Can I give my sick kids expired Tylenol? Doctors say try this first

Amid a shortage of medicines for children, doctors are advising parents to avoid giving their sick children expired medicines and to talk to trusted health professionals about how to manage illness and anxiety.

They also stress that families should not panic buy medicines and understand that there are many ways to help children as hoarding when no one is sick takes medicines off the shelves for people who need them.

“Once we realized there was a shortage, parents’ concerns had obviously increased that they might not have access to medicines in pharmacies,” said Dr. Joseph’s Health Center and St. Michael’s Hospital in Toronto, told CTVNews.ca.

But there are ways to ease those fears, including alternative medications that are available without a prescription, she explained, adding that parents can follow tips on other ways to treat children and infants’ fever symptoms at home.

And using expired drugs is not recommended by Cohen-Silver and several doctors CTV spoke to, who said there were too many uncertainties about the efficacy and safety profile.

Health Canada first confirmed a nationwide shortage of children’s pain medications, which include liquid Tylenol for children and chewable acetaminophen tablets, in mid-August.

According to Danielle Paes, chief pharmacist officer at the Canadian Pharmacists Association, the shortage is due to increased demand, similar to other demand-driven supply issues that have impacted the availability of other drugs and PPE during the pandemic.

“To the best of our knowledge, production levels remain higher than usual, supply continues to arrive at times but it’s really being outpaced by demand,” she told CTVNews.ca.

“A lot of viruses are going around in the community, it’s school season again,” she said.

This week, CTVNews.ca asked families to share their experiences of the drug shortage and how they are coping. Dozens have reported running out of painkillers for their children, and have scoured pharmacies and online stores without success.

Several said their young children had fallen ill within weeks of starting school or kindergarten and it was frightening not having easy access to commercially available medicines.

HOW TO TREAT FEVER AND WHY EXPIRED MEDICATION IS NOT RECOMMENDED

As schools and daycares return to business without mandatory public health measures like mask-wearing, and colder weather could mean an increased spread of COVID-19 along with illnesses like the flu, families fear coping with illnesses without adequate medication options too have to, Cohen-Silver said.

When parents come to her for advice on how to treat their child when they have a fever, Cohen-Silver says she offered some simple advice.

“In general, we think of a fever as a good thing, it’s our body’s response to try and fight infection,” she said. There are options other than medication, including wearing lighter clothing, administering a cool cloth to the skin, and monitoring to see if pain medication is needed, she said. If a child is still active and alert, using pain medication may not be necessary, and consulting a doctor can help in the decision-making process, she explained.

She has also told families that there are ways to ask a pharmacist about over-the-counter medicines that don’t require a prescription. For example, a pharmacist can put together pill versions of the drugs so they’re safe for children, she explained.

When it comes to using expired medications, Cohen-Silver advises against it, as it can be difficult to be sure what happens to medications past their expiration date.

dr Doug Campbell, deputy chief of pediatrics at St. Michael’s Hospital in the Unity Health Network in Toronto, said doctors would normally never recommend expired drugs to children because there can be no guarantee that the drugs will be effective.

He said he advises families on what types of medication to take and whether medication is necessary. “I try to talk to families beforehand so they know why they need these types of drugs, rather than just going out and buying them whenever they want,” he said.

“A lot of families might go and use these drugs when they don’t actually need to, so it creates some anxiety,” he said. “It’s frankly also working with their pharmacist, because doctors need to work more closely with pharmacists to have better conversations… to know what products are available and if they can make a formulation that’s different than what’s on the shelves.” ‘ he explained.

He said families shouldn’t stockpile medicines or buy painkillers on the spur of the moment unless their child is sick. If you have a sick child at home, it would be helpful to speak to a family doctor or pharmacist about medication options, he added.

“It’s these points to keep in mind rather than using expired medication or rather rushing to an emergency,” he said.

When it comes to fevers, Campbell said any temperature above 38 degrees in an infant three months old and younger needs “urgent evaluation by a doctor” and is likely grounds for going to an emergency room, he said.

For older children, if the fever is a one-off and the child is otherwise active, awake, and eating, parents may be able to wait until they see their GP or a walk-in clinician, Campbell said.

According to Paes, community pharmacists are a “key resource and the strongest ally when it comes to medication management.”

“This is an unfortunate situation, but we’re trying our best to support families and carers, and to know that there is a reliable source of medication advice in your community,” she said.

PREPARING FOR THE SPREAD OF AUTUMN DISEASE

COVID-19 is not over yet and it would be best to encourage children to use masks during a time of increased virus spread, particularly in school environments where ventilation may not be adequate, said Dr. Anna Banerji, Pediatrician and Infectious Disease Specialist at Termerty Faculty of Medicine and Dalla Lana School of Public Health at the University of Toronto.

Without the province’s daily tracking of COVID-19 numbers and the lack of PCR testing, it is difficult to determine the level of the disease in the community, she said. Banerji recommends families focus on getting their booster shots and flu shots to combat anxiety related to disease, especially amid a drug shortage.

Fever is not uncommon in children with viral infections, she said. “But if a child is really lethargic or having trouble breathing, breathing rapidly, those are signs they’re dehydrated and should go to the emergency room,” she said.

“But most other viral infections pass and they’re usually relatively mild,” she said.