Why is there a children’s Tylenol shortage? Here’s what parents can do.

Washington Post - Influenza, covid and RSV are causing a rise in demand. Experts discuss what other medications children can take and what they absolutely should not use.

In recent weeks, parents and other caregivers have found it tough to get over-the-counter fever- and pain-reducing medications for their ill children.

Three respiratory viruses — influenza, the coronavirus and respiratory syncytial virus, known as RSV — have been sweeping across the nation, swamping hospital emergency rooms and pediatricians’ offices, and prompting a huge demand for the drugs. Supplies of pediatric formulations such as liquid acetaminophen and ibuprofen have become scarce in many places as manufacturers struggle to keep pace with pressure from worried parents.

The Washington Post spoke with four experts about the shortage and to answer common questions about what parents can do to help their children if they can’t find these drugs. Here’s what they said.

Why is there a shortage of some children’s medications?

First, “the shortages aren’t everywhere,” said William Schaffner, an infectious-diseases specialist and professor of preventive medicine in the department of health policy at Vanderbilt University School of Medicine. “There are spot shortages.”

Schaffner called the situation caused by the three viruses a “tridemic.” He said RSV and influenza “have hit children early and fiercely and simultaneously” leading parents to flock to stores and cause “isolated shortages.”

Joanna Dolgoff, a pediatrician and spokeswoman for the American Academy of Pediatricians, said she has never seen such a situation of “so many respiratory illnesses at the same time hitting so hard” with “emergency rooms, urgent care and doctors’ offices overflowing with patients.”

“Everybody is sick, and everybody needs medicine at once,” and companies can’t keep up with the high demand, Dolgoff said.

Gabrielle Virgo, a pediatrician in Silver Spring, Md., says her practice also has experienced a shortage of amoxicillin suspension, the pediatric formulation of an antibiotic used against childhood bacterial infections. Although antibiotics do not work against viruses — only bacteria — Virgo says physicians are seeing secondary bacterial infections with the current “tridemic” that require first-line antibiotics such as amoxicillin.

“My pharmacists have been out of certain suspension concentrations, but not all, so I have been adjusting my dosing,” she said. “The pharmacists, however, have also had a steady supply of either amoxicillin tablets or capsules, which I can use for my adolescent patients.”

Antibiotics should not be used against viruses alone, she added, since their inappropriate overuse contributes to the growing problem of antibiotic resistant bacteria.

How long is this drug shortage expected to last?

Schaffner believes the problem will be short-lived. Manufacturers are saying they have the stocks and need to get it to retail locations quickly, he said. Schaffner advised people to call different pharmacies and stores to find the medications if they can’t find them at their regular location.

Others think it might be weeks or months, which “doesn’t help somebody whose child is sick today,” Dolgoff said.

What can you substitute for children’s Tylenol or Motrin?

Although name brands such as Tylenol, Advil and Motrin may not be readily available, generic forms might be easier to find and are fine to use, Dolgoff says. Generic Tylenol is acetaminophen, and generic Advil and Motrin are ibuprofen.

Virgo also urges parents to look for store brands, and even sometimes provides prescriptions to her patients for these same drugs in over-the-counter strength, if they have prescription insurance coverage. “I assume this gives them access to a supply of medication independent of what is available over the counter,” she said.

Dolgoff said that it isn’t always necessary to treat a fever with medication and that parents shouldn’t worry if they can’t find one. “A fever itself is not dangerous unless it gets super high, super quick,” she said. “In rare cases, this can spark a febrile seizure, which is concerning.” For most children, she said, treating a fever doesn’t cure the illness or shorten its duration.

Dolgoff offered these pieces of advice to parents or other caregivers: Keep the child’s room cool. Place a fan nearby to keep cool air moving. Dress the child lightly. Have the child drink extra fluids. And consider sponging the child with tepid — not cold — water. The water should feel just slightly warm. Too cold water can cause shivering, which can raise the body’s temperature, she said.

Can children take adult medication? How do you know what dose to give?

Administering adult medication to youngsters can be tricky, even risky, the experts said.

“Young children should not take adult medications,” said Katie Lockwood, a primary care pediatrician at Children’s Hospital of Philadelphia. Teens “can use these forms if that’s what is available but should make sure that they take the same dose they would have taken in the pediatric version.”

If you are unsure what dose to give your child, check with your pediatrician, as taking too large a dose can be dangerous, she said.

To save liquid formulations for infants, older children could use chewables, if available, or tablets if they are able to swallow them. “This is a great time to teach children to swallow pills, as it makes you more flexible when there are drug shortages,” Lockwood suggested.

Giving a child adult medication also depends on the age of the child, Virgo said. “A healthy 160-pound 15-year-old can take the adult tablets of Tylenol or Motrin, but you cannot give adult tablets to a 3-year-old,” she said. “Consult with your pediatrician if you have, for instance, Childrens’ Tylenol Elixir for your 3-year-old and want to use it for your 6-month-old infant. Always remember, we pediatricians want to help you in making safe decisions for your children.”

Most important, anyone considering giving a child adult medication should do so only under the guidance of a pediatrician or family doctor, the experts said. “If it is appropriate for your child, the doctor will determine the correct dosage,” Dolgoff said. “Never try to do this yourself.”

What medications should you definitely not give children and why?

Don’t use aspirin, especially if a child has flu-like symptoms. Aspirin is associated with Reye’s syndrome, a rare but serious condition that causes swelling in the liver and brain, often striking children and teenagers recovering from viral infections, most commonly the flu or chickenpox.

Also, “avoid giving multi-ingredient OTC medications that contain ibuprofen or acetaminophen, as some of the other ingredients may not be needed and can have unwanted side effects in children,” Lockwood said.

Use extreme caution when administering more than one drug at a time, especially when also giving Tylenol, as many over-the-counter medications — including allergy, and cough and cold products — also contain acetaminophen. Too much acetaminophen can cause serious liver damage, resulting in a liver transplant or death. Read the ingredient listings on the labels.

What’s the difference between Tylenol, Advil and other pain relievers?

Tylenol — or acetaminophen — reduces pain and fever, while Advil and Motrin — or ibuprofen — are part of a class called NSAIDs, or nonsteroidal anti-inflammatory drugs, which reduce pain, fever and inflammation. “As with any medication, different children respond best to different medications,” Virgo says. “Tylenol can be given every 4 to 6 hours and is not harsh on the digestive tract. Advil and Motrin can be given every 6 to 8 hours and should not be taken on an empty stomach due to potential digestive system irritation.”

Moreover, acetaminophen is metabolized by the liver and Ibuprofen is metabolized by the kidneys, “so if a child has a liver or kidney disease, they may not be able to take one of these medications,” Lockwood said. Also, ibuprofen should not be given to infants under the age of six months, she said.

“Select the medication that has worked best for your child and follow the dosage instructions,” Virgo said. “If in any doubt, consult your pediatrician. Safety first.”