Childhood Diseases – On a Mission to Educate: Reye’s Syndrome

My last article, Childhood Diseases – On a Mission to Educate: Pink Eye (Conjunctivities) we learned that Pink Eye is highly contagious so about 3 million cases of pink eye occur in the US each year. Treatment is not always needed & can be managed at home. But there can be certain situations that require medical intervention. Pink eye involves inflammation of the conjunctiva which is a thin, clear tissue that lines the inside of the eyelid & covers the white part of the eye or sclera. The inflammation causes the blood vessels to be more visible resulting in a pink or reddish appearance.

Symptoms can include a painful, itchy or burning sensation in the affected eye. There may also be tears or a discharge that forms a crust while one is asleep which results in the eye to be stuck shut when one awakes. Pink eye can also occur in newborns which is called neonatal conjunctivitis. Parents should work with the child’s physician to treat their newborns condition. Today we will move onto another childhood illness, Reye’s Syndrome.

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What Is Reye’s Syndrome?

According to Kids Health (http://kidshealth.org/en/parents/reye.html) Reye’s Syndrome is an “extremely rare but serious illness that can affect the brain and liver. It's most common in kids who are recovering from a viral infection.” In 1963 the first reported case of Reye’s Syndrome was by an Australian pathologist, R. Douglas Reye, who’s name was used to name this disease. Unfortunately it is still not well understood but there have been studies that link Reye’s Syndrome to the use of aspirin (salicylates) or aspirin products during a viral disease. Because of this discovered link to aspirin, the number of reported cases of Reye’s have dropped significantly.

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Reye’s Syndrome causes the brain to swell and there are large amounts of fat that accumulates in the liver and other organs. According to Baby Center (https://www.babycenter.com/0_reyes-syndrome-in-babies_10901.bc) if Reye’s is left untreated, it can quickly lead to liver failure, brain damage and even death. “It can strike anyone at any age, but it usually affects children between the ages of 4 and 12. And while it can occur at any time of year, rates are highest during the flu season months of January, February, and March.”

Baby Center also stated that Reye’s is often misdiagnosed for things like encephalitis, meningitis, a drug overdose, sudden infant death or poisoning. They recommended that if you think your child may have Reye’s syndrome, you should consider it a medical emergency. The earlier the medical intervention, the better the chances there are of survival.

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What Is the Aspirin Connection to Reye’s Syndrome?

According to Reye’s Syndrome (http://www.reyessyndrome.org/aspirin.html) there have been Epidemiological Research done which showed the association between the development of Reye’s Syndrome and the use of aspirin (a salicylate compound) for treating influenza-like symptoms. Reye’s Syndrome also provided the following information: “The U.S. Surgeon General, the Food and Drug Administration, the Centers for Disease Control and Prevention, and the American Academy of Pediatrics the National Reye's Syndrome Foundation, and WHO recommend that aspirin and combination products containing aspirin not be given to children under 19 years of age during episodes of fever-causing or viral illnesses.”

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Parents should know that Acetylsalicylate is another word for Aspirin and that many medicine labels may use words like acetylsalicylate, acetylsalicylic acid, salicylic acid, or salicylate instead of the word aspirin. Reye’s Syndrome strongly recommends that parents should always ask the child’s doctor or pharmacist before administering any medication.

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Who’s At Risk to Reye’s Syndrome?

The most at risk for Reye’s Syndrome according to Health Line (https://www.healthline.com/health/reye-syndrome#causes3) are children and teenagers with underlying fatty acid oxidation disorders. As covered above, any child &/or teen given aspirin during fever-related illnesses have a higher risk for developing Reye’s syndrome. Because aspirin is closely related to the risk of Reye’s, parents need to be very diligent by reading all labels on over the counter (OTC) pain relievers. Did you know that there are many OTC medications that contain salicylates such as Pepto-Bismol (bismuth subsalicylate), Kaopectate (loperamide), & any products containing oil of wintergreen? These types of products should not be given to children who have or may have a viral infection. Also according to Health Line parents should also avoid these things several weeks after the child has received the chickenpox vaccine.

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What Are the Symptoms of Reye’s Syndrome?

The following are the most common symptoms of Reye’s Syndrome according to Stanford Children’s Hospital (http://www.stanfordchildrens.org/en/topic/default?id=reye-syndrome-90-P02620) however it must be noted that each child may experience symptoms differently. It is also important to know that a child may have had a viral illness like respiratory infection, chickenpox or diarrhea before experiencing any Reye’s Syndrome symptoms. Symptoms may include the following:

A full or bulging fontanelle (a soft spot on the top of the head in infants)

Sleepiness or lethargy

Sudden and prolonged vomiting

Combative behavior

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Rapid breathing and heart rate

Seizures

Coma

Increased intracranial pressure

Increased irritability

High-pitched cry

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How is Reye’s Syndrome Diagnosed?

