CHPA Q&A: Update on OTC Children's Pain Relievers and Fever Reducers

Last updated Feb 15, 2023

The document below can serve as a helpful resource in understanding how CHPA’s member companies, some of the largest manufacturers of children’s over-the-counter (OTC) pain relievers and fever reducers, are working 24/7 to replenish supply as quickly as possible by directing these products where they are needed most. It also includes information about where parents can find these medicines and additional self-care options and alternatives to aid in comfort and relief.

Overview

Why has it been more difficult than usual to find OTC children’s pain relievers?

The onset of the 2022 flu season resulted in the earliest and most severe peak in flu cases the U.S. has seen in more than a decade (Source: IQVIA) and also hit during major outbreaks of respiratory syncytial virus (RSV) and ongoing cases of COVID-19. Together, this “tripledemic” is creating an extraordinary demand for OTC children’s pain relievers and fever reducers. In fact, Nov. 2022 sales of these products were up 65% compared to the same time in 2021 and Dec. 2022 sales were up 30% (Source: Information Resources Inc).

Is there currently a shortage of these products?

There is currently no widespread shortage of children’s OTC pain relievers and fever reducers in the United States. The active ingredients in these products are acetaminophen and ibuprofen, which are also not  in shortage according to the FDA’s Drug Shortage Database. While CHPA’s member companies are continuously shipping out products to retailers to replenish supply as quickly as possible, we do recognize there is sometimes limited products on store shelves due to extraordinary demand and that this can be frustrating for parents and caregivers. Our member companies remain focused on ensuring equitable distribution of these medicines to retailers, working with them to direct product to locations where it is needed most, while also doing everything possible to ensure hospitals have children’s pain and fever reducers on hand.

Industry Action

What are manufacturers doing?

CHPA’s member companies, some of the largest manufacturers of children’s pain relievers and fever reducers, are doing everything possible to make sure families have access to these products. They are manufacturing 24/7 and are currently producing upwards of 35-50% more product compared to the prior year. Many manufacturers are also looking to increase capacity by working with contract manufacturers to further increase product quantities. 

Again, given the unusually high demand for many of these products, particularly liquid formulations, our member companies are also focused on ensuring equitable distribution of these medicines, working alongside retailers across the country to direct product to locations where it is needed most, while at the same time doing everything possible to ensure hospitals have children’s pain and fever reducers on hand to treat the sickest children.

Are manufacturers getting the active ingredients they need?

Yes. Some leading acetaminophen ingredient suppliers reported they are shipping more than four times the amount of ingredient in the last quarter of 2022 vs. the same period in 2021. There is no shortage of active pharmaceutical ingredients or excipients. This is a case of manufacturing keeping up with historically high demand, which is why we encourage consumers to only buy what they need, as panic buying and/or stocking up can lead to increased access issues for other families.

Retailer Action

Which retailers are limiting purchases and why?

When certain essential products are in high demand, retailers will sometimes voluntarily set limits on purchases to prevent stock ups and ensure the equitable availability of these products to as many people as possible. Below is a list of retailers who have announced product limits on OTC children’s pain reliever and fever reducers to date:

• CVS – two product limit at all retail locations and online
• Kroger – two product limit of pediatric pain medications and four product limit of cold and flu items
• Target – two bottle limit (online purchases)
• Costco – one bottle limit

Government Action

What is the Federal Government doing?

Agencies: On Dec. 20, 2022, Department of Health and Human Services (HHS) Secretary Xavier Becerra and Food and Drug Administration (FDA) Commissioner Dr. Robert Califf held a joint call with senior leadership from major medicine manufacturers, distributors, and CHPA to discuss the current production and distribution of OTC pediatric medicines. Both FDA and HHS are working collaboratively with manufacturers to monitor inventory levels and to identify and address regulatory barriers to enhanced production capacity. CHPA and many of its member companies continue to be in regular communication with HHS and FDA staff as this issue evolves.  

Congress: On Dec. 22, 2022, HHS hosted a Congressional staff briefing that included leaders from Centers for Disease Control & Prevention (CDC), FDA, and the Administration for Strategic Preparedness & Response (ASPR). CHPA provided materials to inform Members of Congress and their staff about this issue ahead of the holidays. At the request of the White House, this document was sent to all congressional offices, as well as the Senate Health, Education, Labor, & Pensions (HELP) Committee, and House Energy and Commerce Committee. 

