Paediatric analgesia & aspirin
also: paracetamol child · ibuprofen child · NSAID children · aspirin Reye Kawasaki
Overview
Antipyretics/analgesics in children, and the aspirin paradox: contraindicated for Reye syndrome — EXCEPT in Kawasaki disease, the one place children do get aspirin.
Mechanism
Paracetamol: central COX inhibition / poorly understood — antipyretic + analgesic, NOT anti-inflammatory. NSAIDs (ibuprofen): inhibit COX → ↓prostaglandins → anti-inflammatory, analgesic, antipyretic — and the SAME prostaglandin inhibition is why an NSAID closes a PDA in a neonate. Aspirin: irreversible COX inhibition; in children it is linked to Reye syndrome (encephalopathy + fatty liver) during viral illness, hence the under-16 ban — but Kawasaki disease is the deliberate exception.
Indications
- Fever / pain (paracetamol, ibuprofen)
- Kawasaki disease (aspirin — the exception)
- NSAID also used to medically CLOSE a patent ductus (see Ductus arteriosus card)
The agents
weight-based
First-line; safe; overdose → hepatotoxicity (NAC).
weight-based, with food
Avoid in dehydration/shock (renal) and caution in chickenpox/varicella (necrotising soft-tissue infection risk).
CONTRAINDICATED <16 (Reye) EXCEPT Kawasaki disease — high-dose (anti-inflammatory) acute, then low-dose (antiplatelet).
Adverse effects
Encephalopathy + hepatic failure during/after a viral illness — the reason for the under-16 ban.
Use one; only switch/combine if distressed and not responding (NICE NG143).
Cautions & contraindications
Reye syndrome — UNLESS Kawasaki disease (or other specific specialist indication).
Possible link to severe soft-tissue infection.
Interactions
- NSAID + dehydration → AKI
Monitoring & kinetics
Fever response, hydration; in Kawasaki: echo for coronary aneurysms
Weight-based oral dosing; ibuprofen with food.
Source: NICE NG143 — Fever in under 5s · BNF for Children — Analgesics