Aspirin is a staple in many medicine cabinets. But if you have children, this common medication is a potentially dangerous drug. Aspirin has been linked with Reye's syndrome, a rare but serious condition that can affect children and teenagers recovering from a viral infection.

Christine Ziebold, MD, PhD, MPH, pediatric infectious disease specialist at University of Iowa Children's Hospital, talks about Reye's syndrome:

What is in aspirin that causes Reye's syndrome?

It is the active ingredient which is called acetylsalicylate or acetylsalicylic acid, or the abbreviated forms are salicylic acid or salicylate. Many products actually can contain it, not just aspirin, and one needs to look at the back of pill bottles or suspensions for this particular word: salicylic acid. Topical products can also contain it like acne products, sunscreens, even deodorants. We do know from studies, looking back in time at cases that have occurred that using aspirin increases the risk of Reye 's syndrome. And we know from lab studies that aspirin interferes with the function of mitochondrial power plants in ourselves, and that in turn seems to be at the heart of the problem of Reye's syndrome. However, what exactly causes Reye's syndrome is not known.

Why does Reye's syndrome affect children, specifically?

This is a little bit of a matter of speculation, but one certain connection is the fact that children tend to get a lot of viral illnesses, and these, in turn, have been linked to more than 90 percent of cases in the three week period before Reye's syndrome starts. One big reason was varicella, as it was, because it's now almost historical as vaccine has virtually eliminated chicken pox. The other cause is influenza which children tend to be more severely affected by than adults.

When is a child most likely to develop Reye's syndrome?

It starts probably several days after typical respiratory illness when the child is starting to recover.

What are the symptoms of Reye's syndrome?

There's really nothing unique or characteristic about it, and that's the scary part. There's no unusual severity of the illness that might predict it. Fever can be variable—can be there, cannot be there—and as a child is recovering, as I said. Then severe vomiting begins abruptly and this is an almost isolated feature, without diarrhea. It can last for hours to days and the vomiting is really due to a brain injury which we call encephalopathy. It's a slow change in consciousness. The child can slip into a coma. It can be very supple and difficult to pinpoint at first, but it will progress to delirium, seizures, and then finally, respiratory arrest. Some people may progress from one stage to the next over hours or days, or they may stop spontaneously at any stage and then recover and the symptoms go away. But about one-third of people have generalized seizures—I think that's important to know—and even with medical intervention, three out of 10 children in the U.S. for the last long-term surveyance have died; so it has a high mortality.

If a parent suspects their child may be developing Reye's syndrome, what steps should they take?

Go seek medical attention immediately.

How is Reye's syndrome diagnosed?

There's no single lab test, it's basically by a high index of suspicion and it's a rare illness, now. So you have to really have it in the back of your mind, and by excluding other illnesses; like in a small child it could be things like inborn metabolic disorders. In older children or in general, meningitis encephalitis can cause coma. A drug overdose can be a reason of poisoning; head trauma, liver failure of other causes. Unfortunately, there's no real single lab test. But abnormal liver function tests and, if the child is comatose, a rise of ammonia are usually hallmarks of the illness.

How is it treated?

It's basically treated by supporting major life functions, usually in an intensive care unit, and there's no specific treatment, per se. As the brain swells up, the pressure inside the head needs to be carefully monitored and it can cause general under-profusion of the brain, heart beat abnormalities, respiratory arrest—which are the major causes of death, not so much the liver problems. So to decrease the brain pressure, we could use all kinds of things like drugs, fluids, artificial breathing, ventilation, head positioning, glucose is given—especially in children younger than two years.

Can Reye's syndrome be prevented?

I think to a large part we can say yes. First, by not giving any over the counter aspirin to children, but using acetaminophen or Tylenol, and ibuprofen or Motrin instead. This may be difficult in teens who tend to self-administer medications because of products that may not sound like aspirin. Second, I think giving your child varicella and influenza vaccines is another way that has definitely reduced the incidence of Reye's sydrome to an historic low now. Especially if a child has been prescribed aspirin, needs to take it for example for heart problems, that's an important thing to do.

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