Children's aspirin: What you need to know

If you're old enough, you may remember taking a chewable children's aspirin for fever or pain. Often flavored like candy, these tiny tablets were once a staple of home remedies for kids. But for some decades now, aspirin has been found to pose risks to children and is no longer recommended for routine use. In fact, salicylates, a class of medications that include aspirin, are not recommended for use in children or teenagers with certain illnesses, with or without a fever.

In the early 1980s, medical experts found that aspirin use in some children and teenagers was associated with Reye's syndrome, a potentially fatal illness. In 1982, the American Academy of Pediatrics (AAP) issued a statement that children with chickenpox or flu should not be given salicylates. This recommendation was later expanded to include any fever-related or viral illness for all children and teens younger than 18. However, aspirin may be prescribed by a healthcare provider for use in treating certain health conditions in children, such as Kawasaki disease.

Reye's syndrome is a rare but serious illness that causes swelling and inflammation of the brain, as well as impairment or loss of liver function. This condition mostly affects children between the ages of 4 and 12 years. However, people of any age can develop this illness. The exact cause of Reye’s syndrome is unknown.

Reye's syndrome requires medical attention. It can cause the following symptoms:

• Unusual sleepiness, lethargy or confusion
• Unresponsiveness when you try to awaken the affected child
• Disorientation or hallucinations
• Persistent or severe vomiting and nausea
• Diarrhea and rapid breathing in infants younger than 2
• Increased irritability
• Anger or violent behavior

Reye's syndrome can also cause seizures, coma and, in some cases, death.

Yes, many other medicines contain aspirin or aspirin-like components. The active ingredient in aspirin is acetylsalicylic acid (ASA). ASA and other similar salicylate ingredients that are related to ASA can also cause Reye's syndrome. Some over-the-counter cough and cold medicines may contain aspirin or a related ingredients. Read the label carefully for active ingredients and avoid giving children any medicine that contains the following:

• Acetylsalicylic acid
• Acetylsalicylate
• Salicylic acid
• Salicylates
• Bismuth subsalicylate

If you aren’t sure about the ingredients contained in a medication or you have any questions about a certain medication, ask your healthcare provider before giving it to a child. You should also pay attention to the recommended ages and follow the dosing instructions provided on the label.

Yes, alternatives to aspirin may include acetaminophen (Tylenol) and ibuprofen (Advil, Motrin). It's usually safe to give acetaminophen to infants as young as 3 months and ibuprofen to children age 6 months and older unless your healthcare provider gives you different instructions. Check with your healthcare provider before giving your child any medication and report symptoms they may be having. Children with certain medical conditions, such as kidney disease or asthma, may be advised not to take ibuprofen. Call your child’s healthcare provider or seek medical attention if your baby is younger than 3 months old and has a fever above 100.4ºF or symptoms of illness. Also, be careful not to give multiple medications to your child, as some medications contain combinations of active ingredients, which could result in giving too much of an ingredient to your child.

You should not give aspirin to children under 18 unless you have been advised to do so by a healthcare provider. There are very specific conditions in children that may be treated with aspirin under the care of a healthcare provider. Examples include rheumatic fever, artificial heart valves and Kawasaki disease, an uncommon condition that can lead to aneurysms (ballooning) of the coronary arteries.

If your child or teenager has a fever or viral illness, don't use aspirin. You may use a children's pain and fever-reducing medicine containing acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) instead, after consulting your healthcare provider. Be sure to follow all product instructions carefully. If you think your child or teen needs aspirin, be sure to consult your healthcare provider before giving them this medication.

Clinically reviewed and updated by Julie McDaniel, MSN, RN, CRNI, April 2024.