Month: June 2024

I’ve been reading the BMJ again, and finding articles that require us to inspire patients, to help them understand and benefit from our knowledge. This time, I’m introducing an excellent article that appeared in March 2024, written by Emma Lim, Emily Parker and Nicola Vasey. I’ve pinched their statistics.

A couple of years ago now, we saw a surge of cases of scarlet fever, an infectious disease that is treatable with antibiotics. It affects children in particular. At the same time there was a shortage of the liquid preparations of the most suitable antibiotic. It led me to look at Kidzmed, an online resource that helps parents support their children to take tablets.

It led to a reflection. As a child, living in New Zealand at the time, I suffered from recurrent tonsillitis. I was often prescribed antibiotics, and I vividly recall the vile taste of penicillin mixture, and trying to sweeten it with sugar when my mother wasn’t looking. At some point, there must have been a shortage, and the only option was capsules. I was 4, and I managed. Celebration all round, no bad taste and I was so proud that I was grown up enough to manage.

Another childhood memory – my sister and I putting our thrupenny bits in our mouths; it was our pocket money, and we must have been five and six years old. Alice swallowed hers. OOPS, but down it went, and out it came a day later. My brother also managed to swallow an old 50p piece, also without harm, although that caused more excitement on account of the size, and this is not recommended at all, but out it came a day later. Children swallow all sorts of things, often money. Tablets are usually smaller. A note here – small batteries and magnets are also easy to swallow and with much more risk of serious harm than money.

I also remember, as a parent, the relief that our children could manage tablets. No more the risk of travelling with a bottle of paracetamol, sticky and at risk of breaking, not allowed on the plane if it was more than 100ml. Much easier if we could take tablets.

In reality, most capsules and pills are smaller than the amount of food we can manage in a swallow, so it should be easy. The firm consistency of larger tablets can be difficult for some people, but taking tablets with a good swallow of water gets them past the back of the throat and off they go.

Roll on two years. I have read an article in the BMJ about the impact of moving from liquid formulations to pills and capsules. It isn’t just about ensuring that children can get the full range of medications they need, without the bad taste. Medication accounts for 25% of the NHS carbon footprint. In India, a lifecycle assessment of liquid paracetamol versus pills showed that liquid consumes fifteen times the amount of carbon. Some of this is in the cost of transporting a heavier product, with more wasteful packaging.

Pills also have a longer shelf life, and generally don’t need to be stored in the fridge, so there is lower energy use and less waste. They also contain less additives such as colouring, flavouring and stabilisers. Pills can be dispensed in exact quantities, whereas liquids are prescribed by the bottle. This is especially true of antibiotics such as amoxicillin liquid which comes in 100ml, where a course is usually 75ml. Liquids are also more prone to measurement error; 80% of doses measured by parents in a trial had a small error, and 21% of those errors were very large.

Pill swallowing is a life skill that benefits parents, families and the environment. It is especially helpful for children who have chronic diseases such as epilepsy or cystic fibrosis. Children as young as four years old can be trained to swallow pills.

I recommend visiting Kidzmed for information, it really works. Practice with small sweets, and use a bottle with a drinking lid on it. Work up through the sizes and reinforce success with praise and prizes. It is also a good opportunity to talk to your child about being safe with medicines and not swallowing things that are unsafe.

• Find a comfortable place with no distractions, and explain what the objective is.
• Let the child choose their own drink
• Start with the smallest practice pill or sweet
• Put the sweet or practice pill on the centre of the tongue
• Take three gulps of liquid
• Try another pill or sweet following the same steps. Use the words ‘the next one’ rather than ‘the bigger one’.

https://www.youtube.com/watch?v=XwiuU-k2FIM – the video is 14 minutes long.

https://www.nenc-healthiertogether.nhs.uk/parentscarers/medicine-children/pill-swallowing-kidzmed for some more background and some extra resources.