Based on NIH | Is it true that children with chickenpox should not take aspirin because it increases the risk of Reye’s syndrome?

Yes children and teenagers with chickenpox (varicella) should generally not take aspirin or salicylate‑containing products due to the risk of Reye’s syndrome, a rare but serious condition that can damage the liver and brain. ^{[1] [2]}

What Reye’s Syndrome Is

Reye’s syndrome is an acute illness that typically follows a viral infection and can lead to brain swelling (encephalopathy) and liver dysfunction, sometimes rapidly. ^[3] It has been strongly linked, in epidemiologic studies, to aspirin use during illnesses like influenza and chickenpox in children and teens. ^[3]

The Evidence Linking Aspirin and Reye’s Syndrome

• Multiple case‑control studies have shown a strong statistical association between aspirin exposure during a preceding viral illness (including varicella) and subsequent Reye’s syndrome. ^[4] In one major study, the odds of Reye’s syndrome were many times higher among children who had taken aspirin compared with those who had not. ^[4]
• A dose‑response pattern has also been observed, where higher aspirin dosing during the early days of illness correlated with increased risk. ^[5]
• As awareness grew and aspirin use in children decreased, the incidence of Reye’s syndrome declined, supporting a likely causal link. ^[3]

Official Warnings and Guidance

• Over‑the‑counter aspirin labels in the United States carry a Reye’s syndrome warning specifically advising that children and teenagers who have or are recovering from chickenpox or flu‑like symptoms should not use aspirin. ^{[1] [6]}
• Public health authorities have issued advisories cautioning against giving salicylates (aspirin and related products) to children with influenza or chickenpox. ^[2]
• Clinical guidance reiterates that aspirin should not be used for viral infections in children unless a healthcare professional specifically instructs it due to the Reye’s risk. ^[7]

Are There Any Exceptions?

There can be rare, doctor‑directed exceptions (for example, certain cardiac conditions where low‑dose aspirin is medically necessary). In such cases, clinicians may weigh benefits and risks and provide clear instructions, sometimes alongside preventive measures like ensuring up‑to‑date varicella and influenza vaccination to reduce viral infection risk. ^[8] However, without explicit medical direction, aspirin avoidance in this setting is the standard. ^[7]

Safer Fever and Pain Options

For fever and discomfort from chickenpox, non‑salicylate alternatives are preferred unless a clinician advises otherwise. Acetaminophen (paracetamol) is commonly used as an alternative for children with viral illnesses. Historical shifts in pediatric practice replaced aspirin with acetaminophen for this reason. ^[9]

Practical Tips for Families

• Check labels for “aspirin,” “acetylsalicylic acid,” “salicylate,” or “salicylic acid” to avoid hidden salicylates in multi‑ingredient products marketed for colds or pain. ^[10]
• If a child or teen has chickenpox or flu‑like symptoms, avoid aspirin and talk with a healthcare professional about appropriate fever reducers and comfort measures. ^[1]
• Watch for concerning symptoms such as persistent vomiting, unusual behavior changes, or confusion if a child has recently taken aspirin during a viral illness, and seek medical care promptly. ^[11]

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Quick Reference Table

Topic	Key Point	Why It Matters
Risk	Aspirin use during chickenpox/flu in children is associated with Reye’s syndrome. [4] [3]	Reye’s can cause brain and liver injury and can progress quickly. [3]
Labels	OTC aspirin products warn against use in children/teens with chickenpox or flu symptoms. [1] [6]	This is a clear, standardized safety warning for families. [1]
Guidance	Public health advisories recommend avoiding salicylates in viral infections in children. [2] [7]	Consistent guidance helps prevent rare but severe outcomes. [2]
Alternatives	Use non‑salicylate options (e.g., acetaminophen) for fever/pain unless otherwise directed. [9]	Provides relief without the Reye’s risk link seen with aspirin. [9]
Vaccines	Keeping chickenpox and flu vaccines up to date helps lower infection risk. [8]	Fewer viral illnesses mean fewer opportunities for Reye’s to occur. [8]

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Bottom Line

• Children and teens with chickenpox should not take aspirin or salicylate‑containing products because it can increase the risk of Reye’s syndrome. ^{[1] [2]}
• Choose non‑salicylate alternatives for fever and pain, and consult a healthcare professional if unsure. ^[9]
• If aspirin has already been taken and concerning symptoms appear (like vomiting or behavior changes), seek medical care promptly. ^[11]