It may be a tough pill to swallow, but the medical community is becoming more aware of the number of patients who have difficulty swallowing tablets and capsules.
Of course, this isn't a new issue, but a recent study published in the journal Pediatrics revealed the problem may be more widespread than we thought. More than half of the parents polled indicated their child couldn't swallow solid dosage forms like tablets and capsules. Last year an article appeared in the Annals of Family Medicine (Nov. 1, 2014 issue) that addressed this as well.
The recent article in Pediatrics may be the most comprehensive study of the subject to date. The authors reviewed published studies in search of techniques with statistically significant success. The result was that five techniques: behavioral therapy, head posturing, flavored mouth sprays, special swallowing cups and verbal training were all identified as beneficial in helping children learn to swallow tablets or capsules.
"Pill swallowing difficulty is not an uncommon problem, and there are resources that may be available to children based on their particular difficulty," said the lead author of the study, Kathleen Bradford, M.D., a professor of pediatrics at the UNC School of Medicine.
Although not specifically addressed in the study, pharmacists are in a unique position to offer help to patients and parents who need advice on swallowing tablets and capsules.
First, we are in a uniquely privileged setting in which to identify patients for whom swallowing tablets is a problem. We interact with the parent who says something like, "Oh, doesn't that come in a liquid? Johnny doesn't swallow pills." We take the phoned-in prescription for the adult being prescribed liquid amoxicillin or liquid Bactrim. We point out the pill-crusher to the inquiring customer picking up a bottle of OTC ibuprofen.
These are easy clues that a swallowing problem could exist. By identifying these patients, we can offer resources, tips and tools to assist parents seeking to train their children to swallow solid medications.
Secondly, we are keenly aware of just how many medications should not be crushed by patients prior to ingesting. Many prescription and OTC medications need to be swallowed whole. Certain prescription medications often used in children for conditions like ADHD or epilepsy are time-released and not intended to be crushed.
However, in spite of our unique perspective, many pharmacists and pharmacies miss these educational opportunities. Given the attention this problem is getting, it may be time to do something about it.
Ideas for pharmacists looking to help counsel patients who have difficulty swallowing include:
1. Remind patients that the vast majority people who have difficulty swallowing pills can actually overcome this problem. Multiple studies have confirmed the success of training techniques.
2. Carry one or more tools that sometimes are useful to assist patients with difficulty swallowing pills. For example, the Ezy-Dose pill taker's cup is available from many wholesalers and is an inexpensive approach. This product, for what it's worth, is the one I used to help my wife learn to swallow pills for the first time — at 20 years of age! Another product, an oral lubricating spray known as Pill Glide, may also be something worth carrying.
3. Consider developing a simple handout that recommends a well-established process for learning to swallow pills. That process, which you can read about many places online, simply involves beginning with small candies (like cake decorating sprinkles) and moving gradually up through slightly larger candies (e.g., Nerds, Tic-Tacs).
This last suggestion, combined with patience and practice, has been extremely successful in training both children and adults. Experts such as Dr. Katherine Dahlsgaard of the Anxiety Behaviors Clinic at Children's Hospital of Philadelphia recommend it regularly.
Being uncomfortable with pill swallowing isn't fun for anyone. But pharmacists, with the help of a few resources, are in a great position to help patients overcome this fear and enjoy a more natural experience swallowing their medication.
