During Christmas break, 2023, a 5-year-old girl developed mild fever. When the fever became more severe by day 2, her mother, Aparna Udupa (37), decided to give her a non-steroidal anti-inflammatory drug (NSAID) commonly used to treat fever, which her daughter’s pediatrician had prescribed for high-grade fevers.
The girl complained of a stomach ache all night and late into the night, vomited. To her shock, Aparna noticed a trace of blood in her vomit.
“The color of blood in her vomit looked like coffee gourds. We collected this in a bottle and rushed to the doctor immediately. We were told it is a case of extreme gastritis and were prescribed some medicines. An ultrasound was insisted on,” she says.
The girl vomited with strains of blood again while at the clinic. Doctors then decided to conduct a blood test and prescribed antacids for the gastric issues.
One of the parameters, pertaining to blood coagulation was slightly higher than the normal range and doctors insisted on the child’s hospitalization and a scan. “She was admitted for two days after which we were asked to consult a pediatric oncologist. The oncologist repeated the blood tests and the results were normal. After this, the oncologist told us that the NSAID could be the culprit,” says Udupa.
Udupa says that while her son who is administered the same medication whenever he gets a high fever faces no issues, her daughter experienced these serious symptoms.
“The doctors could not really pinpoint why this happened to her. She has a history of gastric trouble, they speculated it to be the cause,” Udupa adds.
Dr Rajath Athreya, lead neonatologist and senior consultant pediatrician, Rainbow Children’s hospital, Sarjapur Road, Bangalore says “In children, fever is a very common and recurrent problem. Along with the child’s fever, what we also treat is parental anxiety. So, parents should be aware of safe medicines especially for repeated use.”
Can NSAIDs cause side effects in children?
According to the UK National Health Service, Ibuprofen, a commonly used NSAID, can cause side effects in some rare cases.
Warning signs include:
- Severe stomach pains
- Vomiting blood
- Poop that looks very dark or black
- Peeing stops or there’s blood in the pee
- Ringing noise in ears
- Asthma that gets exacerbated
“Any child who vomits can also have small tears in the lower part of the food pipe where it joins the stomach and which just by the act of retching can have minor tears. This is the more common cause of blood in the vomit that we see in children,” points out Dr Athreya.
“With Ibuprofen, what usually happens is that the platelets do not work as effectively,” he adds. Dr Athreya says that if parents notice any warning signs such as severe tummy pain, vomiting blood, bleeding spots on the skin, which appear as bright pink spots on the face, arms or legs, it is best to stop the medications and get medical advice.
Dr Chetak AN, senior consultant pediatrician and neonatologist, Motherhood Hospitals, Whitefield, Bangalore says that a child developing rashes after being administered an NSAID is also a warning sign. “Another warning sign is swelling of the eyes or mouth, throat, lips and skin turning bluish or pale in color- these could be signs of the child being allergic to the particular medication.”
Dr Chetak adds that instances of NSAIDs used to treat fever causing these serious side effects in children are very rare. “NSAIDs like ibuprofen are routinely prescribed to treat fevers and most children do not experience any such side effects,” he says, adding “Sometimes, sudden and intense coughing can also lead to the presence of blood in the child’s vomit. It cannot always be linked to the NSAIDs.”
Dr Athreya also adds that parents who have, in the past, administered these medications to their children need not worry.
“NSAIDs mainly can affect the gut. They can cause mild ulcers, gastritis, and sometimes cause vomiting. These are all very rare. Parents should be very careful and not just buy it over the counter or without a doctor’s advice for repeated use,” he says.
Precautions to take
Dr Chetak says that it is important for parents to consult a pediatrician to correctly determine the dosage of the NSAID to be administered, taking the child’s weight into account. Dr Sthreya also adds that one must stick to the dosage prescribed by the doctors and the prescriptions must not be reused. “Antipyretic medicines should be given in prescribed doses up to a maximum of four times a day, repeated once in six to eight hours,” he says. “If symptoms continue, one must consult your pediatrician again.”
“One must also ensure to only administer an NSAID after food. Taking it on an empty stomach may end up causing gastrointestinal distress. Parents must also ensure that a liquid-rich diet is followed,” he says.
Dr Athreya cautions parents against administering mefenamic acid or meftal medication, an NSAID to treat fevers. The Indian Pharmacopoeia Commission issued a drug safety alert in 2023 asking healthcare professionals and consumers to watch out for adverse side effects to the drug.
“The casual, repeated prescription and use of mefenamic acid, over the counter sale is alarming. Ibugesic is part of recommendations for occasional use,” he says, adding that if a doctor prescribes meftal, parents should ask for an alternative.
He also points out that certain NSAIDs are not to be used in the pediatric population. “Nimesulide, an NSAID, for instance, has been banned for pediatric usage by the government of India due to its side effects.”
Dr Athreya says that one of the safest medicines that is usually prescribed to treat fevers in children is paracetamol.
Takeaways
In some rare cases, certain non-steroidal anti-inflammatory drugs (NSAIDs) commonly used to treat fever, can end up causing serious side effects in some children. Doctors caution parents to keep an eye out for warning signs or side effects such as severe stomach pain and vomiting blood after administering an NSAID.
