Pill-Swallowing Problems in Kids Can Be Overcome

Jenni Laidman

April 20, 2015

Children who have trouble swallowing pills can be taught to do so at a young age via several potential interventions, according to an article published online April 20 and in the May issue of Pediatrics.

Amee Patel, MPH, from the University of North Carolina School of Medicine and the University of North Carolina School of Public Health, Chapel Hill, and colleagues searched the PubMed database for studies of pill-swallowing interventions published between December 1986 and December 2013. They included studies that had more than 10 participants aged 21 years and younger. The researchers excluded studies with children who had medical conditions that affect swallowing.

The researchers found four cohort studies and a single case study employing a variety of interventions including behavioral therapy, flavored throat spray, verbal instruction, specialized pill cups, and head posture training. All interventions proved successful, the authors write, although the authors rated only one of the five studies as of "good" quality. They rated three studies "fair," and one study "poor." No study had a control group. Follow-up periods postintervention ranged from 0 to 6 months.

"Unfortunately, studies that evaluate the effectiveness of various pill swallowing interventions are limited by their small sample sizes, observational study design, and lack of controls," the authors write. "At this time, research on the most efficient way to prospectively identify children with pill swallowing difficulties and implement targeted interventions before it is medically necessary for them to swallow pills should be a priority."

One insight from all five studies, the authors note, is that even very young children can learn to swallow pills.

"Parents who are concerned that their children are too young to swallow pills can be assured that some of the interventions have been studied in children as young as 2 years old. In fact, 1 study found that younger children (age 4–5 years) needed less training sessions than older children to learn how to swallow pills."

Two of the studies involved children diagnosed with HIV. One study included 29 children with HIV, aged 3 to 13 years. The researchers used behavioral interventions employing shaping and modeling to teach pill swallowing. Seventeen of the children were able to swallow large capsules and maintain adherence for 6 or more months. However, the method for follow-up was not described in the original study. Reviewers rated the study as "fair" for use of a convenience sample and lack of description of the follow-up method. A study strength, however, was providing detailed intervention instructions to ensure standardization.

In a second study of children with HIV, 22 of 23 children aged 4 to 21 years learned to swallow successfully after behavioral intervention. The researchers also found that the children had significant improvements in their CD 4 counts and viral load 3 and 6 months after training. Reviewers rated this study "fair." Despite its robust measurements for adherence, the authors report, the retrospective study failed to explain how participants were selected or why investigators chose a specific 2-year period to review charts.

In another study of children with dermatologic or respiratory conditions, 47 of 67 children, aged 6 to 11 years, learned to swallow pills via scripted instructions using an ordinary cup, and nine learned using the same instructions with a pill cup. The researchers also rated this study "fair." Despite a large, diverse sample of participants, the authors judged the study's outcome assessments unreliable.

In a study of 11 children aged 9 to 17 years, seven learned to swallow a small candy with the use of a lubricated flavored spray. The review authors rated this study as "poor" because of its small convenience sample, poor outcome measurement, and inconsistent intervention.

Finally, in a study involving 41 children aged 2 to 17 years, all participants learned to swallow pills on learning five different head positions and completing a 2-week practice protocol. The researchers recruited children in this study via advertisement in a tertiary care pediatric hospital. The remainder of participants were siblings or friends of the clinic patients or were the children of hospital staff. Follow-up telephone calls occurred 30 days after the intervention. This study was the only one rated "good" because of its standardized intervention and outcome measurements.

The authors have disclosed no relevant financial relationships.

Pediatrics. 2015;135:883-889. Abstract

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