From Prescription Drugs to Natural Health Products: Medication Use in Canadian Infants

Overview

Journal Children (Basel)

Specialty Health Services

Date 2022 Oct 27

PMID 36291411

Authors

Pascal Bedard

Geoffrey L Winsor

Emma S Garlock

Meghan B Azad

Allan B Becker

Piush J Mandhane

Theo J Moraes

Malcolm R Sears

Stuart E Turvey

Padmaja Subbarao

Fiona S L Brinkman

Anita L Kozyrskyj

Affiliations

Soon will be listed here.

Abstract

Limited data exist on pharmaceutical product use by infants, although available data suggests higher prevalence of use among children under 12 months of age. We conducted a descriptive study of 3050 infants recruited in the CHILD Cohort Study, a prospective, multicenter, longitudinal cohort following children from pregnancy through childhood. Parents were surveyed for use of prescription and over-the-counter drugs, and natural health products (NHPs, including homeopathic products and vitamins) at 3, 6, and 12 months after delivery. By one year of age, 96.0% of children had taken at least one pharmaceutical product. Among 307 reported products, 32 were given to at least 1% of cohort infants. Vitamin D, acetaminophen, ibuprofen, topical hydrocortisone, amoxicillin, and nystatin were the most common medications and natural health products (NHPs) received, with 8/32 of the most frequently used products being NHPs. Overall, 14.7% of pharmaceutical products administered to children were off-label and 35.8% were NHPs or products without a Drug Identification Number (DIN). The use of over-the-counter medications and NHPs is common and off-label use of drugs is frequent, even in the first year of life. This study highlights the importance of conducting studies on medication use in infants, and of infant medication use monitoring by healthcare providers.

Citing Articles

Infant Vitamin D Supplements, Fecal Microbiota and Their Metabolites at 3 Months of Age in the CHILD Study Cohort.

Zhao X, Bridgman S, Drall K, Tun H, Mandhane P, Moraes T Biomolecules. 2023; 13(2).

PMID: 36830570 PMC: 9952978. DOI: 10.3390/biom13020200.

References

Taine M, Offredo L, Dray-Spira R, Weill A, Chalumeau M, Zureik M . Paediatric outpatient prescriptions in France between 2010 and 2019: A nationwide population-based study: Paediatric outpatient prescriptions in France, 2010 to 2019. Lancet Reg Health Eur. 2021; 7:100129. PMC: 8454786. DOI: 10.1016/j.lanepe.2021.100129. View

Gonen M, Alaylioglu M, Durcan E, Ozdemir Y, Sahin S, Konukoglu D . Rapid and Effective Vitamin D Supplementation May Present Better Clinical Outcomes in COVID-19 (SARS-CoV-2) Patients by Altering Serum INOS1, IL1B, IFNg, Cathelicidin-LL37, and ICAM1. Nutrients. 2021; 13(11). PMC: 8618389. DOI: 10.3390/nu13114047. View

Frattarelli D, Galinkin J, Green T, Johnson T, Neville K, Paul I . Off-label use of drugs in children. Pediatrics. 2014; 133(3):563-7. DOI: 10.1542/peds.2013-4060. View

Carnovale C, Conti V, Perrone V, Antoniazzi S, Pozzi M, Merlino L . Paediatric drug use with focus on off-label prescriptions in Lombardy and implications for therapeutic approaches. Eur J Pediatr. 2013; 172(12):1679-85. DOI: 10.1007/s00431-013-2111-7. View

Un Lam C, Stephen Hsu C, Yee R, Koh D, Lee Y, Chong M . Early-life factors affect risk of pain and fever in infants during teething periods. Clin Oral Investig. 2015; 20(8):1861-1870. DOI: 10.1007/s00784-015-1658-2. View

Zhang T, Smith M, Camp P, Shajari S, MacLeod S, Carleton B . Prescription drug dispensing profiles for one million children: a population-based analysis. Eur J Clin Pharmacol. 2012; 69(3):581-8. DOI: 10.1007/s00228-012-1343-1. View

