Surge in kids’ illnesses puts stress on medication supply

By Maureen Gilmer, IU Health senior writer, mgilmer1@iuhealth.org

Riley Children’s Health pediatrician Dr. Shannon Dillon is used to seeing sick kids, but this fall and winter have been busier than ever, with respiratory viruses, including influenza, RSV and COVID, circulating like wildfire.

“There has been a pronounced increase in respiratory illness compared to the last two winters,” she said. “Because so many more kids were either doing school from home or wearing masks, we saw a real drop in every other illness that we usually see. There was almost no influenza the last two winters in the country, which was fantastic while it lasted, but now it’s back.”

The physician and mother of two said the surge in RSV (respiratory syncytial virus) began earlier than ever this year, slamming hospitals, doctors’ offices and urgent care centers.

While RSV has begun to slow, the numbers for influenza and COVID are quickly climbing in Indiana and across the country, causing an increased demand for medications to control symptoms.

And while it might be tougher to find antibiotics and other medications for kids, it’s not due to a manufacturing shortage like what happened with baby formula over the summer.

“There is medication, and so far, we’ve been able to find alternatives for everybody,” the physician said.

If you have struggled to find fever-reducing medications or antibiotics for your child, Dr. Dillon feels your pain but offers advice for how best to navigate this winter of discontent.

Why is it so hard to find cold/flu/pain medications or antibiotics like amoxicillin for children lately?

It’s not that there’s a supply chain issue creating a bottleneck, she said. “It’s partly due to the fact that we are seeing more sick kids for longer this fall than we usually would have at this time,” so people may be going through medications more frequently. And much like the toilet paper shortage at the beginning of the pandemic, she said, “when your kid gets sick again and again and again, you’re more likely to stock up the next time you go to the store. Then there’s not anything there for the next people who go.”

According to the Food and Drug Administration, a national shortage of different medications, including amoxicillin, is expected to last for the next few months due to increased demand.

What should I do if I can’t find the medication my child needs?

The first step, if it’s not at your usual store, look somewhere else, Dr. Dillon advises. “It’s not like we’re seeing that medications are not anywhere right now. If you typically get brand-name Motrin, be OK with looking for generic ibuprofen instead.” Or consider a different formulation. “If you usually get liquid medication, maybe your kids are old enough to do the melt-aways that go on the tongue. A lot of school-age kids are big enough to try tablets. Pretty much any kid who’s at least 50 pounds is big enough to do a Tylenol or an ibuprofen,” she said. And though not all of them will be able to swallow a tablet, you can crush it up and mix it in something like applesauce or Hershey’s syrup. The latter actually masks the taste of medications pretty well, Dr. Dillon said.

How do I know if my child really needs to take something for a cold or fever?

“Parents really don’t like seeing their kids have fevers, but we remind them that it is actually your body’s way of fighting off an infection,” she said. “So, if your kid looks good and is still playful and happy, one of the best ways to not need so much medication is to not give it around the clock just because the thermometer says their temperature isn’t 98.6.” Dr. Dillon said data show that people who take anti-fever medications on a regular basis can have viral symptoms for longer periods of time. “We’re seeing enough kids with influenza having symptoms for long enough right now, we don’t really want to do anything to prolong that,” she said. Obviously, however, if your child has a fever of 103 or 104 and they look uncomfortable or they’re having ear pain, you want to treat them so they’re not in pain, she added.

What about antibiotics?

While an urgent care center might be more likely to prescribe an antibiotic, it’s best to reach out to your child’s regular doctor with concerns when possible. He or she has an established relationship with your family and will be able to follow up more easily, Dr. Dillon said. Taking a less aggressive approach to treatment can be a good thing in some cases.

“Bacteria are smart. They are really great at finding ways to replicate and get around antibiotics, so the more you get exposed to them, the more we see resistant bacteria developing. We try to be better antibiotic stewards today than we were 30 years ago. If your child’s ear maybe looks a little red, but they’re still playful and don’t have a high fever, maybe we watch it for a day or two to see if they even need an antibiotic,” she said. “Sometimes you have no choice if a child is in pain. Nobody likes looking at their kid and feeling like they’re uncomfortable, and certainly no one likes being up with them all night either, so I understand that as a mom.”

When should I call the doctor if I can’t find a medication?

“It never hurts to reach out to your child’s pediatrician if you’re having trouble finding the usual medications, because they can always guide you to what is OK to give and what isn’t,” Dr. Dillon said. “Sometimes people can find only cough and cold medications that are for older children, and we wouldn’t want them to give it to babies. One of the things we often get asked is whether expired medications are OK to give, which is a good thing to touch base on. If it’s only recently expired, that may be OK, but depending on the medication, some can actually get stronger if they sit around for longer, so it can be too big of a dose,” she cautioned. Her office doesn’t often get samples of medications that they can distribute in a pinch, she said, “but we can certainly help guide people to what other options there might be.”

Is it too late to get my child vaccinated for flu or COVID?

The vaccine is the best way to protect for flu and COVID, cases of which are being seen in increasing numbers in Indiana, she said. “We recommend the flu shot, and we definitely recommend the bivalent COVID booster for anybody 5 and older.” The bivalent booster has actually been approved for younger kids, but it hasn’t been rolled out to as many clinic sites for kids to get yet, she said. While you still might get the flu or COVID after being vaccinated, you and your child are much less likely to get seriously ill or get a secondary infection like pneumonia that would require a trip to the doctor, or worse, a trip to the emergency department.

“We also ask parents to be patient with those of us who take care of kids because we’ve all been working a lot harder than usual,” Dr. Dillon said, adding, “If you had told any of us in December of 2019 that this all would be happening, I don’t think we could have made this up.”

And it’s not over yet.

“With all the travel and gatherings over the holidays, I’m pretty sure it’s only going to get worse before it gets better.”

Just remember to take common-sense precautions: Keep your children away from people who are sick, make sure they wash their hands frequently, and consider a return to wearing masks, particularly in crowded situations.