1. Providing Adherence Support to Children and their Families Andrea Jurgrau, MS, CPNP Women and Children Care Center New-York Presbyterian Hospital Columbia-Presbyterian Medical Center

2. An Adherence Program Y Individual sessions with a health educator Y Individual sessions with a nurse Y Pill swallowing readiness training Y Home delivery of medication if family desires Y Individualized medication schedules Y Prepared pill boxes if family desires Y Medication Reminder beepers and timers Y Optional participation in an adherence study Y Behavior modification program with rewards

3. Define Children! l Infants l Toddlers l School Age l Adolescent/Young Adults l And their families!!

4. Infants Special Considerations l Things change rapidly: Feeding and sleeping schedule Level of alertness Interest in taste Ability to move and assert self

5. Helping Infants Liquid Medications

6. Toddlers Special Considerations l More stable schedule with rituals very important l Asserting independence with anticipatory guidance needed l Dealing with oppositional behavior: special tricks?

7. School Age Children Special Considerations l Meeting children where they are developmentally and helping their families do the same l Beginning to work on disclosure l Shared responsibility for medication taking

8. Adolescents Special Considerations l Meet them where they are developmentally/ anticipatory guidance l Disclosure and processing diagnosis l Becoming more responsible for own medications l Scheduling issues

9. Potential Problems and solutions l The adult giving the medication gets sick/ is hospitalized: Always help the family identify a back-up Help family set-up homecare services before a crisis happens

10. Potential Problems and Solutions l The medications taste awful: Work on pill swallowing Help family find ways to hide taste: Big Red Gum, chocolate syrup, M&Ms, other syrups, chocolate milk, peanut butter, peppermint……..

11. Helping Children Pill Swallowing

12. Conclusion l Understanding where children and adolescents are developmentally is vital to helping them achieve adherence to complex medication regimens. l Working with children means helping them AND their families.

13. For more HIV-related resources, please visit www.hivguidelines.org