7 Warning Signs and Symptoms of Reye’s Syndrome You Should Know

Reye’s syndrome is a rare but potentially life-threatening condition that primarily affects children and teenagers recovering from viral infections, particularly chickenpox or influenza. This serious illness causes swelling in the liver and brain, which can lead to severe complications if not recognized and treated promptly. The condition has become much less common since the 1980s when the link between aspirin use in children with viral illnesses and Reye’s syndrome was established.

Understanding the warning signs of Reye’s syndrome is crucial for parents and caregivers, as early recognition can be lifesaving. The symptoms typically appear as a child is recovering from a viral infection, often within 3 to 5 days after the onset of the viral illness. The condition progresses rapidly, making it essential to seek immediate medical attention if you notice any concerning symptoms.

1. Persistent and Severe Vomiting

One of the earliest and most prominent symptoms of Reye’s syndrome is persistent, severe vomiting that doesn’t seem to improve. Unlike typical stomach flu or food poisoning, the vomiting associated with Reye’s syndrome is often relentless and occurs without significant relief between episodes.

This vomiting typically begins suddenly as the child appears to be recovering from a viral infection. Parents may initially mistake it for a stomach bug or a return of the original illness. However, the intensity and persistence of the vomiting should raise concern, especially if it’s accompanied by other symptoms.

Key characteristics of vomiting in Reye’s syndrome:

• Occurs repeatedly over several hours
• Cannot be controlled with typical remedies
• May lead to dehydration
• Often accompanied by extreme fatigue
• Appears suddenly during recovery from viral illness

2. Lethargy and Excessive Sleepiness

Children with Reye’s syndrome often exhibit unusual drowsiness or lethargy that goes beyond normal tiredness from being sick. They may appear abnormally sleepy, have difficulty staying awake, or seem disinterested in activities they normally enjoy.

This excessive sleepiness is caused by the swelling in the brain and changes in brain chemistry. The child may want to sleep constantly, have trouble responding when spoken to, or appear “out of it” even when awake. This symptom can progress rapidly from mild drowsiness to more serious levels of unconsciousness.

Parents should be particularly concerned if their child becomes increasingly difficult to wake or seems confused when they do wake up. This level of lethargy is not typical of regular viral illnesses and requires immediate medical evaluation.

3. Confusion and Disorientation

Mental confusion and disorientation are serious warning signs of Reye’s syndrome that indicate the condition is affecting brain function. Children may seem confused about where they are, what day it is, or may not recognize familiar people or places.

The confusion can manifest in various ways depending on the child’s age. Younger children might appear unusually fussy, irritable, or unable to focus on simple tasks. Older children and teenagers may give nonsensical answers to questions, seem “foggy” or unable to think clearly, or exhibit unusual personality changes.

Signs of confusion to watch for:

• Difficulty answering simple questions
• Inability to recognize family members
• Disorientation about time and place
• Unusual irritability or mood swings
• Difficulty following simple instructions
• Appearing “spaced out” or disconnected

4. Aggressive or Unusual Behavior

Behavioral changes are another concerning symptom of Reye’s syndrome. Children may suddenly become combative, aggressive, or display behavior that is completely out of character for them. This can be particularly alarming for parents who notice their typically calm child becoming agitated or even violent.

These behavioral changes occur because of the increasing pressure and swelling in the brain. The child is not acting this way intentionally but is experiencing neurological symptoms that alter their behavior and emotional control.

Examples of unusual behavior may include unprovoked anger, attempting to hit or bite caregivers, screaming without apparent cause, or extreme restlessness. In infants, this might manifest as inconsolable crying or unusual fussiness that cannot be soothed by typical comfort measures.

5. Seizures or Convulsions

Seizures represent a severe progression of Reye’s syndrome and indicate significant brain involvement. A seizure may appear as uncontrolled shaking or jerking movements of the body, stiffening of muscles, loss of consciousness, or temporary cessation of breathing.

Not all children with Reye’s syndrome will experience seizures, but when they do occur, it signals a medical emergency requiring immediate intervention. Seizures in Reye’s syndrome result from the increasing pressure and swelling in the brain, along with metabolic changes that affect brain cell function.

