From the Guidelines
Pepto-Bismol should be avoided in children due to its salicylate content, which is associated with an increased risk of Reye's syndrome, a rare but serious condition that causes swelling in the liver and brain. According to the guidelines of care for the management of acne vulgaris 1, the use of salicylates in children with varicella infection or influenza-like illnesses is associated with an increased risk of developing Reye syndrome. The study also notes that salicylic acid 6% cream, lotion, and gel and 15% plaster are not recommended in children <2 years of age, and that there is an increased risk of salicylate toxicity with prolonged, excessive use in children <12 years of age. Some key points to consider when deciding whether to use Pepto-Bismol in children include:
- The risk of Reye's syndrome is greatest when salicylates are given during viral illnesses
- Alternative medications like Pedialyte for hydration or acetaminophen (Tylenol) for fever and discomfort are safer options for children under 12
- For children 12 and older, Pepto-Bismol may be used but only under a doctor's guidance
- Parents should always consult with a healthcare provider before giving any medication containing salicylates to children, and should be aware of symptoms of Reye's syndrome, which include persistent vomiting, lethargy, and behavioral changes 1.
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. Allergy alert: Contains salicylate. Do not take if you are Allergic to salicylates (including aspirin) taking other salicylate products
Yes, Pepto-Bismol should be avoided in children due to its salicylate content, especially in those with a history of or current chicken pox or flu-like symptoms, due to the risk of Reye's syndrome 2.
From the Research
Pepto-Bismol and Children
- Pepto-Bismol, which contains bismuth subsalicylate, has been found to be effective in shortening the duration of diarrheal illness in children, as seen in research from developing countries 3.
- However, its use in children is not routinely recommended due to concerns about it potentially causing Reye syndrome, limited effectiveness, compliance, and cost 3.
- Bismuth subsalicylate has been shown to have beneficial effects on chronic infantile diarrhea and can prevent traveler's diarrhea in adults 4.
- A systematic review and meta-analysis found that bismuth subsalicylate can be beneficial for those at risk or affected by food and waterborne diarrheal disease, such as traveler's diarrhea, and may decrease the risk of inappropriate antibiotic utilization 5.
Salicylate Concerns
- The salicylate moiety in bismuth subsalicylate has been found to exert antisecretory effects in patients with diarrhea, and the bismuth and intestinal hydrolysis products have direct antimicrobial effects 4.
- Despite the benefits, the use of bismuth subsalicylate in children is limited due to the potential risk of Reye syndrome, a rare but serious condition that can occur in children who take salicylates while having a viral infection 3.
Usage Considerations
- Bismuth subsalicylate has been used for over 80 years to treat gastrointestinal symptoms, and its effectiveness and safety have been documented in various studies 4, 5.
- However, the decision to use Pepto-Bismol in children should be made with caution and under the guidance of a healthcare professional, taking into account the potential risks and benefits 3.