Children’s medication adherence was fragile long before the pandemic. For many children with chronic conditions, daily routines coordinated by parents and caregivers are a critical part of treatment. These routines ensure that medications are taken consistently, which is essential for managing symptoms and preventing emergency care. However, when these routines are disrupted, adherence can fall significantly, even when medications are affordable, effective, and available.
Before the pandemic, medication adherence among children was already low relative to adults with comparable prescriptions. In 2019, children with chronic asthma had controller medications available on fewer than half of the days in a typical month, well below the 50% threshold often linked to poor long-term control and higher healthcare use. This low adherence is partly due to the sustained involvement of caregivers, making pediatric healthcare uniquely sensitive to disruptions in daily life. Families must manage treatment around school schedules, work hours, transportation, and competing caregiving demands.
Asthma is one of the most common chronic pediatric health conditions and a leading cause of pediatric hospital visits and missed school days. Because symptoms and management are closely tied to family resources, disruptions in adherence can reinforce broader inequities in child health. Studies show that socioeconomic differences in children’s early health translate into lasting gaps in education attainment and adult well-being. Low adherence to controller medication therefore matters not only for short-term asthma control but also as part of the accumulation of disadvantage over time.
Nationwide prescription data reveal how routines broke down during the pandemic. Our analysis draws on a near-universe of U.S. prescription claims between 2018 and 2020, covering roughly two million pediatric asthma patients per month. Individuals were included in the analysis if they had at least one controller medication fill between January and March of each year, and their prescription activity was then tracked through December.
During 2020, adherence to asthma controller medications among children fell sharply with the onset of the pandemic. Comparing each month of 2020 with the same month in 2019, average adherence dropped by roughly 13% from March through December. Declines were steep both in the early months of the pandemic and again at the end of the year, suggesting that adherence did not rebound as daily life adjusted to the pandemic and that the disruption to medication routines was prolonged.
The declines were especially large for younger children. By December 2020, adherence among preschool-aged patients was roughly 40% below its 2019 level, compared with declines of about 25% for school-aged children and 21% for adolescents. These large declines among the youngest children are particularly concerning because they are the least able to recognize symptoms, communicate their needs, or manage medications without direct caregiver support.
Adults, by contrast, increased adherence to their own medications during this period, reinforcing that the downturn among children was specific to pediatric care and not a system-wide change in prescription behavior. The patterns point to attention and household routine as the main drivers of the 2020 decline rather than access, supply, or a change in need.
Although asthma triggers such as physical activity and respiratory illness may have fallen early in the pandemic, those reductions cannot explain the large, persistent, and age-skewed declines observed. Children whose parents used mail-order pharmacies before the pandemic experienced smaller drops in adherence, suggesting that simplifying refills and reducing travel burdens can help maintain medication routines. Additionally, children’s adherence fell less in families where adults were filling their own prescriptions, indicating that parental medication routines help sustain children’s treatment.
La pandemia reveló cómo fuertemente la atención pediátrica depende de la atención parental y de los cuidadores y cómo pequeñas decisiones de diseño pueden hacer que esta dependencia sea más manejable. Los formuladores de políticas, los aseguradores, los proveedores y las familias todos tienen roles que jugar en fortalecer estas rutinas y reducir la atención requerida para mantener el tratamiento. Simplificar la adherencia se puede lograr por defecto con suministros de 60 o 90 días, habilitando reabastecimientos automáticos y haciendo que la entrega por correo sea simple de optar. Coordinar a través de los miembros de la familia alineando fechas de reabastecimiento y ofreciendo horarios de recogida o entrega sincronizados también puede ayudar. Los reguladores de seguros estatales podrían alentar esto estableciendo estándares de farmacia centrados en la familia. Los pediatras, los farmacéuticos y las escuelas pueden reforzar el uso de medicamentos consistente enviando recordatorios de reabastecimiento, discutiendo reabastecimientos durante visitas y coordinando con las familias en regímenes de mantenimiento intensivo. Dirigir el apoyo a los niños más jóvenes, cuyas brechas de adherencia son más grandes, puede ser particularmente efectivo. Por ejemplo, los recordatorios de gestión de medicamentos podrían integrarse en programas como WIC, Head Start o programas de salud temprana. Estos pasos harían que la adherencia sea más resistente a las interrupciones que las familias inevitablemente enfrentan. Fortalecer la infraestructura que ayuda a los niños a mantenerse en tratamiento no solo es una buena política de salud, sino que es una inversión en la salud a largo plazo y la equidad que puede ser especialmente impactante cuando las familias enfrentan estrés financiero o personal.
Apoyo a los niños más jóvenes
Dirigir el apoyo a los niños más jóvenes, cuyas brechas de adherencia son más grandes, puede ser particularmente efectivo. Por ejemplo, los recordatorios de gestión de medicamentos podrían integrarse en programas como WIC, Head Start o programas de salud temprana. Estos pasos harían que la adherencia sea más resistente a las interrupciones que las familias inevitablemente enfrentan. Fortalecer la infraestructura que ayuda a los niños a mantenerse en tratamiento no solo es una buena política de salud, sino que es una inversión en la salud a largo plazo y la equidad que puede ser especialmente impactante cuando las familias enfrentan estrés financiero o personal.
Importancia de la infraestructura
Fortalecer la infraestructura que ayuda a los niños a mantenerse en tratamiento no solo es una buena política de salud, sino que es una inversión en la salud a largo plazo y la equidad que puede ser especialmente impactante cuando las familias enfrentan estrés financiero o personal. Algunos pasos que se pueden tomar incluyen establecer estándares de farmacia centrados en la familia, reforzar el uso de medicamentos consistente y coordinar con las familias en regímenes de mantenimiento intensivo.
