Aim In paediatric pharmacy a wide range of medications are used, which are often not available in formulations suitable for children. We wanted to design a tool that would enhance our patients’ experience of medication taking as well as improving accessibility to medicines, palatability and ease of administration.

Method The European Medicines Agency advises that ‘for chronic diseases, the acceptability of tablets in children may be improved by adequate training’.¹ Among others a study has shown that almost half of two year olds could swallow a 3 mm tablet, increasing to 85% in 5 year olds.²

A leaflet was suggested as the best way to teach our patients and their parents how to swallow tablets as it could be widely distributed. It was developed with a working group of paediatric clinical psychologists and a paediatric pharmacist. The leaflet aims to be encouraging and provide practical tips and advice. It offers seven different techniques for swallowing tablets which were adapted from web-based advice and previous cases. The leaflet was piloted in a small number of patients and they were given a questionnaire.

Results Ten questionnaires were returned, with patients’ ages ranging from 5 to 17. All the patients said that they would now be taking all or some of their medication as tablets. All of the techniques were tried by 2 or more patients and each technique was successful for at least 1 child. The most popular method was the ‘big gulp method’ which worked for 8 patients. This involves swirling the tablet around the mouth for 10 s with as much water as possible and then taking a large gulp until all the water and the tablet have gone.

Positive feedback for the leaflet included ‘feels grown up being able to take a tablet’, taking tablets is ‘easier’ and ‘quicker’; one patient wished they had been given the leaflet sooner. Parents also fed back that ‘there was no longer a fight to take medicines’ and ‘it’s much easier for school to manage’.

Conclusion The findings have shown that this is a very successful and useful tool. It allows children and their families to take ownership of their medicine taking. To enable more patients to benefit, further engagement from multidisciplinary teams e.g. play specialists, is needed. In the long-term this leaflet could be used to proactively start patients on tablets rather than reactively, creating potential cost savings and a reduction in the use of unlicensed medicines and specials.

References

1. European Medicines Agency. Guideline on pharmaceutical development of medicines for paediatric use2013. http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2013/07/WC500147002.pdf [Accessed: 28 July 2016].

2. Thomson SA, Tuleu C, Wong ICK, et al. Minitablets: New modality to deliver medicines to preschool-aged children. Paediatrics2009;123(2):235–238.