Making medicine child-friendly

Research has identified many barriers to taking medicines by asking children why they sometimes don’t take their medicines, but the tests tend to be inefficient and often directly influence answers.

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There are certain situations in life that some people find nasty but are unfortunately necessary, from having to grin and bear it at the dentist to rapidly overheating on a packed and poorly-ventilated train.

Taking medicine can be one of these unpleasant but unavoidable activities, especially when you are a child. 

Adherence to taking medicine is a problem in paediatric patients. Approximately 40% of medicines prescribed to children are never taken.

40% graphic-repeater1

 
 

A bitter pill

The taste and texture of a medicine, together with its appearance, can affect whether the child is willing to take it. A child may be more open to taking their prescribed medicine if it is administered as a liquid rather than as a pill, for example.

Dr Hannah Batchelor, a Senior Lecturer in Pharmaceutics, Formulation and Drug Delivery at the University of Birmingham, is taking these important factors into consideration with her research into the design and manipulation of medicines to create age appropriate drug formulations to maximise clinical efficacy.

‘If a child doesn’t like the taste of their medicine they won’t take their prescribed course properly,’ explains Dr Batchelor. ‘Children who are prescribed an antibiotic may only be exposed to a small amount of the antibiotic now and then rather than completing a full course. This can increase antimicrobial resistance.’

Through her research into the manufacture and acceptability of medicine Dr Batchelor is hoping to ensure that children have medicines that are designed for them, making the potentially difficult experience of taking medicine more tolerable for both the child taking it and the person administering it.

hannah-batchelor-Cropped-230x230
Dr Hannah Batchelor
 

Focussing on cystic fibrosis

Dr Batchelor’s recent work has concentrated on children with cystic fibrosis who are prescribed the antibiotic flucloxacillin, the second most commonly-prescribed penicillin (following amoxicillin) within the UK in 2012, on a prophylactic basis.

‘There is a discussion around whether children born with cystic fibrosis should be given an antibiotic every day until they are four-years-old to prevent them from getting a Staphylococcus aureus infection,’ says Dr Batchelor.

‘If you have cystic fibrosis and develop this type of infection in your lungs it could easily lead to complications. If you are a parent or carer and are able to give them an antibiotic every day at home to stop them having to go into hospital, that’s typically the preferred option.’

However, flucloxacillin is usually administered in oral liquid form and has a very bad taste, with some variations being flavoured with both menthol and pineapple.

 
 

Taking on foul flucloxacillin

In a study led by the University of Birmingham in collaboration with the Cystic Fibrosis Trust, the University of Liverpool and Evelina London Children’s Hospital, the palatability of flucloxacillin, in oral liquid form, was assessed together with factors associated with successful administration.

The results were instructive.

A mixed-methods study that included a structured review of online forums and a survey of parents and carers of children with cystic fibrosis identified a total of 18 strategies, including using a syringe rather than a spoon to direct the liquid within the mouth and offering a ‘reward’.

Parents and carers shared their experiences and suggested that as the child got older administration became less of an issue. ‘Initially it was very, very difficult. However, my daughter eventually got used to it,’ explained one participant. Another explained that after a year of administration their child got used to the taste of the sugar-free version of the antibiotic. 

While 47% of the 255 parents and carers that took part in the survey reported the administration of flucloxacillin was more problematic than other medicines, 89.3% said that they were able to administer ‘most’ or ‘all doses’ of flucloxacillin.

Dr Batchelor and her team also found out that the brand of flucloxacillin administered significantly influenced the degree of difficulty associated with administration to children. They were also able to conclude that using a stronger suspension meant that a smaller volume is needed, making it easier for the child to swallow.

 

A question of taste

There are certain foods that polarize opinion, particularly when you are a child. As you grow older and your taste buds develop you might begin to enjoy the flavour, but not always.

Some of the foods that split opinion the most include:

  • Liquorice
  • Marzipan
  • Coriander
  • Coconut
  • Celery

Administering strategies

Giving your child medicine can be a challenging and traumatic experience. However, there are a number of strategies you can use to make it a more pleasant experience:

  • Be honest with them
  • Offer an incentive
  • Be positive and use encouragement
  • Empower your child
  • Mask the medicine with food or drink if possible

More information is available on the
Great Ormond Street Hospital website.

 

My medicine and me

It is important to allow children to freely express their feelings about medicines to better understand their perspective and to ensure that interventions to improve administration are likely to succeed.

A group of children from Birmingham Children’s Hospital were asked to use poetry as a mechanism to understand their feelings about taking medicines.

The results were remarkable:

 
 

A researcher's perspective

University of Birmingham graduate Claudia Rouse (BMedSc, Medical Sciences, 2015) worked with Dr Hannah Batchelor and the flucloxacillin palatability team for her final year research project.

What attracted you to this area of research?

This type of research gave me the opportunity to work collaboratively with the Cystic Fibrosis Trust on research that I hope will make a difference.

Poor palatability of medicines is an important issue that can cause administration to children to be upsetting for both the parent/carer and the child, undermining the inherent trust that exists between parent and child.

What difference will this type of research make?

I hope that the findings of this research will help children with cystic fibrosis and their parents/carers in the administration of the antibiotic.

The findings of the research, including suggested methods to ease administration, are listed on the Cystic Fibrosis Trust website and are accessible to parents and carers.

What medical discovery do you hope will be made in your lifetime?

I hope to see a cure for Alzheimer’s.

 
 

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