The physician will complete a physical examination and obtain a complete medical history of the child. Usually the doctor will ask the parents if the child has had a recent cold or other viral illness and if he/she has taken aspirin or medication containing aspirin. The following tests may also be ordered to confirm the diagnosis of Reye’s according to Stanford Children’s Hospital:

Blood and liver function tests

Urine and stool tests

Liver biopsy. A small amount of tissue is removed from the liver and studied to help diagnose different illnesses.

Electroencephalogram (EEG). A procedure that records the brain's continuous, electrical activity by means of electrodes attached to the scalp.

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Lumbar puncture (spinal tap). A special needle is placed into the lower back, into the spinal canal. This is the area around the spinal cord. The pressure in the spinal canal and brain can then be measured. A small amount of cerebral spinal fluid (CSF) can be removed and sent for testing to determine if there is an infection or other problems. CSF is the fluid that bathes your child's brain and spinal cord.

Intracranial pressure monitoring (ICP). Measures the pressure inside of the child's head.

Magnetic resonance imaging (ICP). A diagnostic procedure that uses a combination of a large magnet, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

After the physical exam and results of diagnostic testing, the doctor will diagnosis the child with Reye’s Syndrome if the results are positive for it.

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How is Reye’s Syndrome Treated?

Reye’s Syndrome is a very serious illness that is typically treated with hospitalization. The more severe cases are usually treated in the intensive care unit. According to Health Line, there is no cure for Reye’s Syndrome so “treatment is supportive, focusing on reducing symptoms and complications. Doctors will make sure the child stays hydrated and maintains balanced electrolytes. They’ll evaluate cardiorespiratory (heart and lung) status, and liver function will be carefully monitored. Children with seizures will be given appropriate medications to control them and their side effects.”

Medications primarily used to treat Reye’s include:

Insulin to increase glucose metabolism

Corticosteroids to reduce brain swelling

Diuretics to get rid of excess fluid

When breathing is an issue, a respirator may be used to assist in breathing

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Outcome of Reye’s Syndrome?

The outcome depends on how quickly the diagnosis is made and medical intervention is initiated. According to Health24 (http://www.health24.com/Medical/Diseases/Reye-syndrome-20120721) the outcome is also dependent on the severity and duration of the encephalopathy. “Mild cases will recover quickly with no neurological deficits, whereas the more severe cases take longer to recover and may have significant neurological deficits. Death is rare and is due to brain death from the cerebral edema.”

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How to Protect Your Child From Reye’s Syndrome?

The most significant thing to protect your child from Reye’s Syndrome is to NOT GIVE YOUR CHILD ASPIRIN.

According to Baby Center to safeguard your child’s health parents need to take the following precautions:

Never give aspirin to your child, or to anyone 19 years old or younger. If your child has a virus (or even viral-like symptoms), ask his doctor what medications you might safely give him for pain relief, if necessary.

Don't take any products containing aspirin if you're nursing, because the drug is passed through breast milk.

Read labels carefully to avoid accidentally giving aspirin to your child. Many over-the-counter drugs contain aspirin, including some antacids, anti-nausea, and cold and sinus medicines. Be on the lookout for terms like salicylate, acetylsalicylate, acetylsalicylic acid, salicylamide, and phenyl salicylate, which may be used instead of the word aspirin. (Many over-the-counter drugs aren't safe for young children. Check for age restrictions, and ask a doctor if you have any questions about the appropriateness of a drug for your child.)

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In conclusion Reye’s Syndrome is a rare but very serious illness that usually occurs in children. It can affect all organs of the body but it mostly affects the brain and the liver. Reye’s usually occurs after a viral infection, most commonly chickenpox or influenza. No one actually knows what causes it but there is a strong correlation to the use of aspirin or aspirin containing medications during viral infections. Some symptoms of Reye’s Syndrome are vomiting, irritability or aggressiveness, confusion, lethargy, seizures & coma. There is no cure for Reye’s Syndrome however if there is quick and early medical intervention, symptoms can be managed with better outcomes.

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I hope you learned something from this article about Reye’s Syndrome. There are many resources on the internet if you need more specific information. I will continue this series with another childhood disease post. I hope you will continue to join me in this quest to learn about these illnesses that children usually encounter when they are young. Thank-you for reading my article on ”Childhood Diseases – On a Mission to Educate: Reye’s Syndrome”. If you would like to follow me, please check HERE