In the event of a natural disaster, epidemic or terrorist attack, the U.S. may not have enough medical resources to aid affected children, according to a report from the American Academy of Pediatrics.

Children are particularly vulnerable to illness and injuries during these emergency situations and their distinct needs - such as special drug formulations or dosing and pint-size medical devices - mean supplies set aside for adults may not work for them.

To start fixing the problem, the U.S. needs more investment in treatments that are appropriate for children, including research to develop age-appropriate therapies as well as investments to increase the nation's stockpile of remedies already made for kids, according to the report from AAP's Disaster Preparedness Advisory Council.

"Without research and development the pipeline of new and innovative medical countermeasures will not be achieved or sustained," said lead report author Dr. Daniel Fagbuyi of George Washington University in Washington, D.C.

"Life or death is what's at stake," Fagbuyi, a retired infantry veteran with expertise in disaster and terror response, added by email.

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While significant strides have been made in recent decades to improve the U.S. stockpile of supplies needed for children in emergencies, there's still a lot to be done, Fagbuyi and colleagues write in the journal Pediatrics.

To meet the needs of children, the nation's disaster stockpile should include life-saving equipment, devices, supplies and medications that are appropriate for children.

With medicines and vaccines in particular, the stockpile should have pediatric formulations such as liquid alternatives to pills adults might swallow, as well as age-based or weight-based dosing instructions, the report authors say.

One considerable challenge to adding more pediatric treatments to the stockpile is the paucity of research done in kids, which is due in part to difficulties getting consent from parents to include children in clinical trials and meeting clinical trial requirements that are more stringent for kids than adults, Dr. Laura Faherty of the University of Pennsylvania and the Children's Hospital of Philadelphia noted in an accompanying editorial.

Doing more research as public health disasters unfold may help scientists better understand how to help children in these emergency situations, Faherty said by email.

The goal is to rapidly learn what works and what doesn't, and to get this information quickly, Faherty said, adding, "The systems to do good research must be set up in advance to more quickly figure out what's going on during an outbreak or similar public health emergency, and respond accordingly."

Cost can also be an obstacle, particularly because many pediatric versions of drugs are liquids that may have a shorter shelf life than pills for adults and be harder to transport and store, noted report co-author Dr. David Schonfeld of the University of Southern California.

"Yes, there are limited resources available for preventive and treatment services, and we always need to balance the likely benefit against the cost," Schonfeld said by email. "But if as a country we decide to create a national stockpile of medical countermeasures, I feel we have an obligation to ensure that children are protected at least to the same extent as adults - which is not the current situation."

The need for better pediatric emergency supplies has also become more pressing as the perceived domestic risk for exposure to chemical, biologic and radiologic agents has increased, noted Dr. Steven Krug, a researcher at Northwestern University Feinberg School of Medicine in Chicago and chair of the AAP Disaster Preparedness Advisory Council.

"Disasters will continue to occur," Krug said by email. "We therefore need to be prepared and we need to be able to better weather the storm."