A Pediatric Hepatologist on Reye Syndrome, Plus a Protein-Packed Recipe for Families

When it comes to children’s liver health, prevention and everyday choices matter more than many parents realize. In an interview with The Educated Patient, Debora Kogan-Liberman, M.D., a pediatric hepatology specialist at NYU Langone Health, breaks down what parents and caregivers need to know about Reye syndrome — a rare but life-threatening condition that can affect children and teens, often after common viral illnesses like the flu or chickenpox.

Kogan-Liberman explains why aspirin use during viral infections is strongly linked to Reye syndrome, the warning signs families should never ignore and why early recognition can be lifesaving. Alongside this important conversation, we’re also sharing a liver-friendly recipe from the American Liver Foundation — a simple, nutrient-dense spinach- and feta-stuffed chicken breast that supports overall liver health and fits easily into family meals.

Together, the interview and recipe reinforce a powerful message: Informed choices, from medications to nutrition, play a critical role in protecting children’s long-term health.

Spinach- and Feta-Stuffed Chicken Breast

Ingredients

• 1 large chicken breast (about 6 ounces)
• 1/2 cup fresh spinach
• 1/4 cup crumbled low-fat feta cheese
• 1 teaspoon olive oil

Directions

1. Preheat oven to 375 F. Line baking sheet with parchment paper or tinfoil.
2. Slice chicken breast in half, cutting only about 3/4 of the way through. Stuff chicken breast with spinach and feta.
3. Brush with olive oil and bake for 30-35 minutes or until the inside of the chicken reaches 165 degrees.
4. Serve with your favorite vegetables on the side!

What is Reye syndrome, and why is it considered such a serious condition in children and teens?

Debora Kogan-Liberman, M.D.: Reye syndrome is a rare but life-threatening condition that causes acute encephalopathy and liver dysfunction, primarily affecting children and adolescents. Reye syndrome was described in 1963 in children presenting with a viral illness, most commonly influenza and varicella, followed by a few days of apparent improvement before the acute onset of profuse vomiting, rapid neurological deterioration and death in 40% of the cases.

Although the exact etiology of Reye syndrome remains unknown, early epidemiologic studies showed an association between Reye syndrome and aspirin use during a viral illness. Subsequent studies revealed that many affected patients had inborn errors of metabolism. The most widely accepted pathogenic mechanism involves an abnormal immune response to a viral infection, potentially exacerbated by drugs or toxins, leading to inflammatory cytokine release and mitochondrial injury, affecting fatty acid metabolism and resulting in hepatic dysfunction and cerebral edema.

Why is the use of aspirin during viral illnesses linked to Reye syndrome, and what do we know about that connection today?

DKL: In 1980, more than 500 cases of Reye syndrome were reported and 80% of patients had a history of aspirin use during a preceding viral illness. That same year, the Centers for Disease Control and Prevention advised against the use of aspirin in children with viral infections. Following this public health recommendation, the incidence of Reye syndrome declined dramatically. Although a strong statistical association between aspirin exposure and Reye syndrome has been demonstrated, a definitive causal relationship has not been established. Experimental studies have shown that aspirin can alter mitochondrial morphology and impair mitochondrial function, supporting a plausible mechanism.

Which children are most at risk, and are there specific illnesses or situations that raise concern?

DKL: Children and adolescents with both recognized and unrecognized inborn errors of metabolism have an increased risk of developing Reye syndrome when exposed to viral infections. External agents and toxins, including pesticides and insecticides, and certain medications such as salicylates, phenothiazines and valproic acid can also contribute to mitochondrial injury, increasing the risk for Reye syndrome.

What early warning signs should parents and caregivers watch for after a child has had the flu or chickenpox?

DKL: Reye syndrome is a biphasic disease. The first phase consists of a viral prodrome, such as influenza or varicella, followed by a brief period of apparent improvement. The second phase is characterized by the acute onset of profuse vomiting, rapid neurological decline, altered mental status and progression to coma. Parents and caregivers should be alert to children who appear to be recovering from a viral illness but then suddenly develop persistent vomiting, dehydration, lethargy, seizures or changes in behavior and consciousness.

How is Reye syndrome diagnosed and treated if it’s suspected, and why is early recognition so important?

DKL: Reye syndrome is diagnosed primarily based on clinical presentation, including a recent viral illness, possible exposure to aspirin, and a rapid clinical deterioration marked by vomiting and neurological changes. Laboratories’ findings typically include elevated liver enzymes, hypoglycemia, elevated ammonia and abnormal coagulation studies. Brain imaging might show cerebral edema, and a liver biopsy — when performed — reveals fatty infiltration. Early recognition is critical, as prompt initiation of treatment is required to correct hypoglycemia and high ammonia, reduce cerebral edema, and minimize the risk for permanent neurological injury and death.

What is the most important prevention message you want every parent and caregiver to remember about Reye syndrome?

DKL: Parents should consult their pediatrician during any viral illness and provide supportive care as recommended. Medications containing aspirin should be avoided, as well as herbal teas or alternative remedies. Parents and caregivers should promptly inform the health care provider of any new, worsening or concerning symptoms.