White House: CHPA’s government affairs team is in close contact with the Administration on this issue. Additionally, we are pleased to know that ensuring a resilient supply chain is a priority for the President and that for the first time in history, we have a dedicated entity to identify risks and make recommendations through HHS’s newly established public health industrial base expansion and supply chain management office.

Where To Find Children's Pain Relievers & Fever Reducers

*Note: the below examples include, but are not limited to, all locations selling these OTC products*

Independent/Community Pharmacies

• Pharmacy locations in your community with fewer than four locations. Find a local pharmacy near you.

Chain Drug Stores

• CVS
• Rite-Aid
• Walgreens

Grocery Stores

• HEB
• Kroger
• Albertsons

Wholesale Retailers

• Costco
• Sam’s Club

Big Box Stores 

• Walmart
• Target
• Bed Bath & Beyond

Dollar Channel Retailers

• Dollar General
• Family Dollar

Convenience Stores

• 7-Eleven
• Speedway
• Wawa

Unable to Locate These Products?

What are my other options?

Different brands, formulations, non-pharmaceuticals: If you are unable to find the name brand product you typically use, remember store brands contain the same active ingredients as their brand name counterparts. If a liquid medicine is out of stock, consider different formulations (chewables, for example) for children over age two. Recognize there are a range of self-care options and alternatives to aid your child’s comfort and relief, including non-pharmaceutical strategies such as cold compresses, certain drinks and refreshments to help replenish fluids and electrolytes, and rest and relaxation to minimize exertion and stress.

Ask your pediatrician for help: Often, pediatric offices will have samples on hand. Understand when it’s an emergency. A fever is not always a bad thing, but it’s important to understand the warning signs and when to seek emergency care vs. staying home. If you are unsure, always speak with your healthcare provider or pediatrician about all available options and what is best for your child’s specific needs and situation.

Can I use adult pain and fever reducers in smaller doses for children?

CHPA does not advise giving adult medicines to children in smaller doses. If you have a sick child and are unable to locate OTC children’s pain relievers and fever reducers, speak with your healthcare provider or pediatrician about your range of options. You might have more options than you think based on your child’s age and weight. This guide can serve as a resource in determining which specific products may be used to relieve your child’s pain and/or treat their fever.

Can I use expired medications?

The expiration date on OTC medicine is there for a reason: the medicine will work best if it’s used before the expiration date. FDA additionally reminds consumers that once the expiration date has passed there is no guarantee that the medicine will be safe and effective.

Timeline

How long is this expected to last?

In terms of when supply will fully catch up with demand, we are encouraged that RSV has peaked and that recent forecast figures from the week ending Jan. 7 indicate a sharp decline across all regions in cough, cold, and flu activity over the last two weeks. Generally, activity declines over the holidays due to disruptions in typical transmission networks such as school breaks and/or work vacations, however, this recent drop was four times greater than those reported in a typical season, with much lower illness activity is expected through the remainder of the season. Additionally, as of Jan. 16, Walgreens and Rite-Aid have lifted their purchasing limits on these products due to "improved in-stock conditions". CHPA is hopeful this decline continues, and that this will lessen demand in the near future. However, during the winter months, infection control measures to prevent the spread of germs are more important than ever. It is also not too late to get a flu shot, which can help protect against serious illness.

Responsible Purchasing Is Critical

Buy Appropriate Amounts

Please do your part this flu season and only buy what you need. While there is not a widespread shortage of these products, if parents start “stocking up,” other families will be unable to access the medicines they are seeking. In times of great stress, it’s important we each do our part. Talk with your pediatrician about the appropriate amount of medicine needed to get your child through this cough, cold, and flu season.

Purchase From Trusted Retailers

It is disturbing any time predatory sellers attempt to take advantage of consumers seeking essential products. We’re hopeful some of the limits retailers are now placing on purchases will help mitigate this problem and urge you to be vigilant about sources of purchase that are unfamiliar, as there is a greater chance the products might not be authentic or stored according to manufacturer recommendations. 

Understand the Amount of Product You Already Have

It is important to always read and follow the label when giving medicine to your child, and to only use a medicine that treats your child’s specific symptoms. When possible, dose by your child’s weight using the directions on the label or instructions from your healthcare provider. Always use the dosing device (oral syringe or dosing cup) that comes with the product. When it comes to understanding the amount of product you already have on hand, let’s say your child who weighs 30 pounds is sick and you have one 120ml bottle of liquid children’s pain reliever – you have more than 20 doses on hand. Visit KnowYourDose.org for more information and a guide to help understand the right amount of medicine to give your child based on their age and weight.