Many children and adolescents find it difficult to swallow pills. A recent survey of close to 300 parents revealed that 30-40 % of children refused or rejected a pill or liquid medication; more than 50% of children were unable to swallow a standard size pill or small capsules.
This becomes particularly problematic where there are no alternatives to taking pills and especially so in children who encounter chronic illnesses. (A very helpful resource can be found at the Crohn’s and Colitis foundation: http://www.ccfa.org/assets/pdfs/PillSwallowing.pdf)
Researchers are constantly looking for the best ideas to overcome this very common obstacle. A recent publication in Pediatrics (May 2015) updated us on all articles published on pill swallowing since 1987. The authors were only looking at children who did not have any neurological or swallowing problems—in short, only healthy and uncomplicated children. Furthermore, they were only interested in studies where intervention was successful and where children were subsequently consistent at swallowing pills.
The comprehensive systematic review of all the articles on this topic were narrowed down to only a few well-designed studies, including a study which was conducted here in Calgary at the Alberta Children’s Hospital (This study led by Dr. B Kaplan received world-wide attention. For more in-depth information visit http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912624/)
The bottom line in all of the current research is that the most successful interventions in helping children learn to swallow pills include: behavioral therapy, flavored throat sprays, using a specialized pill cup, simple verbal instructions and head posture training.
Some parents are concerned that their child may be too young to learn how to swallow pills, but research shows that children as young as two years old can be taught successfully how to swallow a pill. The head posture training research originating out of Calgary stands out for its simplicity and the fact that it is less time consuming than behavioral therapy. In this study 33 of 44 children completed a 2-week practice protocol after being taught five different head positions. All 33 children were able to successfully and consistently swallow pills after completing their head posture training. A video of this method can be watched by visiting www.ucalgary.ca/research4kids/pillswallowing
Some experts argue that children between age four to five years need less training sessions to swallow pills than older children. They speculate that younger patients are “pill naïve” before pill swallowing training and therefore have fewer negative experiences when learning to swallow pills.
The pharmaceutical industry has done its best to provide medications which are more user-friendly. For example some companies are very proud of the fact that their ADHD medication are produced in capsules, but that these capsules can be broken and sprinkled on certain foods. This has made it much easier to administer these medications at the start of the day when the family is often in a rush to have breakfast and get ready for school.
The old concept of a spoonful of sugar helping the medicine go down may have worked in the 1960’s when it was popularized in the musical “Mary Poppins” More and more families are uncomfortable to expose their children to sugar-sweetened products for reasons that vary from sugar contributing to obesity, to sugar being linked to behavioral abnormalities.
There are no landmark studies which looked at the correlation between picky eaters and children who struggle taking their medications. But there is a very rare condition where children have been diagnosed as supertasters—these children have an extra aversion to bitter-tasting substances and truly can be excused for disliking broccoli! It is not easy to get ones child tested for being a supertaster, because these children have been identified mostly in research-based investigations specializing in taste bad-programming.
The good news is that the majority of children who struggle to swallow pills can be taught how to overcome this important obstacle toward taking their medication consistently and without too much drama. As Dr. Kaplan comments in one of the videos on www.ucalgary.ca/research4kids/pillswallowing, it can be very stressful for families who have children where medication-time become a nightmare, but with simple and proper practice there is hope and a better quality of life.
DR. PETER NIEMAN IS A COMMUNITY PEDIATRICIAN WITH 28 YEARS OF EXPERIENCE. HE APPEARS BIWEEKLY ON CTV MORNING LIVE AND HOSTS A BLOG ON CHILDRENS HEALTH AT WWW.HEALTHYKIDS.CA DR. NIEMAN HAS AUTHORED AN UPCOMING BOOK, “MOVING FORWARD” WHICH WILL BE REALEASED IN AUGUST.
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