Which statement MOST indicates that a 12-year-old with rheumatic fever on long-term aspirin therapy is experiencing a serious adverse reaction?

• A. I hear ringing in my ears
• B. I put lotion on my itchy skin
• C. My stomach hurts after I take that medicine
• D. These pills make me cough

Answer: (A)

Tinnitus, or ringing in the ears, is a classic sign of salicylate toxicity from long-term aspirin use. In a child taking aspirin for rheumatic fever, elevated salicylate levels can affect the inner ear and auditory nerves, producing tinnitus and sometimes hearing loss. This is a warning sign that requires prompt evaluation and likely cessation or dose adjustment of aspirin to prevent more serious toxicity.

While stomach upset can occur with NSAIDs, it is a common, less alarming side effect and not as urgent as signs of toxicity. Local skin itching from a lotion is not related to aspirin toxicity, and a cough is not the typical presentation of salicylate toxicity in this context.

Also important to remember: aspirin in children carries a risk of Reye syndrome, a life-threatening condition, so any new or worsening symptoms should be evaluated quickly by a clinician.