Prospective Assessment of Pill-Swallowing Ability in Pediatric Patients

Abstract

Difficulty with pill-swallowing ability (PSA) is common in children, yet formal evaluation is rare. The objective of this study was to prospectively evaluate and compare PSA of inpatient and outpatient children using the Pediatric Oral Medications Screener. We identified children aged 3 to 17 years admitted to a general or subspecialty pediatric service at a university hospital or outpatient clinic. Using the Pediatric Oral Medications Screener, patients were observed swallowing 3 different-sized placebo pills (5 mm tablet, 10 mm tablet, and 22 mm capsule), and subjective measures were assessed from parents and children. We analyzed 47 inpatients and 62 outpatients. Sixteen percent of patients could not swallow any pill, 11% only swallowed the small pill, 14% swallowed up to the medium pill, and 60% swallowed all formulations. After controlling for multiple factors, inpatients had superior PSA compared with outpatients ( P = .004). These results suggest targeted inpatient screening and widespread outpatient screening would likely identify children with reduced PSA.

Identifying and addressing pill aversion in adults without physiological‐related dysphagia: A narrative review

“…Some attempts have been made in paediatric studies such as that of Jones et al, who state the dimensions of placebos and Rashed et al who used sweets and cake decorations of equivalent sizes to licensed medicines to aid “pill swallowing training”. 35 , 49 A reporting consensus needs to be reached in order to make valid comparisons and conclusions across studies.…”

“…Taking this into account, a recent Japanese study declares that the ideal indices for tablet/capsule size is to consider length + width + height with a cut‐off acceptability of 21 mm. Some attempts have been made in paediatric studies such as that of Jones et al, who state the dimensions of placebos and Rashed et al who used sweets and cake decorations of equivalent sizes to licensed medicines to aid “pill swallowing training” 35,49 . A reporting consensus needs to be reached in order to make valid comparisons and conclusions across studies.…”

From paediatric formulations development to access: Advances made and remaining challenges

“…106 In another trial involving HIV-infected children, most children were capable of switching from syrup to scored adult-dose tablets of combination antiretroviral medicines at about 3 years. 107 Furthermore, there is accumulating evidence that some children aged 2-5 years can swallow tablets, and even capsules 65,66,68,108 (Table 8). More recently, Bracken et al have shown that tablets of 6-10 mm in size are potentially acceptable formulation for children aged 4-12 years.…”

Assessing the ability of boys with Duchenne muscular dystrophy age 4–7 years to swallow softgel capsules: Clinical trial experience with edasalonexent

“…1 However, inability to swallow tablets and capsules is a common issue in young children. 2,3 In one study, as few as 25%-45% of patients aged 4 to 7 could swallow solid dosage forms, with the ability to do so improving at older ages. 2 Nonetheless, patients as young as 4 to 5 years old can learn to swallow tablets with training and, in one study, learned more quickly than older children.…”

“…2,3 In one study, as few as 25%-45% of patients aged 4 to 7 could swallow solid dosage forms, with the ability to do so improving at older ages. 2 Nonetheless, patients as young as 4 to 5 years old can learn to swallow tablets with training and, in one study, learned more quickly than older children. 4 There have been recent efforts to understand and improve approaches to oral dosing in paediatric populations, 5,6 but little has been reported in children with progressive neuromuscular disorders who have muscle weakness and impaired motor ability, including oral motor activity.…”