A pair of doctors have found there’s no universal solution to the problem of children swallowing pills. But there are techniques that work.

Anyone with unpleasant childhood memories of being told to swallow a pill that appeared to be the size of a crayon will find welcome news in a study out of the University of North Carolina School of Medicine.

In an article posted today in the journal Pediatrics, Dr. Kathleen Bradford and Dr. Ravi Jhaveri reported on their research in “Effectiveness of Pediatric Pill Swallowing Interventions: A Systematic Review.”

Their goal was to evaluate studies performed on pill swallowing interventions in children since 1987.

One study concluded that 50 percent of children have problems swallowing standard-size pills or capsules.

Since Bradford is a pediatric hospitalist and Jhaveri is an infectious disease specialist, both deal on a daily basis with hospitalized children. They’re familiar with the issue of young patients being unable or unwilling to swallow pills.

Since Jhaveri and Bradford often collaborate, they decided to investigate what techniques other clinicians used and what sort of results they had.

Jhaveri, in particular, remembers one young boy who was about to be sent home to continue his treatment, but “he couldn’t take the pills he needed.”

“We decided to look at how common the problem was and what solutions were available,” Jhaveri said.

“The earlier transition [we can make] to oral therapy from intravenous therapy, the sooner we can get some kids home,” Bradford added. “We don’t want to keep catheters in any longer than necessary. When children can’t take pills, they stay in the hospital too long.”

That’s not good for the children or a hospital’s bottom line, she noted.

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Of the 211 studies Bradford and Jhaveri looked at, only five met their criteria. That was the researchers’ first lesson: how few large, well-organized studies there are. They were assisted in their analysis by a trainee with a master’s degree in public health.

The researchers discovered problems swallowing pills can arise from a variety of causes, including the child’s stage of development, fear, anxiety, parental pressure, or intolerance of unpleasant flavors. In all the studies, some children showed improvement with intervention.

But the researchers didn’t find a magic bullet. It turns out difficulty with pill swallowing is not a one-size-fits-all sort of issue.

Several techniques used in different studies showed good results, but the doctors did not find universal improvement with any of them. The techniques include behavioral therapy, flavored throat spray, specialized pill cups, simple verbal instruction, and head posture training.

In addition, pill swallowing training in 2-year-olds helped increase the likelihood of pill swallowing success.

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More research is needed, Bradford said, but even with what’s available so far, it’s clear that children can be taught techniques that work for them.

Millions of prescriptions are written every year for children, the doctors said, and the great majority of them are for pills. So it’s in everyone’s interest to make pill taking as easy and non-threatening as possible.

Even if the pill looks as big as a crayon.

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