Medication Adherence: Tips for Helping Kids and Parents

Elizabeth B. Rand, MD; Laurie Scudder, DNP, PNP


September 30, 2013

Editorial Collaboration

Medscape &

Editor's Note:
Medication adherence is a critical issue in all patient populations. The factors that affect adherence in children, however, are unique. For one, providers are dealing with 2 distinct audiences -- children and their parents -- who may or may not be working together. As children develop, medication adherence becomes increasingly in their control. Providers must recognize a growing child's role in adherence and address issues and concerns of both the child and the parents. Medscape asked Elizabeth Rand, MD, Medical Director of the Liver Transplant Program at The Children's Hospital of Philadelphia, to share her advice about issues specific to the children for whom she cares.

Dr. Rand: Medication adherence is a potential problem for solid organ transplant recipients, because if medications are not taken properly, organ rejection can occur and may even result in loss of an organ graft. For this reason, we like to approach medication adherence at every visit and check with families about how medications are being taken.

In younger children, problems with adherence are really problems with the parents administering medication, and it can be helpful to ask about the parents' difficulties. It may be useful to change the formulation of the medication, or the flavoring, depending on the age and size of the child.

For older children, the problem may be more at the level of the child than the parent. A child or young adult may report having taken medications when in fact he has not, or may simply forget about the medications while the parents assume that they are being taken. In these cases, older children may benefit from the use of a cell phone reminder or some other electronic prompt.

Pill boxes are very useful for children who are taking medications that are in pill formulation. And if the child is having difficulty swallowing a large tablet, it may be possible to replace that dose with 2 smaller tablets that will be easier to swallow.

Additionally, it is important that education about a medication, along with the reasons why adherence is critical, be provided in a culturally competent manner. Families of varying ethnicities may view medication through a different cultural lens. Therefore, ascertaining their beliefs about a child's health, and the reasons for an illness, is important.

There are a number of online resources to help clinicians and families (Table). Many include downloadable materials developed using strategies to assist patients with limited health literacy and can be viewed in several languages.

Table. Medication Adherence Resources for Children and Parents

Resource What It Does
Smartphone apps (available from app stores) Numerous apps are available that assist patients via alarm/reminders, text messaging, or "push notification." A review article describing features of numerous apps is available on Medscape. Most are available without charge. A healthcare professional tool that allows providers to customize and print patient-friendly medication schedules and discharge instructions. Integrates with electronic medical records. Available in English and Spanish. A companion smartphone app is available for patients.
Medication Adherence Time Tool Developed by the American College of Preventive Medicine, this site compiles resources for clinicians about strategies to support adherence, particularly for patients with limited health literacy. Includes a downloadable companion resource for patients.
Script Your Future A national campaign developed by the National Consumers League. Includes links to a variety of adherence tools, including tools specific to medications used to treat cardiovascular disease, asthma, diabetes, and other conditions.
Pill boxes with and without alarms Devices that combine audible, light-emitting, and vibrating alarms, timers, automatic pill dispensers, and locks. Able to be customized for a wide range of medication schedules. Numerous devices available.