People seeking over-the-counter medication for their sick children are often finding sparse or empty shelves, as a spike in respiratory illnesses pushes pediatricians and emergency rooms to the limit.
Usual supplies of fever- and pain-reducing medicines, such as liquid acetaminophen and ibuprofen recommended for children with RSV, flu or the coronavirus, have not kept up with demand in recent weeks in pockets of the country hit hardest by surging illnesses.
Unlike in Canada where the government has issued emergency orders to address a shortage of acetaminophen and ibuprofen, commonly known by the name brands Tylenol and Advil, and similar products, U.S. manufacturers and retailers emphasized that supplies should rebound within weeks. On the prescription side, increased demand for the antibiotic amoxicillin has caused shortages in the United States, Canada and parts of Europe.
In the meantime, pediatricians say they worry limited access to medicines could result in more urgent-care and emergency visits as parents struggle to keep sick children comfortable.
"It's a huge problem," said Kristina Powell, a pediatrician in Williamsburg, Va., and president of the Virginia chapter of the American Academy of Pediatrics. "This is a result of the 'triple-demic.' Parents run to Walmart or Target, the shelves are empty. . . . This is going to be a long fall and winter of viral infections."
A crop of influenza-like illnesses, which includes RSV, hit the South and Southeast hard a month ago, federal data show, and those illnesses have slowly progressed westward. By mid-November, Texas, New Mexico and Tennessee reported the highest incidence of illness, while levels remained very high in Virginia and D.C., followed closely by Maryland, according to data tracked by the Centers for Disease Control and Prevention.
Kylie Moriarty, 30, of Buffalo, Mo., searched her local Walmart for Tylenol or ibuprofen to treat her sick 9-year-old daughter and found nothing but empty shelves. That seemed odd, she said, because just last week she had no trouble buying the same products for her 2-year-old son in a merry-go-round of illnesses affecting families with young children.
"I was very frustrated that it's 2022 and we can't keep something in stock for parents to help their children get better," she said in a phone interview. "It makes me want to cry, almost, because these are my kids."
She and her husband called other pharmacies looking for medicines to soothe the girl and couldn't find any guaranteed availability.
"When they're sick, there's only so much that loving on them and cuddling with them you can do. So when there's no medicine or something that you can give them . . . it's hard," Moriarty said.
Feeling powerless, the couple gave up and cautiously shared their younger child's more concentrated medicine with the older one, which seemed to help. Just as they began to relax, their little boy came home from day care with a fever. Moriarty plans to schedule an appointment with his pediatrician for treatment - and samples to take home.
The ordeal reminded her of the height of the pandemic when supply chain problems left consumers scrambling for toilet paper and other basics.
Generic varieties play a large role in the market for over-the-counter comfort drugs, and that industry runs on profit margins so lean that companies typically lack capacity to boost production on short notice, according to supply chain experts. That left shelves bare during the early days of the pandemic.
The same dynamic is playing out now as RSV, flu and the coronavirus hit simultaneously, prompting sporadic shortages of commonly used ibuprofen and Tylenol at some hospitals and retail stores.
The extent of those shortages isn't clear. The Food and Drug Administration hasn't reported any shortages of fever or pain medications. Drugmakers, pharmacists and industry organizations say there aren't any constraints to manufacturing and expect supplies to rebound within weeks.
The University of Utah's Drug Information Service, which tracks drug shortages, received its first report of a shortage of liquid ibuprofen - generally for children - on Monday, and quickly confirmed it with several manufacturers. Most of the drugs tracked by the service are purchased in large quantities by hospitals, but some formulations had over-the-counter labels. Erin Fox, the service's director, said it was impossible to know how widespread retail shortages were given the variety of store-branded versions.
"There are definitely distribution and supply chain problems that still exist," she said, such as a company not being able to hire enough drivers. "These shortages seem to be mostly a demand spike and should resolve relatively quickly," she added.
Until then, both chain stores and independent pharmacies are dealing with the unpredictability of high demand and uncertain supplies.
Martin McCarthy struck out at 5 p.m. Wednesday when he stopped by Brookville Pharmacy in Chevy Chase, Md., looking for liquid Motrin for his 10-year-old son, who probably picked up a bug at school.
The pharmacy's stock of children's fever reducers was depleted after two busy weeks of parents and grandparents stopping in to buy Tylenol or Motrin for little ones suffering from colds, RSV, flu and other viruses.
By Wednesday evening, only three boxes of generic ibuprofen chewables, two boxes of generic acetaminophen chewables and six boxes of suppository acetaminophen remained. Other parents peeked down the aisle looking for liquid fever reducer and fever reducer for children younger than 3, only to leave empty-handed.
McCarthy scanned the cold-medicine aisle for a few minutes and called home to confirm that his son would tolerate grape-flavored chewable tablets instead of the liquid Motrin he was used to.
"It is surprising because it's basically completely out," he said. "And it's just generic."
A spokeswoman for Walgreens said McCarthy's experience is typical. Even if their usual choice of medication is unavailable because of high demand, parents can usually find an alternative.
"Although demand for pediatric OTC medications have increased, Walgreens is prepared and able to continue meeting the needs of our customers and patients. We are working with our diverse set of suppliers and distributors to ensure our patients have the products they need most," Walgreen spokeswoman Zoe Krey said in a statement.
Martha Welman, a pediatrician and medical director at Neighborhood Health, a primary care provider serving low-income and underinsured patients in Alexandria, Arlington and Fairfax, said staff will sometimes call pharmacies to find medicines for patients - a time-consuming process at a busy time.
"If it's between helping someone find a medicine or seeing a sick child, we have to make that choice. We're all kind of compromising right now," she said.
Perrigo, an Ireland-based manufacturer of over-the-counter products, said "shortages are occurring in a number of markets we supply" because of high demand. The company has increased production of medications for fever and pain by 46 percent through October compared with a year ago, and increased shipments by a similar rate.
The Consumer Healthcare Products Association, which represents companies making over-the-counter drugs, said parts of the country are seeing a rise in pediatric illnesses but that there aren't "overall widespread shortages here in the United States" of children's pain relievers.
"We understand it might be frustrating for some parents who are unable to quickly locate these products from their usual pharmacy or retailer due to limited out-of-stocks in some stores," the association said in a statement, but it emphasized the importance of calling around for medications and not hoarding, which could lead to widespread shortages.
Elizabeth Murray, a pediatric emergency medicine physician at Golisano Children's Hospital in Rochester, N.Y., said from the bed shortage to overflowing emergency rooms, the last thing parents need is another hurdle. But until the early and aggressive onset of respiratory illness abates, health-care providers and parents have no choice but to ride it out together.
"Everyone would like to have one thing to blame and there isn't one thing to blame," she said. "This is happening for a variety of reasons and we're going to move through it and we're going to be okay."