Helping Kids Take Their Medicine – PediaCast 603

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Description

Clinical pharmacists, Addie Brown and Emily Stephan, visit the studio as we chat about helping kids take their medicine. From bad-tasting liquids and tricky pills to busy schedules and worried parents, there are plenty of barriers that keep kids from taking their medicine as prescribed. We provide tips and tricks for parents… and we hope you can join us!

Topics

Helping Kids Take Their Medicine
Pill Swallowing

Guest

Addie Brown
Clinical Pharmacist
Nationwide Children’s Hospital

Emily Stephan
Clinical Pharmacist
Nationwide Children’s Hospital

Links

Helping Hands
Tips and Tricks for Swallowing Pills and Liquid Medications
Medicine: How to Give by Mouth
Coping with Medicines

Mobile Apps
My Med Schedule Plus
Medisafe
Baby Feed Timer

Episode Transcript

[Dr Mike Patrick]
This episode of PediaCast is brought to you by Pharmacy Services at Nationwide Children's Hospital. 

[MUSIC]

[Dr Mike Patrick]
Hello everyone, and welcome to another episode of PediaCast. We are a pediatric podcast for moms and dads.

This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 603.

We're calling this one Helping Kids Take Their Medicine. I want to welcome all of you to the program. We are so happy to have you with us.

You know, getting kids to take their medicine is not always easy. In fact, it's difficult probably more times than it's easy. From bad tasting liquids and tricky pills to busy schedules and worried parents, there are plenty of barriers that can get in the way.

However, taking medication as prescribed, which is what healthcare professionals call medication adherence, is critical for helping children get better and stay healthy. Today, we're talking with two pharmacists from Nationwide Children's Hospital about practical strategies parents can use to help kids take medication safely and consistently. We'll explore why adherence matters, common barriers families face, and lots of practical tips from pill swallowing practice to taste masking tricks and tools that will help families stay on schedule.

Our two pharmacists visiting the studio today are Addie Brown and Emily Stephan. They are both clinical pharmacists with Nationwide Children's. Before we get to them, I do want to remind you the information presented in our podcast is for general educational purposes only.

We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you're concerned about your child's health, be sure to call your healthcare provider. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.

So, let's take a quick break. We'll get our guests settled into the studio, and then we will be back to talk about helping kids take their medicine. It's coming up right after this.

[MUSIC]

[Dr Mike Patrick]
Addie Brown is an ambulatory patient care pharmacist with Primary Care Pediatrics and the Developmental Behavioral Programs at Nationwide Children's Hospital. Emily Stephan is an advanced patient care pharmacist with the Pulmonary Medicine Program, also at Nationwide Children's. Both have a passion for supporting parents who are having difficulty getting their kids to take medicine, whether it's outright refusal, unpleasant taste, inability to swallow pills.

Whatever the difficulty, they have tips and tricks to help. That is our topic today, helping kids take their medicine. Before we dive in, let's offer a warm PediaCast welcome to our guests, Addie Brown and Emily Stephan.

Thank you both for visiting the studio today.

[Addie Brown]
Thanks, Dr. Mike. I'm excited to be here. 

[Emily Stephan]
Yeah, thanks for having us. We're very excited.

[Dr Mike Patrick]
You know, I am really excited about this one, too, because I don't think a shift in the emergency department goes by where I don't have a parent say, he doesn't take medicine well. And we try to, you know, offer advice and encouragement. So I'm hoping to get some more tools in my toolbox today in terms of helping parents out, because it really can be quite frustrating, you know, for everyone, for the doctor who wants to get a particular medicine in, for the kid who really, you know, doesn't want to be uncomfortable, and for the parent that just wants their kid to get better.

And so, this really is something that I think is going to have a lot of practical use for folks. So, Addie, let's start with the basics. What do health care providers mean when they talk about medication adherence?

We're just going to, you know, define some terms here out of the gate. What is medication adherence?

[Addie Brown]
Sure. Great question. So, medication adherence is the extent to which a patient takes their medication as prescribed by their doctor.

That includes correct timing, correct dose, duration, and even refills if it needs to be refilled. Medication adherence ensures effectiveness of the medication and leads to a better quality of life for the patient. Missing doses can prevent symptom relief and lead to less optimal outcomes.

[Dr Mike Patrick]
Yeah, and Emily, why is medication adherence particularly challenging for kids and families?

[Emily Stephan]
Yeah, so I think like all of us, right, nobody wants to be taking medications all the time. But of course, kids often, and even sometimes caregivers, don't fully understand what the reason is for needing that medication. And additionally, we can't always explain well that reason to our kids.

Or even if we can do it in a child-friendly language, they are still going to be scared no matter how important you tell them it is. So those are definitely barriers specifically for kiddos. And then most of us as parents, we're pretty busy.

We have our own schedules. Our kids have their, you know, activities and things. And so typically, as an adult, taking your medication is pretty quick because you know you have to do it and you just get it over with.

But sometimes with a child, it can be a bit of a process, so we need to build in a little bit of extra time.

[Dr Mike Patrick]
Yeah, yeah. Because otherwise, we're going to get stressed, and you know, then we get angry, and then things do not go well for sure. So, I love that, building in extra time.

