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Swallowing Pills? Children Can Learn How

Five strategies were identified that help get the medicine down

MONDAY, April 20, 2015 (HealthDay News) -- Children who have trouble swallowing needed pills aren't out of luck, according to a new study. At least five different strategies may help them swallow pills and capsules more easily, researchers found.

"Pill swallowing difficulty is not an uncommon problem, and there are resources that may be available to children based on their particular difficulty," said study co-author Dr. Kathleen Bradford, a pediatrician at North Carolina Children's Hospital in Chapel Hill. "Addressing this problem and researching more effective ways to implement these interventions can help improve medication administration and compliance in children."

The key, one expert said, is that children practice, especially when they are not sick, so they don't need to learn on the fly.

"I recommend practice, lots of water and start small," said Dr. Jaime Friedman, a pediatrician at Children's Primary Care Medical Group in San Diego. "My partner taught his son using Tic Tacs."

Starting "pill swallowing training" earlier rather than waiting till your child has had bad experiences is also helpful, Bradford's team reported.

The researchers looked for all studies from 1986 to 2013 that focused on improving difficulties with pill swallowing for children. They found five studies that identified a successful method to help kids swallow pills more easily.

The successful strategies included using flavored throat spray first, giving children verbal instructions, behavioral therapies, using a specialized pill cup and training children to use five different head postures.

The findings were published online April 20 in the journal Pediatrics.

An estimated 10 to 20 percent of children will have problems swallowing pills, Bradford said, though some studies noted in this paper showed even higher percentages.

Study co-author Dr. Ravi Jhaveri, also a pediatrician at North Carolina Children's Hospital, said there are many reasons children have problems with pill swallowing. "Some are behavioral, including anxiety, and others include problems with pill size, texture and taste, as well as the physical technique required to swallow a pill," he said.

For many medications, doctors can prescribe a liquid, but liquid is not always an option, said Friedman, who was not involved in the study.

"For some medications like most ADHD meds, there isn't a choice, so the kids have to learn," Friedman said. "I think children have trouble because it is a new sensation and they are afraid of gagging or choking or vomiting."

The methods described in the studies offer some helpful solutions, Friedman said.

"I think a combined method of behavioral interventions and teaching head positions seems most plausible," she said. "The paper was not specific about what the behavioral interventions were, but I think relaxation is key."

Modeling, or demonstrating, was also found helpful as a behavioral therapy.

Most of the studies reviewed in this paper involved small numbers of children, but they showed high levels of success with the various methods.

For example, one study teaching behavioral interventions enabled 17 of 29 children to take large capsules for at least six months. Another study with behavioral interventions had success with all but one of 23 children.

In another study involving 67 children who initially could not swallow pills, 47 learned to do so by following scripted instructions, and nine others learned with the script once they had a small pill cup.

The study with the flavored throat spray had just 11 children, seven of whom could swallow a small candy after using the throat spray.

Finally, all 33 children who were taught five different head positions and completed a two-week practice plan were able to swallow pills successfully after those two weeks.

More information

The U.S. National Library of Medicine has tips on giving children's medications.

SOURCES: Kathleen Bradford, M.D., division of general pediatrics and adolescent medicine, North Carolina Children's Hospital, Chapel Hill, N.C.; Ravi Jhaveri, M.D., associate professor, pediatrics, division of infectious diseases, North Carolina Children's Hospital; Jaime Friedman, M.D., F.A.A.P., pediatrician, Children's Primary Care Medical Group, San Diego, Calif.; May 2015, Pediatrics
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