1. Swallowing medicines: a study of paediatric patients Fatimah Abbas, Aston University

2. An Aston University Research project by Fatimah Abbas Supervised by Dr. D. Terry Swallowing medicines: a study of paediatric patients

3. Background  Most drugs are formulated as tablets or capsules  Some patients have swallowing difficulties (1)  Liquid formulations have disadvantages (2)  Capped NHS funding means cost-effective alternatives are necessary

4. Aim  To identify opinions and experiences of patients and their parents or carers regarding liquid and tablet formulations for children

5. Methods Participant selection 20 patients: -Group 1: tablets -Group 2: other oral formulations -Age 2-11 -Oral formulations -Parent/carer presence Participant identification -drug charts -handover sheets. -screening questions Data collection 20 semi-structured interviews over two week period. Data analysis Qualitative thematic analysis

6. Results I Experience with tablets Group 1: n=10* Group 2: n=3 Positive Patients Group 1: n=5 Group 2: - Parents/carers Group 1: n=10 Group 2: n=10 Negative Patients Group 1: n=4 Group 2: n=3 Parents/carers Group 1: n=2 Group 2: n=5 *one patient had a progressive experience

7. Results II Difficulty with tablets Group1: n=3 Group 2: n=1 Patients able to swallow tablets whole Group 1: n=3 Group 2: - Age patients learned to swallow 4 years old 5 years old 10 years old How patients learned to swallow tablets Food: n=2 Liquids: n=1

8. Results III Barriers Age (n=6) Fear of choking (n=3) Taste (n=1) Refusal of tablets (n=1)

9. Results IV PreferenceLiquids Patients Group 1: n=8 Group 2: n=10 Parents/carers Group 1: n=8 Group 2: n=7 Tablets Patients Group 1: n=2 Group 2: - Parents/carers Group 1: n=2 Group 2: n=2

10. Results V Yes (n=16) No (n=3) Don’t know (n=1) Is it useful to have tablets for children? Yes (n=18) No (n=2) Is it beneficial to teach children to swallow tablets? Yes (n=3) Modelling, grading and use of food and liquids No (n=17) Awareness of training methods for tablet swallowing? Yes (n=19) Don’t know (n=1) Interest in using a training method?

11. Key findings & conclusions  Children aged 2-11 years required tablets  Older children did not have better experiences with tablets  Children as young as age 4 years swallowed tablets  Liquids preferred by patients and parents  Swallowing difficulties largely due to tablet refusal and fears of choking  Modelling and grading were known training methods (3)

12. Study limitations  Scale of the study and pilot study  Interview duration and depth  No true account of patient opinions and experiences  No specific distinction between types of tablets  Multiple coding not possible

13. Future research  Initial versus current tablet experiences  Underlying reasons for tablet refusal  Types of tablets  Drug effects  Comparing training methods (4-6)  Large scale study

14. References 1. Wolf DC. Dysphagia. In: Walker HK, Hall WD, Hurst JW, (eds.) Clinical Methods: The History, Physical, and Laboratory Examinations. Third edition. [Online] Boston: Butterworths; 1990. 2. Nunn T, Williams J. Formulation of medicines for children. British journal of clinical pharmacology. [Online] 2004; 59(6): 674-676. 3. Cruz-Arrieta E. Pill-swallowing training: A brief paediatric oncology report. Primary Psychiatry. [Online] 2008; 15(7): 49-53. 4. Meltzer EO, Welch MJ, Ostrom NK. Pill Swallowing Ability and Training in Children 6 to 11 Years of Age. Clinical Paediatrics. [Online] 2006; 45(8): 725-733. 5. Diamond S, Lavallee DC. Experience With a Pill-Swallowing Enhancement Aid. Clinical Paediatrics. [Online] 2010; 49(4): 391-393. 6. Kaplan BJ, Steiger RA, Pope J, Marsh A, Sharp M, Crawford SG. Successful treatment of pill-swallowing difficulties with head posture practice. Paediatrics & Child Health. [Online] 2010: 15(5): e1-5.

15. Question time...

17. Appendix I Total patients (n=20) Group 1 (n=10) Age range: 2-11 years Group 2 (n=10) Age range: 2-9 years