They also stress that families should not panic buy medicine and understand that there are many options to help children, as stockpiling when no one is sick takes medicine off the shelves for people who need it. “When we noticed that there was a shortage, there was obviously an increased concern from parents that they might not be able to access the drugs in the pharmacies,” said Dr. Justine Cohen-Silver, a staff pediatrician at the Women and Children’s Health Program in St. Joseph’s Health Center and St. Michael’s in Toronto, CTVNews.ca reported. But there are ways to ease those anxieties, including alternative over-the-counter medications, she explained, adding that parents can follow tips for other means of managing children’s and infants’ fever symptoms at home. And using expired drugs is discouraged by Cohen-Silver and several doctors CTV spoke with, who said there is too much uncertainty about the efficacy and safety profile. Health Canada first confirmed in mid-August a nationwide shortage of children’s pain medications, which include liquid children’s Tylenol and chewable acetaminophen tablets. According to Danielle Paes, chief pharmacist at the Canadian Pharmacists Association, the shortage stems from increased demand, similar to other demand-driven supply challenges that have affected the availability of other drugs and PPE throughout the pandemic. “As far as we know, production levels remain higher than usual, supply continues to come in intermittently, but it’s really outstripping demand,” he told CTVNews.ca. “There are a lot of viruses going around in the community, it’s back to school season,” he said. This week, CTVNews.ca asked families to share their experiences with drug shortages and how to deal with them. Dozens have visited to say they have run out of painkillers for their children and have scoured pharmacies and online stores with no luck. Several said their young children have gotten sick within weeks of starting school or daycare, and it’s stressful not having easy access to over-the-counter medications.

As schools and daycare centers reopen without mandatory public health measures such as wearing masks, and colder weather could mean an increased spread of COVID-19 along with illnesses such as the flu, families fear they will have to deal with disease without enough drug options, Cohen-Silver said. When parents came to her asking for guidance on how to handle their child if they have a fever, Cohen-Silver says she gave her 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,” he said. There are other options besides medication, such as wearing lighter clothing, applying a cool cloth to the skin and monitoring to see if pain relievers are necessary, he 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 in the decision-making process, he explained. He also told families there are options, such as asking a pharmacist for over-the-counter medications that don’t require a prescription. For example, a pharmacist can compound pill versions of drugs so that they are tolerable for children, he explained. When it comes to using expired medications, Cohen-Silver recommends against it, as it can be difficult to be sure what happens to medications after their expiration date. Dr. Doug Campbell, the associate chief of pediatrics at St. Michael’s at Unity Health Network in Toronto said, normally, doctors would never recommend expired drugs for children because we can’t guarantee that the drug will be effective. He said he advises families on what kind of medication they should take and whether medication is necessary. “I try to talk to the families beforehand so they know why they need these kinds of drugs, rather than going out and buying them whenever,” she said. “A lot of families go and use these drugs maybe when they don’t really need them, so it creates some stress,” he said. “It’s also really 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 do a formulation that’s different than what’s off the shelf.” , explained. She said families should not stockpile medications or impulse buy pain relievers when their child is not sick. If they have a sick child at home, it would be helpful to talk to a family doctor or pharmacist about medication options, she added. “These are points to keep in mind, rather than using expired drugs or rushing to an emergency,” he said. As for a fever, Campbell said any temperature above 38 degrees in an infant three months old and younger should be evaluated “urgently by a doctor” and a trip to the emergency department is likely, he said. In older children, if the fever is a one-time occurrence and the child is otherwise active, awake and eating, Campbell said parents may wait to see their family doctor or a clinic physician. Paes says community pharmacists are “a key resource and strongest ally when it comes to medication management.” “This is an unfortunate situation, but we are trying to do our best to support families and carers and to know that there is a reliable source of medication advice available to you in your community,” he said.

HEALTH CANADA IS AWARE OF SUPPLY LIMITATIONS

In a statement to CTVNews.ca, Health Canada said companies continue to inform the agency that they are experiencing ongoing supply constraints due to demand along with “supply chain issues.” “The supply of these products has been limited since the beginning of this year, as some products are experiencing intermittent stocks. As supply remains limited 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 state of supply and identify possible mitigation strategies,” he said in an email. The agency also said it does not recommend using expired drugs, as the expiration date is determined by many factors, including the effectiveness and stability of the drugs. She recommends parents and caregivers talk to health professionals about alternative medication if needed.

PREPARATION FOR THE SPREAD OF AUTUMN DISEASE

COVID-19 is not over, and it would be best to encourage children to use masks during a period of increased spread of the virus, especially in school settings where ventilation may not be adequate, said Dr. Anna Banerji, pediatrician and infectious disease specialist at the 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 a lack of PCR testing, it’s hard to tell the levels of the disease in the community, he said. Banerji recommends that families focus on getting booster shots and flu shots to help combat stress around illness, especially amid drug shortages. Fevers are not uncommon among children when it comes to viral infections, he said. “But if a child is really lethargic or having trouble breathing, breathing rapidly, those are signs that they’re dehydrated and they need to go to the emergency department,” he said. “But most other viral infections will pass and are usually relatively mild,” he said.