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. 2022 Sep 27;9(10):1475.
doi: 10.3390/children9101475.

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

Pascal Bedard  1 , Geoffrey L Winsor  2 , Emma S Garlock  2 , Meghan B Azad  3   4 , Allan B Becker  3 , Piush J Mandhane  5 , Theo J Moraes  6 , Malcolm R Sears  7 , Stuart E Turvey  8 , Padmaja Subbarao  6 , Fiona S L Brinkman  2 , Anita L Kozyrskyj  5
Affiliations

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

Pascal Bedard et al. Children (Basel). .

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.

Keywords: drugs; family medicine; general practice; medicine and pharmaceutical industry; pediatrics; pharmacy; primary care.

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Conflict of interest statement

The authors declare no conflict of interest. The funder had no role in the design of the study, the collection, analyses and interpretation of data, writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart for participants included in study.
Figure 2
Figure 2
Number of pharmaceutical products (prescription, over-the-counter drugs, and natural health products) taken at each time period expressed as a violin plot and overlaid with box and whisker plot where whiskers represent the 5th and 95th percentiles. The thick and solid black line is the median and the dashed black line is the mean.
Figure 3
Figure 3
Use of drugs from the most common Anatomical Therapeutic Chemical (ATC) drug groups, by age.
Figure 4
Figure 4
Chord diagram or “globe” showing 57 significant mutual information (MI) scores calculated for all possible pairs of medications taken together by child subjects throughout the first year of life. The thickness of the red line corresponds to MI score magnitude for pairs of medications with an MI score threshold of ≥0.005 and p-value corrected for multiple testing (p ≤ 0.05). Pharmaceutical medications are grouped into their respective top-level ATC code (alimentary tract and metabolism (A), dermatologicals (D) anti-infectives for systemic use (J), nervous system (N) and respiratory system(R)) or into natural health products (NHP) or over-the-counter (OTC) drugs.
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