Types of seizures that may occur:

• Generalized tonic-clonic seizures (whole body convulsions)
• Focal seizures (affecting one part of the body)
• Absence seizures (brief loss of awareness)
• Myoclonic seizures (sudden muscle jerks)

If your child experiences any type of seizure activity, call emergency services immediately.

6. Loss of Consciousness or Coma

As Reye’s syndrome progresses without treatment, children may lose consciousness or slip into a coma. This represents the most severe stage of the illness and requires emergency medical intervention. Loss of consciousness occurs when the brain swelling becomes so severe that it impairs the brain’s ability to maintain normal awareness.

The progression to unconsciousness may happen gradually or rapidly. A child might become increasingly difficult to rouse, respond only to painful stimuli, or become completely unresponsive. Any level of reduced consciousness is a medical emergency.

Before complete loss of consciousness, you might notice progressive stages of declining awareness, such as the child responding only to loud voices, then only to physical touch, and eventually not responding at all.

7. Weakness or Paralysis in Arms and Legs

Some children with Reye’s syndrome develop weakness or even paralysis in their limbs. This symptom can affect one side of the body or all extremities, depending on which areas of the brain are most affected by the swelling.

The weakness may present as difficulty walking, trouble grasping objects, inability to lift arms or legs, or a general lack of muscle strength. In infants and very young children, this might be noticed as “floppiness” or decreased muscle tone when held.

This neurological symptom indicates that the brain damage is affecting the areas responsible for motor control and muscle function. Like other severe symptoms, any sudden weakness or paralysis requires immediate medical attention.

Additional symptoms that may accompany Reye’s syndrome:

• Rapid breathing or hyperventilation
• Dilated pupils
• Hearing loss
• Speech difficulties
• Vision problems

Main Causes of Reye’s Syndrome

While the exact cause of Reye’s syndrome remains not fully understood, medical research has identified several key factors that contribute to its development:

Viral Infections

Reye’s syndrome most commonly develops during recovery from viral infections, particularly:

• Influenza (flu): Both influenza A and B viruses are associated with Reye’s syndrome development
• Chickenpox (varicella): One of the most common viral triggers for the condition
• Upper respiratory infections: Common colds caused by certain viruses
• Gastroenteritis: Viral stomach infections in some cases

Aspirin Use in Children

The use of aspirin or aspirin-containing medications in children and teenagers with viral illnesses is the most significant known risk factor for Reye’s syndrome. This discovery led to widespread recommendations against giving aspirin to children under 18 years old, unless specifically directed by a physician for certain conditions.

The connection between aspirin and Reye’s syndrome is so strong that the dramatic decline in Reye’s syndrome cases since the 1980s is directly attributed to decreased aspirin use in children.

Metabolic Disorders

Some children have underlying metabolic disorders that may increase their susceptibility to Reye’s syndrome. These include:

• Fatty acid oxidation disorders
• Urea cycle disorders
• Carnitine deficiency
• Other inherited metabolic conditions

Toxin Exposure

Certain environmental toxins and chemicals have been investigated as potential contributing factors, including:

• Paint thinners
• Herbicides and pesticides
• Aflatoxins from mold

However, the role of these toxins in causing Reye’s syndrome is less established than the viral-aspirin connection.

Prevention of Reye’s Syndrome

While Reye’s syndrome cannot always be prevented, several important steps can significantly reduce the risk:

Avoid Aspirin in Children

The most important preventive measure is to avoid giving aspirin or aspirin-containing medications to children and teenagers under 18 years old, especially when they have viral illnesses or fever. Always check medication labels carefully, as aspirin may be listed under different names such as:

• Acetylsalicylic acid
• Salicylic acid
• Salicylate
• ASA

Use Safe Fever Reducers

For treating fever and discomfort in children, use acetaminophen or ibuprofen instead of aspirin. However, always consult with your healthcare provider about the appropriate medication and dosage for your child’s age and condition.

