At-a-Glance
Unintentional pediatric medication exposures: Nearly 20,000 U.S. emergency department visits occur each year for oral prescription medication ingestions in children younger than 6 years. Clonidine and buprenorphine account for the highest hospitalization estimates.¹
Empiric neonatal sepsis therapy: Ampicillin remains a core antibiotic for early-onset neonatal sepsis but is typically paired with gentamicin because resistance among Enterobacterales limits ampicillin monotherapy reliability.
Methylphenidate supply disruptions: Manufacturing constraints and rising demand are expected to keep methylphenidate supply inconsistent through 2026, requiring clinicians to anticipate therapeutic substitutions and medication access challenges.²
New & Notable
An estimated 19,473 emergency department visits occur annually in the U.S. for unintentional oral prescription medication exposures in children younger than 6 years old. Children aged 2-3 years account for 37.4% of visits and males represent 52.9% of cases.
Hospital admission occurs in 29.7% of ED visits. Medications most frequently associated with hospitalization include clonidine (622 annual estimated admissions) and buprenorphine (507 admissions).
After adjusting for prescribing volume, the medications most commonly linked to ED visits per million dosage units dispensed are guanfacine, buprenorphine, aripiprazole, clonidine, and dexmethylphenidate.
The analysis captured only the first two documented oral prescription medications per ED visit, which may underestimate multi-drug exposures
Prevention efforts should emphasize caregiver education on medication storage, particularly for buprenorphine and ADHD medications, which show disproportionately high exposure rates relative to prescribing frequency. Packaging innovations for medications such as guanfacine and clonidine may help reduce pediatric ingestions.¹
Clinical Pearl
Ampicillin remains one of the most commonly used antibiotics in neonates and continues to anchor empiric therapy for early-onset sepsis.
It provides reliable Gram-positive coverage against key neonatal pathogens including Group B Streptococcus, Enterococcus faecalis, and Listeria monocytogenes.
Gram-negative resistance limits its reliability alone. Approximately half of neonatal Escherichia coli and Klebsiella pneumoniae isolates may be ampicillin resistant.
For this reason, empiric therapy usually combines ampicillin with an aminoglycoside such as gentamicin to expand Gram-negative coverage.
This combination remains standard empiric therapy because it provides adequate coverage while avoiding unnecessary use of broader-spectrum antibiotics.
Penicillin antibiotics and their spectrums of activity by subclass are reviewed in the video: Penicillins Overview in a Neonatal Context
Pediatric Pulse
Global Methylphenidate Shortage Expected to Persist Through 2026
Health authorities report that methylphenidate supply remains unpredictable because of manufacturing constraints and rising demand. Some systems are prioritizing long-acting formulations for pediatric patients while recommending alternative treatments for new adult ADHD diagnoses.
For pediatric clinicians, this may require therapeutic substitution, brand switching, or use of non-stimulant options such as atomoxetine or alpha-2 agonists. Clinicians should also prepare families for possible medication interruptions that may affect school performance or behavior.²
References
Daubresse M, et al. Emergency department visits and hospitalizations for unintentional pediatric exposures to oral prescription medications in the United States. JAMA Pediatrics. 2026.
Pharmac. ADHD drug shortage expected to persist through 2026 due to unpredictable methylphenidate supply. 2026. https://www.rnz.co.nz/news/national/588692/pharmac-warns-unpredictable-supply-means-adhd-drug-shortage-expected-all-year
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— Dr. Su