Clinicians, Parents Struggling With Shortage of Kids’ Liquid Pain Relievers

Amid all the other problems for pediatric clinicians, patients, and families caused by the “tripledemic” of COVID-19, influenza, and respiratory syncytial virus (RSV), they now have something else to contend with: a shortage of children’s over-the-counter brand-name liquid pain relief and fever-reducing medications such as ibuprofen (Advil or Motrin) and acetaminophen (Tylenol).

“Just yesterday in clinic, I had a mom tell me how she went to four stores looking for medication for her child,” Hailey Nelson, MD, a pediatrician at Valley Children’s Healthcare in Madeira, California and spokesperson for the American Academy of Pediatrics, said in a phone interview. “This is unprecedented in pediatrics — that this many children are sick at the same time.”

It’s not just parents treating children at home either. “We have not had access to children’s Tylenol at our health center for the last 4 weeks,” Alyssa Levin-Scherz, MD, the head of pediatrics at DotHouse Health in Dorchester, Massachusetts, told CBS Boston. The shortage has gotten so bad that national retail chain pharmacies such as CVS and Walgreens have started limiting purchases of these medications.

Why is this happening? “It’s really demand-driven,” former FDA commissioner Scott Gottlieb, MD, said Sunday on CBS’s “Face the Nation.” “Distributors made estimates on how much demand there would be this year. They’ve had lower demand the past 2 years because there was less bacterial infections because we were all taking certain steps to prevent the spread of [COVID-19] disease. Demand went up this year; they anticipated some increase in demand, but not as much as we’re seeing and not this early in the season. So it’s not any kind of disruption in supply.”

What can clinicians do to help? Since these medications also are available by prescription, Nelson said she has written prescriptions for them for some patients, but “some of my pharmacies don’t have it available [even] in prescription form.”

She also has reminded parents they can use generic or store-brand versions of these medicines as long as they properly account for the age and weight of their child. “And we do have some wiggle room for older children who maybe can do chewables instead — or if they have a bigger kid, there is room for parents to teach their child to swallow pills.” Nelson steers parents away from crushing pills or listening to people on social media who say parents can make their own liquid formulations. “Please don’t do that, because I can’t guarantee what the dosage is that way.”

Finally, “the important thing as a doctor is to remind parents a fever is sign that the child’s immune system is working and they’re fighting off infection,” she said. “They should look at how to make their child comfortable if they don’t have access to medications, because not all fevers need to be treated.” Nelson tells parents to allow their child to rest and give them “extra snuggles” and a lukewarm bath if they’re not feeling well; also, they should be kept hydrated with water and Popsicles.

Children’s hospitals are coping with the shortage as best they can. “Our hospitals are managing these shortages much like other shortages, by prioritizing formulations for those that require solutions as well as preparing patient-appropriate dosages as needed,” Terri Wilson, director of supply chain services at the Children’s Hospital Association, said in a statement, adding that performing these tasks “requires additional staff time.”

The FDA told MedPage Today in an email that “the public should rest assured the FDA is working closely with numerous manufacturers and others in the supply chain to understand, mitigate, and prevent or reduce the impact of intermittent or increased demand [for] certain products. The FDA understands that manufacturers expect availability to continue to increase in the near future.” The agency is also offering its assistance to manufacturers to identify sources of raw materials or other drug components.

The Consumer Healthcare Products Association, which represents over-the-counter pain medicine manufacturers, said companies are doing their best to replenish the supply. “Manufacturers continue operating at maximum capacity to replenish children’s pain and fever reducers to meet current extraordinary demand,” the organization said in a statement posted on its website.

“While there is not a widespread shortage and our member companies are continuously shipping out products to retailers to replenish supply as quickly as possible, we recognize that limited products on store shelves is frustrating for parents and caregivers,” the association continued. “With demand for these products increasing by 65% from this same time last year, we also understand why some retailers have voluntarily set limits on purchases to ensure the availability of these products to as many consumers as possible.”

In a statement, Johnson & Johnson, maker of Children’s Tylenol and Children’s Motrin, said, “We continue to experience high consumer demand driven by an extremely challenging cold and flu season. While products may be less readily available at some stores, we are not experiencing widespread shortages of Children’s Tylenol or Children’s Motrin. We recognize this may be challenging for parents and caregivers, and are doing everything we can to make sure people have access to the products they need, including maximizing our production capacity, running our sites 24 hours a day, 7 days a week, and continuously shipping out product. We will continue to partner with retailers to provide these products to consumers.”