Stable Overall Volume, Shifting Structure: Nine Years of Paediatric Outpatient Prescribing and Dispensing in Finland, 2017–2025

Péter Csonka,1 Juho Leppänen,2 Hanna Koskinen,2 Heini Kari21Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; 2Research Unit, The Social Insurance Institution of Finland (Kela), Helsinki, FinlandCorrespondence: Péter Csonka, Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland, Email [email protected]: Paediatric outpatient prescribing varies across Europe, and whole-population data spanning the COVID-19 pandemic remain scarce. We characterised trends in dispensation prevalence, age and sex patterns, therapeutic class shifts, and prescriber channels for all children in Finland, 2017– 2025.Methods: We conducted a nationwide registry-based drug utilisation study of all children under 18 years resident in Finland in 2017– 2025, using individual-level data from the Kanta Prescription Centre. Drugs were classified by ATC code. Annual prevalence was the proportion of the year-end resident child population with at least one dispensation; age and sex patterns were modelled with sex-specific quasi-Poisson generalised additive models.Results: Over 2017– 2025, 1,324,517 children received 21.1 million dispensations. Mean annual dispensation prevalence was 50.4%, or 45.1% when systemic antibiotics were excluded. Anti-infective dispensing (ATC J) fell from 298 to 237 per 1,000 children and did not return to pre-pandemic levels. Nervous system drug prevalence (ATC N) rose from 107 to 155 per 1,000, driven mainly by adolescents (lisdexamfetamine +709%, sertraline +305%, methylphenidate +207%). Boys predominated to age 13 (boy-to-girl ratio peaking near 1.5); by age 17, girls received roughly 1.7 times as many dispensations as boys. The adolescent gap persisted after excluding hormonal contraceptives, and boys showed the larger relative rise at ages 14– 17. The public-sector share of prescriptions fell from 62.1% to 57.9%, with prescribing to children under 6 years shifting from public general practice to private paediatrics.Conclusion: Overall paediatric dispensation volume in Finland was broadly stable across 2017– 2025, but the underlying structure changed substantially. Antibiotic stewardship gains held, central nervous system medicine use rose continuously, and the channel mix shifted toward private paediatric care for younger children. If access to private care depends on family resources, this shift may widen inequalities in children’s access to prescribed medicines, although socioeconomic factors were not assessed here.Keywords: drug utilisation, pharmacoepidemiology, paediatric outpatient prescribing, medicine dispensing, nationwide registry study, Finland, COVID-19 pandemic, antibiotic stewardship, central nervous system medication, health equity