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

Children's cold and flu medication becoming harder to find on pharmacy shelves.

In the midst of a shortage of children’s medications, physicians are advising parents to avoid giving their sick kids expired medication, and to speak to trusted health professionals about how to manage illnesses as well as their anxieties.

They are also stressing that families should not panic-buy medication and understand there are lots of options to help kids, as hoarding when no one is ill takes medication off the shelves for people who need it. 

“When we noticed there was a shortage, there was obviously heightened concern from parents that they might not be able to access medications at the pharmacies,” Dr. Justine Cohen-Silver, a staff pediatrician at the Women and Children’s Health Program at St. Joseph’s Health Centre and St. Michael’s Hospital in Toronto, told CTVNews.ca.

But there are ways to mitigate those anxieties including alternative medication options available without a prescription, she explained, adding that parents can follow tips on other means of managing children and infants’ fever symptoms at home.

And using expired medications is not recommended by Cohen-Silver and several physicians CTV spoke to, as they said there’s too much uncertainty about the effectiveness and safety profile.

Health Canada first confirmed in mid-August, a shortage across the country of children’s pain relief medications, which include liquid Children’s Tylenol and chewable acetaminophen tablets.

According to Danielle Paes, the chief pharmacist officer at the Canadian Pharmacists Association, the shortage stems from increased demand, similar to other demand-driven supply challenges that affected availability of other medications and PPE throughout the pandemic.

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

“There’s a lot of viruses going around in the community, it’s back to school season,” she said.

This week, CTVNews.ca asked families to share their experiences with the medication shortage and how they are managing. Dozens reached out to say they’ve run out of pain relievers for their kids and have combed through pharmacies and online stores without any luck.

Several said their young children have become sick within weeks of starting school or daycare and it’s anxiety-inducing to be left without easy access to off-the-shelf medication. 

HOW TO MANAGE A FEVER AND WHY EXPIRED MEDICATIONS AREN'T RECOMMENDED

As schools and daycares are back in session without mandatory public health measures such as mask-wearing, and colder weather could mean increased COVID-19 spread along with illnesses such as flu, families fear having to cope with illness without enough medication options, said Cohen-Silver.

When parents have come to her seeking guidance on how to treat their child if they have a fever, Cohen-Silver says she’s been providing some simple advice.

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

She’s also told families that there are options including asking a pharmacist for behind-the-counter medication that does not require a prescription. For instance, a pharmacist can compound pill versions of the medications so they are tolerable for kids, she explained.

When it comes to using expired medications, Cohen-Silver recommends not to, as it can be difficult to be certain of what happens to medications after their expiry dates.

Dr. Doug Campbell, the deputy chief of pediatrics at St. Michael’s Hospital in the Unity Health Network in Toronto said, normally, physicians would never recommend expired medicine for children as it can’t be guaranteed that the medication will be effective.

He said he counsels families on what types of medications to take and whether medication is necessary. “I’m trying to talk to families ahead of time so that they know why they need these types of medicines, rather than just going out and buying them whenever,” he said.

“Many families go and use these medicines perhaps when they don’t actually need to, so it creates some anxiety,” he said. “It’s also frankly working with their pharmacist, because physicians 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 from what's on the shelves,” he explained.

He said families should not hoard medication or impulse buy pain relievers when their child isn’t sick. If they 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 those types of points to keep in mind, rather than using expired medicine or rather than rushing to emergency ” he said.

When it comes to fever, Campbell said any temperature above 38 degrees in an infant three months old and younger needs to be assessed “urgently by a physician,” and is likely cause to go to an emergency department, he said.

In older children, if the fever is a one-off and the child is otherwise active, awake, and eating, Campbell said parents may be able to wait to consult their family doctor or a walk-in clinic physician.

Paes says that community pharmacists are a “key resource and strongest ally when it comes to managing medication.”

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

HEALTH CANADA AWARE OF SUPPLY CONSTRAINTS

In a statement to CTVNews.ca, Health Canada said companies continue to inform the agency that they face ongoing supply constraints due to demand along with “supply chain issues.”

“Supply of these products has been constrained since earlier this year with some products experiencing intermittent stock-outs. As there continues to be limited supply locally, Health Canada is working closely with industry, provinces and territories as well as stakeholders across the supply chain to facilitate information sharing, assess the supply situation and identify potential mitigation strategies,” it said in an email.

The agency also said it does not advise expired medications be used as the date of expiry is determined by multiple factors including medication effectiveness and stability. It recommends parents and caregivers speak to health professionals for alternative medication if needed.

PREPARING FOR FALL ILLNESS SPREAD

COVID-19 is not over and it would be best to encourage children to use masks during a period of heightened virus spread, especially in school environments where the ventilation may not be adequate, said Dr. Anna Banerji, a 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 tracking daily COVID-19 numbers and lack of PCR testing, it’s difficult to tell the levels of illness in the community, she said. Banerji recommends families focus on getting their booster shots and flu shots to help combat anxieties around illness, especially in the midst of a medication shortage.

Fevers are not uncommon among children when it comes to viral infections, she said. “But if a child is really lethargic, or is having difficulty breathing, is breathing rapidly, those are indications that they are dehydrated and should go to the emergency department,” she said.

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