Gap

While hospitals struggle to find room for young patients, parents have few options for O.T.C. medicines to soothe their sick children.

Acetaminophen toxicity is the leading cause of liver transplantation in the United States. But differences in physiology mean that an extrapolated dose can produce wildly different levels of the drug in children’s blood. For the common RSV, one in two hundred infected kids needs to come to the hospital. This year, a much larger cohort of kids—not just kids in the first winter of life but also older toddlers like Sam—are getting their first infections. In the context of the shortage, pediatricians are advised to “watch and wait,” and forgo antibiotics whenever we safely can—a practice that pediatricians generally follow anyway. Over-the-counter cough medicines don’t reliably work in adults, either, but a medicine that is marginally effective in a grownup can be worse than useless in a kid, because a kid’s body is smaller and structurally different. (In babies under six months, it’s more like one in fifty.) For the rest, helpful medicines and therapies are sparse. Most of the work of determining which kids are in danger relies on experience rather than technology. Before COVID, the cohort of kids under age one would be exposed for the first time each winter. The crisis continues, and we are facing local shortages of fever medicines as well as a national shortage of one of our most important and commonly used liquid antibiotics, amoxicillin. While we’ve been able to get it here in the hospital, outpatient pediatricians are substituting broader-spectrum antibiotics or calling from pharmacy to pharmacy in search of amoxicillin. She will stay in the emergency room overnight, but we pediatricians will take over her care so that the E.R.