"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.

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 interviews between September 2016 to February 2017 (mean duration: 35 min). 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.