Ibuprofen and Other NSAID Warning for Children with Flu
Ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) are often given to children with flu or the common cold. However, parents should know there is a risk of kidney damage associated with ibuprofen and other NSAIDs, even when these drugs are taken at the recommended dosages.
Do children with flu need ibuprofen?
When children get the flu, a cold, or a similar illness with fever, a common treatment, parents have been warned not to give their youngsters aspirin, because of the risk of Reyes syndrome. Reyes syndrome is a potentially fatal condition associated with the use of aspirin in children and teens (although it also can affect adults).
Therefore, many parents choose ibuprofen, naproxen, or ketorolac. Indeed, there are several over-the-counter ibuprofen products on the market specifically targeted at babies and children to reduce fever and relieve pain.
Warnings associated with NSAIDs for children typically include a rare risk for heart attack, stroke, and gastrointestinal bleeding. However, a new study published online in the Journal of Pediatrics also warns that nearly 3 percent of cases of acute kidney injury in children have been associated with use of NSAIDs.
Investigators at Indiana University and Butler University arrived at their conclusions based on a review of medical records at Riley Hospital for Children in Indianapolis from January 1999 through June 2010. A total of 1,015 cases of acute kidney injury were found.
Among those cases, the authors determined that 27 children, or 2.7 percent, had sustained acute kidney damage solely from the use of NSAIDs. Ibuprofen was the most commonly used drug (67% of cases), followed by naproxen and ketorolac.
In nearly every case, the medications had been given to the children before they were admitted to the hospital. Most of the children received doses within the recommended limits, but they still experienced symptoms such as vomiting, abdominal pain, and a reduction in urine output.
The investigators believe the 2.7 percent figure is low, because many of the children with acute kidney injury had other factors that could have contributed to the damage as well, and NSAID use was just one of them.
One reason ibuprofen and other NSAIDs have the potential to cause kidney damage is that they restrict blood flow to the parts of the kidney that filter out toxins. Children with flu and/or fever are frequently dehydrated because of their elevated temperature, diarrhea, or vomiting, which can place them at greater risk of kidney damage.
What can parents do?
Children who experience flu, the common cold, or fever should keep well hydrated. Water, noncaffeinated teas (herbal teas), vegetable broths, and diluted fruit juices are suggested.
An alternative to ibuprofen and other NSAIDs for treatment of fever is acetaminophen (Tylenol). However, fever is the body’s way to fight infection and does not always need to be treated.
According to Jason Misurac, MD, one of the study’s authors and a fellow in pediatric nephrology at Indiana University, although acetaminophen is an option, “another alternative would be no medication at all, at least for a while, to let the body fight the infection.”
In fact, researchers at the Roswell Park Cancer Institute in Buffalo, New York, reported that a moderate elevation in body temperature actually helps immune cells perform better. A fever is not considered to be a medical concern unless the temperature is greater than 100.4 F.
In addition, the American Academy of Pediatrics’s guidelines on fever in children notes that “fever is a physiological mechanism that has beneficial effects in fighting infection,” and that while parents may give anti-fever (antipyretics) medications such as ibuprofen or acetaminophen to help reduce a fever, “the primary goal should be to help the child feel more comfortable, rather than to maintain a ‘normal’ temperature.”
All of this information regarding the use of NSAIDs in children is food for thought. Parents whose children have flu or fever may want to consult their doctor before dispensing ibuprofen or other NSAIDs, or any medication, to determine if it is necessary or safe.
American Academy of Pediatrics
Misurac J et al. Nonsteroidal anti-inflammatory drugs are an important cause of acute kidney injury in children. Journal of Pediatrics 2013. DOI:10.1016/j.jpeds.2012.11.069