electrolyte and glucose levels in the body. 

The child may need to be intubated and placed on a breathing machine if he slips into a deep coma. Healthcare providers will perform neurological assessments frequently and much care is taken to keep the child's temperature regulated.

What is the Prognosis for Children with Reye's Syndrome?

The chance of survival for a child with Reye's Syndrome is largely dependent on the severity of the coma.  The deeper the coma, the more likely that serious and permanent brain damage was suffered.  

Still, for those babies and children who are diagnosed with the condition, Reye's Syndrome is extremely serious. Reye's has 6 stages of progression, from 0 to 5. A total of 18 percent of children who are admitted to the hospital at stage 0 will die, while of those admitted at stage 5, 90 percent do not survive. If treatment is not sought until after stage 3, permanent and serious brain damage is expected. It is of dire importance to seek treatment as early as possible.  If treatment begins while the syndrome is in stages 0 to 2, most children will make a full recovery.

Read More: Baby Aspirin Benefits and Risks During Pregnancy

Put the Aspirin Down

Yes, Reye's is rare, but the danger is real. Parents should keep a well-stocked medicine cabinet with age-appropriate medications for their children. For children between the ages of 6 months and 12 years old, acetaminophen and ibuprofen are recommended. Not giving any fever-reducing medication is preferred over giving Aspirin, and even "old wives' tricks" like cold and wet cloths can help bring a fever down. Unless you need it yourself for a specific reason, it is best for parents not to keep Aspirin at home at all.

Children are going to get sick; any parent knows this fact.  But vaccinations against chicken pox (the varicella-zoster immunization) and the annual influenza immunization are available and should be seriously considered. Not contracting those two illnesses isn't a guarantee against Reye's since it can occur after any viral infection, but those are the two main illnesses that have lead to Reye's Syndrome statistically.

Most importantly, parents should remain alert to any mental changes in their children in the days following a viral infection. Early diagnosis and aggressive treatment of Reye's Syndrome increase a child's chances of making a full recovery.  Contact your child's pediatrician or your family medicine practicitioner if you have any suspicions or concerns.