Proper Viral Illness Management

Take appropriate steps to manage viral illnesses in children:

• Ensure adequate rest and hydration
• Monitor symptoms carefully during recovery
• Seek medical attention if symptoms worsen or unusual symptoms appear
• Follow healthcare provider recommendations for illness management

Vaccination

Keeping children up to date with vaccinations, particularly the annual flu vaccine and varicella (chickenpox) vaccine, can help prevent the viral infections most commonly associated with Reye’s syndrome.

Screen for Metabolic Disorders

Newborn screening programs can identify some metabolic disorders that may increase Reye’s syndrome risk. If your child is diagnosed with a metabolic disorder, work closely with healthcare providers to manage the condition and reduce complications.

Read Medication Labels

Always read over-the-counter medication labels carefully before giving them to children. Some combination cold and flu medications may contain aspirin even if it’s not obvious from the product name.

Frequently Asked Questions

How quickly does Reye’s syndrome develop?

Reye’s syndrome typically develops rapidly, with symptoms usually appearing 3 to 5 days after a viral illness begins, often just as the child seems to be recovering. The condition can progress quickly from initial symptoms like vomiting to more serious neurological symptoms within hours to days, which is why immediate medical attention is crucial.

Can adults get Reye’s syndrome?

While Reye’s syndrome primarily affects children and teenagers, adults can develop the condition, though it’s extremely rare. When it does occur in adults, it typically follows the same pattern of developing after viral infections and may be associated with aspirin use or underlying metabolic conditions.

Is Reye’s syndrome contagious?

No, Reye’s syndrome itself is not contagious. However, the viral infections that often precede Reye’s syndrome (such as flu or chickenpox) are contagious. The syndrome is a reaction that occurs in certain individuals, not an infection that can spread from person to person.

What is the survival rate for Reye’s syndrome?

With early detection and prompt medical treatment, the survival rate for Reye’s syndrome has improved significantly. However, the condition is still serious, and outcomes depend on how quickly treatment begins and the severity of brain swelling. Some children may experience lasting effects even after recovery.

Can Reye’s syndrome happen more than once?

It is possible, though rare, for a child to develop Reye’s syndrome more than once. This is more likely in children with underlying metabolic disorders. If a child has had Reye’s syndrome, it’s especially important to avoid aspirin and be vigilant about symptoms during future viral illnesses.

Are there any long-term effects after recovering from Reye’s syndrome?

Long-term effects depend on the severity of the condition and how quickly treatment was initiated. Some children recover completely, while others may experience lasting neurological effects such as learning difficulties, developmental delays, muscle weakness, or seizure disorders. Early treatment significantly improves the chances of full recovery.

What should I do if I suspect Reye’s syndrome?

If you suspect Reye’s syndrome, seek emergency medical care immediately. Call emergency services or go to the nearest emergency room right away. Do not wait to see if symptoms improve, as the condition can progress rapidly. Early medical intervention is critical for the best possible outcome.

Can Reye’s syndrome be diagnosed with a simple test?

There is no single test for Reye’s syndrome. Diagnosis typically involves a combination of blood tests to check liver function and metabolic markers, tests to rule out other conditions, and sometimes a liver biopsy. Doctors also consider the patient’s recent medical history, including recent viral illnesses and medication use.

Is it safe to give my child any pain reliever during a viral illness?

Acetaminophen and ibuprofen are generally considered safe alternatives to aspirin for treating fever and discomfort in children with viral illnesses. However, you should always consult with your healthcare provider before giving any medication to determine the appropriate choice and dosage for your child’s specific situation.

Why has Reye’s syndrome become less common?

The incidence of Reye’s syndrome has decreased dramatically since the 1980s, primarily due to increased awareness about the dangers of giving aspirin to children with viral illnesses. Public health campaigns and warning labels on aspirin products have led to a significant reduction in aspirin use in children, which has correspondingly reduced Reye’s syndrome cases.

References:

• Mayo Clinic – Reye’s Syndrome
• National Institute of Neurological Disorders and Stroke – Reye’s Syndrome
• NHS – Reye’s Syndrome
• Centers for Disease Control and Prevention – Reye’s Syndrome
• National Organization for Rare Disorders – Reye Syndrome