priority, and as is highlighted on all medicine containers, medicine must be kept out of the reach of children both in hospital and the community. It is important to watch a child taking their medication to ensure that they have taken it. If medicine is left next to the child in hospital or community, it may be taken by another child, knocked over or forgotten.
In younger children they may not have the ability to swallow a tablet and even in older CYP the tablet may be so large they have difficulty swallowing. In tablets that are enteric‐coated it is important not to crush them so as to aid swallowing. Enteric coating is used for medicines that cause irritation to the upper gastrointestinal tract and the coating is broken down in the stomach by digestive acids, allowing the medication to be absorbed through the stomach and intestines. Crushing the tablet will increase the risk of gastric irritation. Where possible, liquid preparations should be prescribed. This is commonly seen in over the counter medicines that can be purchased in pharmacies or supermarkets, and an example of this is paracetamol, which is available in numerous formats.
Clinical Consideration
In a local store or pharmacy find out the following information:
| PARACETAMOL TABLETS | SOLUBLE TABLETS | MELTS | CALPOL INFANT SYRUP | CALPOL 6 PLUS | PARACETAMOL SUPPOSITORY | |
|---|---|---|---|---|---|---|
| What is the recommended age range? | ||||||
| What is the strength of the active ingredient? | ||||||
| What is the cost of medicine? | ||||||
| How many tablets or doses are in each container? | ||||||
| What additional company (trade) names can you find for each of them? |
Adolescents
Teenagers develop through a complex range of emotions, physical changes and exploring identity. Through the onset of puberty hormones such as testosterone and oestrogen are produced, resulting in growth spurts and the production of secondary sexual characteristics such as body odour, body and facial hair, breast development and menstruation. During this time there is an increase in self‐awareness and the need to be accepted by peers and society. There is an increase in mental health conditions developing in this age group, including eating disorders, anxiety, depression as well as lack of confidence. It has been noted that young people often rebel against strict boundaries and want to be treated and act like adults, leading to risk‐taking behaviours.
Coping with ill health and being separated from friends and peers can be very isolating, especially when in hospital for long periods with a complex or long‐term condition. Taking medication or carrying emergency medication, such as an epi pen in case of an allergic reaction, ventolin inhaler in case of an asthma attack or insulin and equipment to monitor and correct blood sugar levels in diabetes, can be rejected by some.
Young people should be involved in the decision‐making process about their treatment and share the responsibility where appropriate. Their independence should be supported and plans developed to encourage their self‐management as they move to adulthood and in the future leaving the family home. Encouraging independence supports normality in life and allows young people to stay at friends houses or go on residential trips with their peers. Promoting the self‐management of treatment and medication develops responsibility, time‐management and decision‐making skills. One area that can be difficult with this is supporting parents to allow their child to have some independence and responsibility for their own health. When medication is vital, not taking medication can be life‐threatening. This is very difficult for parents/carers, having maintained their child’s safety and health for many years.
Episode of Care
Krishna aged 15 years has cystic fibrosis and has had 3 hospital admissions in the last 6 months for chest infections requiring antibiotics and increased physiotherapy. Krishna has regular medication including digestive enzyme tablets to take with food, salbutamol inhaler as a bronchodilator, dornase alfa to thin the secretions in his lungs and antibiotics for a chest infection. Due to the amount of regular medications taken at home Krishna brings his medications in to hospital to show the admitting nurse practitioner during the assessment so that the ongoing treatment can be maintained, and a review of the medication optimisation can occur effectively.
Whilst in hospital Krishna’s own medication can be used if he were able to self‐medicate and a lockable cupboard is at the side of his bed. This gives Krishna some independence and control over his treatment.
Prior to discharge the level of each of Krishna’s medications are assessed by a pharmacist and a top up supply given on discharge preventing medication expiring whilst being in hospital and being wasted. This system is effective when CYP are on long‐term medications.
Tablets
Tablets should be considered as more accurate than liquid medicines and therefore safer, they are cheaper and easier to obtain from pharmacies and more convenient to transport and administer. Non‐enteric‐coated tablets maybe broken into smaller pieces if scored or crushed, they can be given on a spoon, or placed on the back of the tongue and swallowed with a drink. It is advisable to teach children to swallow tablets as soon as possible and this can be done as an inpatient or outpatient using a structured process. Tse et al. (2019) published the KidzMed project findings, which focused on teaching children how to swallow tablets with a structured programme within one outpatient appointment. This project, how it was set up, and the successful outcomes will be discussed in more detail in Chapter 3, which concerns legal and ethical issues. Parents may also need support to encourage their child to take tablets and to be taught the most effective methods to swallow a tablet or capsule.
Distraction Techniques
Play and distraction have been used in healthcare for many years to relax children and reduce fear and anxiety. The use of role play with children should not be underestimated. Children’s nurses need to develop a good relationship with their patients and a good place to start is to find out their favourite games, toys, characters and television programmes or films. Using a favourite soft toy or character to take their medicine first can help young children to take their own medicine. Praise and rewards are another way of encouraging children who are reluctant to take their medicine. Forcing a child to take medication is not ethical