Knopf H, Wolf I, Sarganas G, Zhuang W, Rascher W, Neubert A . Off-label medicine use in children and adolescents: results of a population-based study in Germany. BMC Public Health. 2013; 13:631. PMC: 3706213. DOI: 10.1186/1471-2458-13-631. View

Stagnara J, Besse P, El Kebir S, Bordet M . Symptoms associated with teething and response to three treatments, including homeopathic medicine: a multicenter prospective observational study among 190 French pediatricians. Minerva Pediatr. 2016; 70(6):519-528. DOI: 10.23736/S0026-4946.16.04585-0. View

Lizano-Diez I, Kargodorian J, Pinero-Lopez M, Lastra C, Marino E, Modamio P . Off-label drug use in neonates and infants in Spain: A five-year observational study. Pharmacoepidemiol Drug Saf. 2021; 31(3):270-282. DOI: 10.1002/pds.5354. View

10.

Olsson J, Kimland E, Pettersson S, Odlind V . Paediatric drug use with focus on off-label prescriptions in Swedish outpatient care--a nationwide study. Acta Paediatr. 2011; 100(9):1272-5. PMC: 3187868. DOI: 10.1111/j.1651-2227.2011.02287.x. View

11.

Vernacchio L, Kelly J, Kaufman D, Mitchell A . Medication use among children <12 years of age in the United States: results from the Slone Survey. Pediatrics. 2009; 124(2):446-54. DOI: 10.1542/peds.2008-2869. View

12.

Crocker B, Green T, Barr S, Beckingham B, Bhagat R, Dabrowska B . Very high vitamin D supplementation rates among infants aged 2 months in Vancouver and Richmond, British Columbia, Canada. BMC Public Health. 2011; 11:905. PMC: 3265491. DOI: 10.1186/1471-2458-11-905. View

13.

Star K, Ralph Edwards I . Pharmacovigilance for children's sake. Drug Saf. 2014; 37(2):91-8. DOI: 10.1007/s40264-013-0133-8. View

14.

Drall K, Field C, Haqq A, de Souza R, Tun H, Morales-Lizcano N . Vitamin D supplementation in pregnancy and early infancy in relation to gut microbiota composition and colonization: implications for viral respiratory infections. Gut Microbes. 2020; 12(1):1799734. PMC: 7524344. DOI: 10.1080/19490976.2020.1799734. View

15.

Subbarao P, Anand S, Becker A, Befus A, Brauer M, Brook J . The Canadian Healthy Infant Longitudinal Development (CHILD) Study: examining developmental origins of allergy and asthma. Thorax. 2015; 70(10):998-1000. DOI: 10.1136/thoraxjnl-2015-207246. View

16.

Krzywinski M, Schein J, Birol I, Connors J, Gascoyne R, Horsman D . Circos: an information aesthetic for comparative genomics. Genome Res. 2009; 19(9):1639-45. PMC: 2752132. DOI: 10.1101/gr.092759.109. View

17.

Shonna Yin H, Dreyer B, Ugboaja D, Sanchez D, Paul I, Moreira H . Unit of measurement used and parent medication dosing errors. Pediatrics. 2014; 134(2):e354-61. PMC: 4187234. DOI: 10.1542/peds.2014-0395. View

18.

Godwin M, Crellin J, Mathews M, Chowdhury N, Newhook L, Pike A . Use of natural health products in children: survey of parents in waiting rooms. Can Fam Physician. 2013; 59(8):e364-71. PMC: 3743713. View

19.

Van Howe R, Storms M . Gastroesophageal reflux symptoms in infants in a rural population: longitudinal data over the first six months. BMC Pediatr. 2010; 10:7. PMC: 2831886. DOI: 10.1186/1471-2431-10-7. View

20.

Alpcan A, Tursun S, Kandur Y . Vitamin D levels in children with COVID-19: a report from Turkey. Epidemiol Infect. 2021; 149:e180. PMC: 8365038. DOI: 10.1017/S0950268821001825. View