A months-long cold medicine shortage continues to persist in Hawaii — part of an ongoing national trend.

The cold medicine shelf at the local Longs Drugs? Pretty empty. Target? Pretty empty, as well.

Many retail drugstores have bare shelves in the over-the-counter cold medicine area, particularly for the most popular brands of fever- and pain-reducing medication for children under 12. At some stores even cough drops are wiped out.

It’s been this way since at least Christmas, and retailers have not been able to assure the public of any end in sight.

Signs on the empty shelf at one Longs Drugs store say, “We’re sorry. The supplier is temporarily unable to supply this product to retailers.”

Meanwhile, CVS Health, which operates Longs Drugs in Hawaii, says there is a product limit of two on all children’s pain relief products for all CVS Pharmacy locations and at cvs.com.

“We’re committed to meeting our customers’ needs and are working with our suppliers to ensure continued access to these items,” said a CVS spokesperson via email.

At Target, limitations are in place for online purchases — if they are available. A recent online search for liquid Children’s Tylenol on Oahu yielded “out of stock” results for grape, cherry and bubble gum. In an Oahu store a sign says due to high demand, purchases would be limited to two per guest.

“We continue to closely monitor the industrywide supply constraints of this category to help ensure product is available for our guests,” said a Target spokesperson. “We currently have online product limitations in place.”

What is behind the children’s medicine shortage?

Possibly the “tripledemic” — the surge of respiratory syncytial virus, influenza and COVID-19 that occurred over winter months — which drove up demand for cold medications.

The Consumer Healthcare Products Association insists the shortage is not due to lack of supply on the part of manufacturers.

“Manufacturers continue operating at maximum capacity to replenish children’s pain and fever reducers to meet current extraordinary demand,” said CHPA in a statement posted online. “While there is not a widespread shortage and our member companies are continuously shipping out products to retailers to replenish supply as quickly as possible, we recognize that limited products on store shelves is frustrating for parents and caregivers.”

CHPA said the “tripledemic” is creating an extraordinary demand for over-the-counter children’s pain relievers and fever reducers but that there is no shortage of active pharmaceutical ingredients.

In November the trade group said sales of these products were up 65% compared with the same time in 2021. December sales were up 30% compared with the same time in 2021.

“This is a case of manufacturing keeping up with historically high demand,” said CHPA, “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.”

Although RSV and flu are abating nationally, supply has not yet appeared to catch up.

What are parents to do?

Dr. Caroline Chang, a pediatrician at Kaiser Permanente, said there was a peak in RSV and flu at the end of 2022; both have both come down but may not completely be gone yet. The COVID-19 pandemic has thrown usual flu and cold patterns into an abnormal pattern, she noted.

Fortunately, Kaiser has its own pharmacy, which has managed to keep up its supply of children’s cold medicines.

Chang said generic brands with acetaminophen or ibuprofen are just fine in place of popular brands like Tylenol and Motrin. For children who are able to chew, chewable tablets might be easier to find than the liquid medications.

Children ages 6 months and older can use generic brands for acetaminophen and ibuprofen to reduce pain and fever. Babies 6 months and younger should stick with acetaminophen.

Other ways to help a child with fever include a bath or cold compresses to help them feel more comfortable. Honey also can help soothe a child’s sore throat, but should not be given to a child under 1 year old.

“I like to remind parents that fever automatically by itself doesn’t always need to be treated, either.” she said. “The fever is part of the body’s response to the infection and indication the body is fighting it. The key is rest, fluids and time to let your body do what it needs to do. However, we don’t want people to be miserable, so if you have a headache or sore throat, that’s where Tylenol and ibuprofen help you get more comfortable.”

A parent should contact their pediatrician if the child has a predisposed condition like asthma and is believed to have the flu or COVID-19, she said. For flu, children with these conditions may be candidates for Tamiflu.

Fevers generally last 48 to 72 hours, but if there is no improvement and the child is not drinking, eating or getting out of bed, parents should also call their pediatrician. Also, parents should call their pediatrician if a child has gone through fever, shown improvement, and it flares up again on day five, indicating a possible secondary infection.

Some relief may be in sight, as RSV and influenza, which started earlier than usual this season, have abated nationally.

Epidemiologist Caitlin Rivers, a senior scholar at Johns Hopkins, noted in her most recent report that influenzalike illness continued to recede in the third week of January, with only three jurisdictions — New Mexico, New York City and Puerto Rico — still reporting high levels.

Hawaii has been categorized at the minimal level for weeks, but flu can last year-round here. The most recent flu report says while flu cases appear to have increased earlier than past seasons, “it is not yet known whether case numbers will reach a peak.”

To date, 19 clusters of influenzalike illness have been reported to the state Department of Health, including one the week of Jan. 8-14. So far this season, 6.6% of all specimens tested have been positive for influenza.

The positivity rate for COVID-19 declined to 4.7% Wednesday, down from 6.0% the previous week, according to the Health Department, while the seven-day average of cases fell to 109 per day. Many cases, however, go unreported due to home tests.

GUIDANCE FOR DEALING WITH SHORTAGE OF CHILDREN’S FEVER MEDICATIONS

>> Encourage your child to drink lots of fluids, including water and electrolyte-containing fluids for children. Staying well hydrated is important to help your child feel better and fight the infection.

>> Keep the child’s room comfortably cool. Dress them in light clothing.

>> If your child is sleeping or playing comfortably, you don’t need to give them fever-reducing medicine. The medicine is most useful to treat discomfort.

>> Remember that fever in children should never be treated with aspirin or rubbing alcohol as both can cause serious illness.

>> Do not use adult formulations (including cutting or crushing tablets) without talking to your pediatric team about safe dosing. It’s important to give the dose based on the child’s weight.

>> Purchase only the quantity that you need for your child, to avoid worsening shortages and ensure available supply for others.

Source: MassachusettsDepartment of Health/Massachusettschapter, American Academy of Pediatrics