ObjectivesLack of consensus regarding the semantics and definitions of pediatric polypharmacy challenges researchers and clinicians alike. We conducted a scoping review to describe definitions and terminology of pediatric polypharmacy.MethodsMedline, PubMed, EMBASE, CINAHL, PsycINFO, Cochrane CENTRAL, and the Web of Science Core Collection databases were searched for English language articles with the concepts of “polypharmacy” and “children”. Data were extracted about study characteristics, polypharmacy terms and definitions from qualifying studies, and were synthesized by disease conditions.ResultsOut of 4,398 titles, we included 363 studies: 324 (89%) provided numeric definitions, 131 (36%) specified duration of polypharmacy, and 162 (45%) explicitly defined it. Over 81% (n = 295) of the studies defined polypharmacy as two or more medications or therapeutic classes. The most common comprehensive definitions of pediatric polypharmacy included: two or more concurrent medications for ≥1 day (n = 41), two or more concurrent medications for ≥31 days (n = 15), and two or more sequential medications over one year (n = 12). Commonly used terms included polypharmacy, polytherapy, combination pharmacotherapy, average number, and concomitant medications. The term polypharmacy was more common in psychiatry literature while epilepsy literature favored the term polytherapy.ConclusionsTwo or more concurrent medications, without duration, for ≥1 day, ≥31 days, or sequentially for one year were the most common definitions of pediatric polypharmacy. We recommend that pediatric polypharmacy studies specify the number of medications or therapeutic classes, if they are concurrent or sequential, and the duration of medications. We propose defining pediatric polypharmacy as “the prescription or consumption of two or more distinct medications for at least one day”. The term “polypharmacy” should be included among key words and definitions in manuscripts.

Purpose To examine the range of prevalence of pediatric polypharmacy in literature through a scoping review, focusing on factors that contribute to its heterogeneity in order to improve the design and reporting of quality improvement, pharmacovigilance, and research studies. Methods We searched Ovid Medline, PubMed, EMBASE, CINAHL, Ovid PsycINFO, Cochrane CENTRAL, and Web of Science Core Collection databases for studies with concepts of children and polypharmacy, along with a hand search of the bibliographies of six reviews and 30 included studies. We extracted information regarding study design, disease conditions, and prevalence of polypharmacy. Results Two hundred eighty‐four studies reported prevalence of polypharmacy. They were more likely to be conducted in North America (37.7%), published after 2010 (44.4%), cross‐sectional (67.3%), in outpatient settings (59.5%). Prevalence ranged from 0.9% to 98.4%, median 39.7% (interquartile range [IQR] 22.0%‐54.0%). Studies from Asia reported the highest median prevalence of 45.4% (IQR 27.3%‐61.0%) while studies from North America reported the lowest median prevalence of 30.4% (IQR 14.7%‐50.2%). Prevalence decreased over time: median 45.6% before 2001, 38.1% during 2001 to 2010, and 34% during 2011 to 2017. Studies involving children under 12 years had a higher median prevalence (46.9%) than adolescent studies (33.7%). Inpatient setting studies had a higher median prevalence (50.3%) than studies in outpatient settings (38.8%). Community level samples, higher number and duration of medications defining polypharmacy, and psychotropic medications were associated with lower prevalence. Conclusions The prevalence of pediatric polypharmacy is high and variable. Studies reporting pediatric polypharmacy should account for context, design, polypharmacy definition, and medications evaluated.

Rates of chronic conditions among pediatrics have been steadily increasing and medications used to treat these conditions have also shown a proportional increase. Most clinical trials focus on the safety of solitary medications in adult patients. However, data from these trials are often times extrapolated for use in pediatric patients who have different pharmacokinetic processes and physical profiles. As research increases and more drugs become available for pediatric use, the issue of polypharmacy becomes more of a concern. Polypharmacy is defined as the practice of administering or using multiple medications concurrently for the treatment of one to several medical disorders. With the increased rates of diagnosed complex disease states as prescribed mediations in pediatric patients, the prevalence and effect of polypharmacy in this patient population is largely a mystery. Polypharmacy falls within the realm of expertise of specialized pharmacists who can undertake medication therapy management services, medical chart reviews, and other services in pediatrics. Pharmacists have the time and knowledge to undertake pertinent interventions when managing polypharmacy and can play a major positive role in preventing adverse events. The aim of this paper is to review the literature on pediatric polypharmacy and provide insight into opportunities for pharmacists to help with management of polypharmacy. Information on adverse events, efficacy, and long-term outcomes with regard to growth and development of children subject to polypharmacy has yet to be published, leaving this realm of patient safety ripe for research.