by Amy Spangler
December 29, 2011

Doctors speak and parents listen—give feverish children under the age of 21 acetaminophen rather than aspirin. Why? Because research shows that aspirin use increases the risk of Reye’s syndrome.

Sounds simple enough. But a recent New York Times article suggests that good intentions may have unintended consequences. Since the no aspirin policy was implemented, cases of Reye’s syndrome have decreased but asthma rates have risen.

Dr. Arthur Varner was the first to suggest a possible link between acetaminophen and asthma in an article published in 1998 in The Annals of Allergy and Asthma Immunology. Since then, numerous studies have shown similar results, including a large analysis of data on more than 200,000 children that found an increased risk of asthma among children who had taken acetaminophen.

Most recently, Dr. John T. McBride, a pediatrician at Akron Children’s Hospital in Ohio, in an article published in the December 2011 issue of Pediatrics suggests that there is enough evidence for doctors to recommend not giving acetaminophen (using ibuprofen instead) to children with asthma or those at risk for developing the disease.

However, Dr. Mahyar Etminan, a pharmocoepidemiologist at the University of British Columbia and lead author of a meta-analysis on acetaminophen use and asthma published in 2009 urges caution. Despite evidence showing an increase in the risk of asthma and wheezing in children and adults exposed to acetaminophen, it’s unclear whether acetaminophen is responsible for the increase or whether the viral infection that prompted the use of acetaminophen is the cause. Parents of study children were asked to remember how much acetaminophen they gave their child and how often. Because parents of children with asthma are more attune to events leading up to an attack, they may be more likely to recall giving their child acetaminophen.

Until more data is available (several trials are currently underway), parents are urged to talk with their child’s health care provider about treatment options for fever. Given that both acetaminophen and ibuprofen have been linked to asthma and aspirin to Reye’s syndrome, perhaps using anti-fever medications sparingly is the best course of action for parents.

Click here to read more about treating fevers.