Background
The assumption that most children require liquid medicines is a misconception. Evidence is emerging that children prefer tablets, if they have been taught to swallow. Liquid medicines have disadvantages: short expiry, unpleasant taste, dose measurement, inconvenient to store and carry, and cost (e.g. warfarin 1mg/1ml suspension costs £100/150ml bottle, tablets (28 x 5mg) less than £2/box. Using a tablet/capsule offers numerous advantages over liquids: improved safety, convenience and reduced costs. Even young children can swallow tablets; yet to date, there are no systematic swallowing training sessions established as an integrated part of the NHS healthcare service available to children.
This project aims to train children how to swallow solid dosage forms; to test and evaluate this intervention within a hospital setting; to determine identify the proportion of children at the study site who can, with training, be swapped from liquid medicines to tablets/capsules and to assess the child and their parent/carer and healthcare professionals’, involved in the study, opinions of the PS intervention.
This project will be conducted with a view to carrying out a large multicentre randomised controlled trial
(RCT) in the future.
Objectives
1. Develop a structured programme of different swallowing training techniques and design an educational booklet to be given to trained children and their parents/carers.
2. Train PS teachers (nurse, pharmacist) on how to deliver swallowing training session.
3. Identify the proportion of inpatients children and their parents/carers, at the study site, who are recruited to receive the intervention (PS swallowing training).
4. Identify the proportion of children and their parents/carers, at the study site, who agreed to swap to tablets/capsules after receiving the intervention (PS training swallowing training).
5. Follow-up children and their parents/carer after they go home to Assess the acceptability of PS swallowing training to participating children and to their parents/carers by identifying their opinions regarding the provided training. Also assess the children’s ability to maintain the skills gained after
they go home – essential for ensuring that the training provides long-term success.
6. Identify the views, opinions and experiences of healthcare professionals involved in the feasibility study regarding the proposed PS intervention.
Methods
The intervention will be developed and conducted in a children’s hospital in England:
1. Develop a structured programme (PS) for teaching swallowing techniques to children. Train Pill school teachers on different swallowing techniques and prepare PS educational booklet to be given to children and their parent/carer to support them keep swallowing tablet when they go home.
2. Thirty inpatients children and their parents/carers will be recruited to receive swallowing training session. Training sessions will be conducted in the hospital before the child is discharged home.
3. Child and carer follow-up questionnaires will be used to evaluate their satisfaction with the training and the children’s ability to maintain tablet swallowing skills.
4. A focus group with healthcare professionals involved in the pilot feasibility study will be formed to assess their experience and opinions regarding the PS intervention.
How the results of the research will be used:
Having developed, tested and evaluated the feasibility of conducting PS swallowing training for children within the NHS hospital setting findings will be used to apply for further funding to conduct large (randomised) studies and explore how we can:
1. Promote the PS concept to facilitate appropriate use of solid forms of medicines for children and establish PS in community settings; GPs and community pharmacies.
2. Evaluate effectiveness and long-term sustainability,
3. Assess the potential cost savings and cost-effectiveness of PS.
This project will have immediate benefits to children and their parents, and will have a national impact on the NHS within a short time-frame.
