Navigating Pediatric Medication Shortages: A Call for Caution and Solutions

In the face of a shortage of pediatric pain and fever medications, concerned parents are contemplating the use of adult acetaminophen, often considering dosage reduction for their children. However, caution is urged by Brandon Dionne, an associate clinical professor in Northeastern's School of Pharmacy.

While the active ingredient in adult acetaminophen tablets is the same as that in liquid drops and chewable tablets for children, Dionne emphasizes the crucial difference in dosages. Unlike fixed dosages for adults, pediatric dosages are determined based on both age and weight. Dionne explains that adult dosages typically range from a minimum of a 325-milligram regular strength tablet every three to four hours to a maximum of 500 milligrams in that time period.

Comparatively, pediatric dosages, as per Tylenol's guidelines, vary significantly based on age and weight. Dionne highlights the challenge of achieving precise measurements when attempting to cut down adult formulations to meet these specific pediatric requirements.

Despite warnings from Tylenol against cutting adult doses for children, many parents are doing so due to the shortage of pediatric acetaminophen. A Canadian poison control organization has even published a conversion dosing guide to assist parents in navigating this challenging situation.

The guide provides dosage conversions for both acetaminophen and ibuprofen based on tablet strengths. Dionne acknowledges the difficulty in using a pill cutter for ibuprofen due to its small size. Moreover, administering crushed tablets to children poses additional challenges compared to liquid formulations or chewable tablets.

The Ontario Poison Control Centre recommends consulting pharmacists for advice on crushing and serving acetaminophen or ibuprofen. However, the shortage has prompted parents to share advice and warnings on social media platforms.

In addition to the shortage of acetaminophen, there is also a reported scarcity of oral amoxicillin, with parents receiving half the usual amount for their children. Dionne suggests alternatives such as checking back later for supplies, considering generic alternatives, obtaining written prescriptions, or exploring compounding pharmacies that can create pediatric versions of medications.

The ongoing shortage of pediatric medications is attributed to a "tripledemic" of pediatric RSV, flu, and COVID-19. Despite the complex challenges posed by this situation, experts emphasize that the root cause lies in supply chain issues rather than any inherent difficulties in production.

Nada Sanders, a distinguished professor at Northeastern's D’Amore-McKim School of Business, calls for reassurances regarding the supply chain, especially as the winter approaches, bringing an increased likelihood of illnesses. Neil Maniar, director of Northeastern’s master of public health program, emphasizes the importance of acetaminophen and amoxicillin in managing and treating illnesses.

Dionne advises against hoarding pediatric medications, as it exacerbates the difficulties for other children in need. Instead, he encourages parents to buy only what they anticipate needing in the short term. Overall, the shortage of essential pediatric medications underscores the need for a comprehensive and resilient supply chain to ensure the well-being of children during times of increased health challenges.