The Problem with Crushing Adult Tablets
A remarkable proportion of medicines given to children are unlicensed for paediatric use. Nurses crush adult tablets, pharmacists compound extemporaneous liquids, and parents split scored tablets into fractions. None of these workarounds are ideal. All of them introduce dose uncertainty. Some destroy formulation features, like modified release coatings, that were essential to the drug’s performance.
The push towards age-appropriate paediatric formulations is a regulatory priority. The EMA’s Paediatric Investigation Plan requirement and the FDA’s Paediatric Study Plan mandate that sponsors plan paediatric development early, not as an afterthought once adult registration is secured.
Dose Flexibility: The Core Paediatric Formulation Challenge
Adults generally all receive the same dose. Paediatric patients are dosed by weight, which means the same drug needs to be deliverable across a ten-fold or more dose range. A tablet that comes in two strengths cannot achieve that. The formulation must be inherently flexible.
This is why oral liquids, oral dispersible tablets, and multiparticulate systems (granules, mini-tablets, pellets) dominate paediatric formulation science. Each allows dose adjustment without tablet splitting, compounding, or approximation.
Age-Appropriate Formulation Options by Patient Group
| Age Group | Preferred Formulation Types | Key Formulation Considerations |
| Neonates (0-28 days) | Oral liquids; orodispersible films | Extremely small doses; swallowing reflex not developed; strict excipient restrictions; benzyl alcohol contraindicated |
| Infants (1-23 months) | Oral liquids; orodispersible granules mixed with food | Palatability critical; volumes below 5 ml preferred; no capsules or standard tablets |
| Young children (2-5 years) | Chewable tablets; orodispersible tablets; oral liquids | Palatability essential; age-appropriate flavours; tablet size below 6 mm for swallowability |
| Older children (6-11 years) | Film-coated tablets; mini-tablets; oral liquids | Swallowability improving; tablet size up to 8 mm generally acceptable; can begin to consider capsules |
| Adolescents (12-17 years) | Adult-equivalent formulations generally acceptable | Consider adult formulation with paediatric dosing; review excipient limits for age |
Age-group classifications follow EMA ICH E11(R1) and WHO definitions. Formulation acceptability within each group varies by patient and clinical context.
Excipients: Not Everything That Is Safe in Adults Is Safe in Children
Paediatric patients metabolise and excrete differently from adults. Enzyme systems are immature in neonates and infants. Renal function is proportionally different. Excipients that are routinely used in adult formulations can be hazardous in young children.
Benzyl alcohol, used as a preservative in many injectable products, has been associated with gasping syndrome and death in premature neonates. Propylene glycol, a common solubiliser, can accumulate in infants with immature metabolic pathways. Sorbitol at high doses causes osmotic diarrhoea and dehydration in young children.
The EMA’s guideline on excipients in the label and package leaflet and the EMA’s reflection paper on the use of excipients in paediatric formulations are required reading for any team developing a paediatric formulation. The acceptable daily intake thresholds for excipients in children are often significantly lower than the amounts present in adult formulations.
Palatability: The Formulation Variable That Determines Adherence
A paediatric formulation that children refuse to take is not a medicine; it is a negotiation. Palatability, covering taste, smell, texture, and mouthfeel, is a genuine development objective, not a cosmetic one.
Taste masking is one of the most technically challenging aspects of paediatric oral formulation. Bitter APIs are the norm in pharmaceutical development. Options include polymer coating of drug particles, complexation with ion exchange resins, microencapsulation, and flavouring. Each approach has limits, and the most effective strategy depends on the API’s physicochemical properties and the target formulation.
Formal paediatric acceptability testing using age-appropriate assessment tools, such as hedonic scales adapted for young children, is increasingly expected as part of the development programme and is recognised in EMA guidance as a component of the pharmaceutical development evidence package.
Ardena’s Paediatric Formulation Experience
Ardena’s formulation teams have experience developing paediatric oral formulations including orodispersible tablets, oral liquids, and multiparticulate systems across its European sites. The team is familiar with the EMA’s paediatric regulatory requirements and with the practical challenges of excipient selection, taste masking, and dose flexibility that make paediatric development distinct from adult work.
