In a child with influenza-like illness, the use of which medication is strongly associated with the development of Reye's syndrome?

• A. Acetaminophen
• B. Ibuprofen
• C. Aspirin
• D. Naproxen

Answer: (C)

Using aspirin in a child who has an influenza-like illness is strongly associated with Reye's syndrome, a rare but serious condition that combines acute brain swelling (encephalopathy) with fatty liver damage. This syndrome typically follows a viral illness like influenza or varicella after aspirin is given, and it can progress rapidly to vomiting, confusion or agitation, and, in severe cases, coma and hepatic failure. The underlying issue is thought to involve mitochondrial dysfunction from aspirin use during a viral infection, leading to hepatic steatosis and cerebral edema.

Because of this clear link, aspirin should be avoided for fever or pain in children and adolescents. Safer alternatives include acetaminophen or ibuprofen for fever or discomfort. Naproxen is another NSAID but is not associated with Reye's syndrome; however, the key takeaway is that the risk is specific to aspirin in the setting of a viral illness.