ORIGINAL RESEARCH article
Front. Pediatr.
Sec. General Pediatrics and Pediatric Emergency Care
"We've managed to find our own path of how we do it": Exploring parental perceptions of using Age-inappropriate Formulations at home - A qualitative study
Provisionally accepted
- 1Department of Women's & Children's Health, University of Liverpool, Faculty of Health and Life Sciences, Liverpool, United Kingdom
- 2Paediatric Medicines Research Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
- 3conect4children Stichting, Utrecht, Netherlands
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Introduction The administration of medicines to children poses distinct challenges, largely due to the limited availability of authorised, commercially available, age-appropriate formulations (AaFs). In the absence of suitable options, parents and carers are often required to manipulate age-inappropriate formulations (AiFs) to facilitate administration. However, little is known about their perceptions and experiences when administering AiFs to children at home. Methods Qualitative exploratory study. Participants were recruited from a UK paediatric hospital. Semi-structured interviews were conducted either in participants' homes or at the hospital. Interviews were audio-recorded, transcribed verbatim, and thematically analysed using NVivo v10. Topics explored included formulation types, dosage form manipulation, medicine supply, and administration practices. Results Over sixty outpatient clinics were screened; 34 families expressed interest, and 13 completed QUAL AiF paper Frontiers v2.0 28.01.2026 Page | 2 interviews between September 2016 to February 2017 (mean duration: 35 minutes). Eleven interviews were conducted at home and two in hospital; 12 participants were mothers, and 8 of the 13 children discussed were female. Thematic analysis identified five key themes: (1) inappropriate formulations; (2) unlicensed medicine and off-label prescribing; (3) framework of appropriateness; (4) knowledge, training, communication, and relationships; and (5) patient and family experience. Parents often relied on prescriber instructions without fully understanding the implications of manipulating medicines, indicating a gap in support and knowledge transfer. Discussion These findings highlight the emotional and practical burdens families face when administering age-inappropriate medicines, including the time and effort required to ensure accurate dosing and safe administration. The study emphasises the need for increased access to child-appropriate formulations of essential medicines and more child-centred prescribing practices. Where legacy medicines remain the only option, healthcare professionals can support children to safely swallow solid oral dosage forms, such as tablets, and educate families on safe medicine manipulation. Further research is needed to better understand the magnitude of these burdens and guide future paediatric formulation development.
Keywords: Children, Home, Medicines administration, off-label medicines, parent, qualitative research, Theoretical Framework of Children's Medicine Acceptability, unlicensed medicines
Received: 30 Sep 2025; Accepted: 30 Jan 2026.
Copyright: © 2026 Duncan, Bracken, Hawcutt, Peak and Turner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jennifer Claire Duncan
Dan Hawcutt
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