From the Guidelines
Aspirin has very limited indications in pediatrics, primarily for Kawasaki disease and certain cardiac conditions, due to the risk of Reye syndrome. The primary indications for aspirin in children include Kawasaki disease, where it is given at an initial anti-inflammatory dose of 80-100 mg/kg/day divided into four doses during the acute phase, followed by a lower antiplatelet dose of 3-5 mg/kg/day once daily after fever resolution, as recommended by the American Heart Association 1. Aspirin is also indicated for children with certain cardiac conditions such as those with mechanical heart valves or specific thrombotic disorders, typically at antiplatelet doses of 3-5 mg/kg/day 1. Key considerations include:
- Avoiding aspirin for fever or pain management in children or teenagers due to the association with Reye syndrome, particularly during viral illnesses like influenza or chickenpox.
- Using alternative antipyretics and analgesics such as acetaminophen or ibuprofen instead.
- Initiating and monitoring any aspirin therapy in children under the guidance of a pediatric specialist. It's also important to note that the concomitant use of ibuprofen should be avoided in children with coronary aneurysms taking aspirin for its antiplatelet effects, as it antagonizes the irreversible platelet inhibition induced by aspirin 1. Annual influenza vaccination is recommended for children on long-term aspirin therapy to reduce the risk of Reye syndrome 1. Given the potential risks and the availability of alternative treatments, aspirin's use in pediatrics should be approached with caution and strictly according to established guidelines.
From the FDA Drug Label
Warnings Reye's syndrome: Children and teenagers who have or are recovering from chicken pox or flu-like symptoms should not use this product, if changes in behavior with nausea and vomiting occur, consult a doctor because these symptoms could be an early sign of Reyes syndrome, a rare but serious illness The FDA drug label does not answer the question.
From the Research
Indications for Aspirin in Pediatrics
The indications for Aspirin (Acetylsalicylic Acid) in pediatrics are primarily focused on the treatment of Kawasaki disease, a leading cause of acquired heart disease in children.
- Kawasaki Disease Treatment: Aspirin is used in conjunction with intravenous immunoglobulin (IVIG) to prevent coronary artery abnormalities in Kawasaki disease 2, 3, 4, 5, 6.
- Dosage Considerations: The optimal dose of aspirin remains controversial, with studies comparing low-dose (3-5 mg/kg/day) to high-dose (30-50 mg/kg/day) aspirin therapy 2, 3, 5, 6.
- Efficacy and Safety: Research suggests that low-dose aspirin may be as effective as high-dose aspirin in reducing the risk of coronary artery abnormalities, with potentially lower risks of adverse effects such as liver function impairment 2, 3, 6.
- Ongoing Research: Further studies, including randomized controlled trials, are needed to determine the most effective and safe dose of aspirin for the treatment of Kawasaki disease in pediatric patients 4, 5.