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Aim To explore potential cost and carbon savings that could be achieved by substituting oral liquid medications (OLM) with solid oral dosage formulations (SODFs) such as tablets and capsules for paediatric inpatients in a tertiary paediatric centre in the Northwest of England. The European Medicines Agency suggests that patients as young as three years old can learn to swallow SODFs. 1 Ancillaries, storage and increased waste produced by OLMs (due to reduced shelf-life) demonstrate that SODFs are generally, more sustainable. Despite studies demonstrating the financial and carbon saving benefits of SODFs, they continue to be underutilised in the paediatric population.2 3 Methods Data was collected over three weeks in January 2025. Electronic medication records for inpatients aged 4-16 years were reviewed across 6 selected wards: General Surgery, Complex Medical, Neurosurgery and Orthopaedics, Neurology and Rehabilitation, General Medical and Emergency Decisions Unit. Oncology and NICU/PICU wards were excluded due to the nature and complexities of treatment regimens. Patients with feeding or tracheostomy tubes were also excluded.Patients were screened through the NHS Digital National Opt-out portal before pseudonymisation. Patients were categorised into three groups based on SODF prescribing suitability:Suitable: SODF could be prescribed without any changes;Potentially Suitable: clinically acceptable changes needed, such as licensing modification or dose adjustment needed equal or less than 10%;Unsuitable: SODF not appropriate due to already being prescribed SODF, no suitable alternative formulation available, or dose adjustment higher than 10% required. Potential cost savings were calculated by comparing OLM price with SODF price for a one week course using the February 2025 NHS Drug Tariff.Though the exact carbon emissions produced by each medicine could not be quantified, existing literature4 was explored to determine potential carbon savings that could be extrapolated to the study data.Results 105 patients prescribed 375 OLMs were included in this study. Based on the suitability of prospectively prescribing SODFs: 89 (24%) medicines were suitable for switch to SODF, 66 (18%) medicines were potentially suitable and 220 (59%) medicines were unsuitable. 82 patients (78%) had the potential to be prescribed at least one SODF, with 40% of OLMs having a suitable, cheaper SODF option available. Assuming a 100% success rate of pill-swallowing programmes, and that the cheapest SODFs per medicine were selected, the potential cost savings could amount to £198,605 per year. Switching a 14-year-old from diazepam liquid to tablets displayed the highest cost saving between formulations of £374.87p/week.Extrapolating from previous studies to our data suggests switching from liquid to paracetamol tablets could save 12,555kg CO2e (68%) each, totalling 652,860kg CO2e saved per year. Similar carbon savings could be expected for other active drugs.Conclusion This study supports paediatric ‘pill-swallowing’ programmes to increase SODF prescribing where clinically appropriate, aligning with NHS Net Zero carbon emission and cost saving goals. Targeted interventions can promote sustainable resource use and reduce carbon footprint. Challenges like patient/parent acceptance, dose flexibility and staff training must be addressed to facilitate this change. Future research should focus on education, formulation innovation and healthcare staff training.References Van Riet-Nales DA, Wang S, Saint-Raymond A, et al. The EMA quality guideline on the pharmaceutical development of medicines for paediatric use. International Journal of Pharmaceutics 2012;435(2):132–134.Dua D, Emmet V, Lim E, et al. The KidzMed project: teaching children to swallow tablet medication. Archives of Disease in Childhood 2020;105(11): 1105–7Lim E, Parker E, Vasey N. Why learning how to swallow pills is good for patients, parents, and the planet. The British Medical Journal 2024;384: e076257-eDavies JF, McAlister S, Eckelman MJ, et al. Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle assessment. British Journal of Anaesthesiology 2024;133(6): 1439–1448