1. This systematic review identified several interventions that successfully taught children how to swallow pills, including behavioral therapies, verbal instructions, flavored throat spray, specialized pill cups, and head posture training.
2. There is a need for more robust studies to identify most effective interventions for pill swallowing difficulties in the pediatric population as all currently available studies lacked control groups and had inconsistent outcome measurement.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Children often struggle with swallowing pills and this can affect medication administration adherence. This systematic review sought to identify and evaluate studies on effective interventions to mediate pill swallowing difficulties in children. Identified interventions included flavored throat spray, verbal instructions, specialized pill cup use, behavioral therapies, and head posture training; all were successful in teaching children how to swallow pills. One study found that children ages 4-5 years required less training sessions than older children to successfully learn how to swallow pills. Two studies specifically looked at HIV+ children required to take antiretroviral pills and found that adherence improved for 6 months or greater post-intervention. This study is limited by a lack of generalizability given exclusion of non-English studies and use of only 1 database for literature search. However, physicians should be aware that many interventions can successfully teach children to swallow pills and that this may improve medication adherence.
In-Depth [systematic review]: Five studies were included in this systematic review including 4 cohort studies and 1 case series. Inclusion criteria included English studies published between December 1986 and December 2013 studying patients aged 0 to 21 years with pill swallowing difficulties. Studies were excluded if patients had comorbidities including dysphagia or severe developmental disabilities that may impair ability to swallow. Study sample sizes ranged from 11 to 124 participants. All studies improved participants’ ability to swallow pills through their intervention. Only 1 prospective cohort study, examining the effectiveness of head posture training with a 2 week follow-up was rated as “good” by study authors. Three of the studies were rated as “fair”, and 1 study was rated as “poor”. Studies were inconsistent with regard to sample selection and outcome measurement and follow-up, and none of the identified studies had a control group.
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