I mean, right there is our first nugget. You know, just, you know, give yourself time. Recognize that this is, you know, you're going to need to put your patient's hat on because you're going to need some patients more than likely, and it may not go well.

For a lot of the providers that are listening out there, we've talked about medication adherence. Another term that we talk about is compliance. Addy, what's the difference between compliance and adherence?

Or are they the same thing? And does it matter that we differentiate between those two?

[Addie Brown]
I think both of those terms sometimes are used pretty interchangeably, but they actually don't mean exactly the same. Adherence is more of a personal commitment to a practice agreed upon by two individuals, in our case today, between a doctor and the patient. And compliance is more conforming to rules or laws and more of like a general sense.

So, it's best to refer to it as medication adherence.

[Dr Mike Patrick]
Okay, so compliance kind of insinuates that maybe someone's on purpose not taking their medicine. And I guess an example of that for me is I take medicines every day, and I have to take them in the morning and the evening. And I have a little system, you know, like I have the pill case by my toothbrush, that kind of thing.

And yet, sometimes I'll go to take my evening medicine and my morning medicine still in the pill case, so I know I didn't take it even though I was supposed to. I certainly did not do that intentionally. It just sometimes happens.

And even doctors who are patients, this happens sometimes. And so, don't be too hard on yourself, but we do, you know, want to try to be more adherent for all of us so that we can reap the benefit of the medications. So then, Addie, what are some of the biggest barriers that prevent families from giving medications consistently?

[Addie Brown]
Yeah, I think there are quite a few barriers that can pop up. A couple that come to mind are drug regimen complexity. So, you know, if you have to take it twice a day, or maybe it's a wean, so we take, you know, a certain dose and then tomorrow you take a smaller dose or something like that.

Also, as Emily mentioned, not understanding the importance of taking a medication can be a barrier, as well as lack of communication, right? So, as she mentioned too, families are busy and, you know, maybe mom is giving a morning dose and dad's giving an evening dose or something along those lines. And so, lack of communication can be a barrier in medication adherence as well.

[Dr Mike Patrick]
Yeah. And then, you know, understanding exactly why you're taking that medicine, like what it's doing in your body, that is something that often has to happen at the visit with the provider who's prescribing the medicine. And I just want to, you know, make the case that this is a really important thing.

Like, you don't have to get into the weeds of the science, but we do want folks to know, like, why is this important? It's not just a black box. And I think that explanation and that teaching, especially in a busy clinical practice, it can be tough, but it's really, really important that everybody understands what this medicine is doing.

Another thing that parents worry about is side effects. Emily, how does that concern affect medication adherence?

[Emily Stephan]
Yeah. So, I think knowing about side effects, we think of it as being a good thing because as the providers, we want the patients and the parents to know, like, what to look out for, kind of sometimes the worst-case scenario, so that those things can be addressed quickly if something does happen. But also, if you get too into the weeds of the side effects, it can start causing some anxiety worrying, you know, are all of these things going to happen or is this really scary thing going to happen?

And most of the time, all the side effects that are covered with you are really rare that they're going to happen. So, having a better understanding, you know, what might happen? If it happens, is it going to last just for a short amount of time?

And then your child may kind of get over that after they've been on the medication for a little bit, or is it something that's going to stick around? And if so, is it something that we can manage with another medication or some other sort of intervention, or is it something we just need to put up with? And then also making sure that you talk with your provider about, you know, how can we treat those side effects?

Or is it something that we shouldn't even be trying to treat? Is it a larger concern? Is it causing shortness of breath, you know, my kids having blisters, maybe signs of allergic reaction?

Obviously, those things need to be addressed right away and maybe the medication held, but making sure you loop your physician or other provider in about that. And I think, too, to your point, Dr. Mike, about knowing what the medications do, I think just, you know, as a parent, I want to empower people to ask questions if they're not sure about side effects or what things people do. We are never, you know, frustrated if people ask more questions or clarifying questions about those things.

I think, you know, it's important to remember that when we're in medicine, we have explained some things over and over and over again. And so, we really appreciate the feedback from parents on making sure we're explaining in a way that works best for you and your family.

[Dr Mike Patrick]
Yeah, yeah, absolutely. There are lots of times that I see kids who, you know, I ask, are they being treated? And just to give a concrete example, let's say it's a kid who has a history of constipation and it's been recommended that they take MiraLAX to help them to go to the bathroom.

So, you know, you ask that they're having belly aches again and they haven't had a bowel movement for a couple of days and you ask, are they taking their MiraLAX? Well, no, because that caused whatever. But they also didn't tell their doctor who prescribed that medicine that they're not taking it anymore, that they were having problems with it.

You know, you just kind of assume, oh, this side effect is not manageable and I'm just going to stop it. You know, with MiraLAX in particular, it can cause diarrhea. But we're, you know, we're trying to get all that poop out.

And so sometimes you have to create a little, you know, bit of an inconvenience in order to get to our goal. And again, just explaining that that might happen and what to do can keep a kid on that medicine through those side effects just by having that teaching and education up front. Now, dosing schedules.

We mentioned that, you know, sometimes families are so busy and, you know, mom and dad might not remember who gave the medicine or who's supposed to give it. There are, you know, we can change the dosing schedule to some degree for medicines when there are multiple doses per day. Is that really a lot harder for families, Addy?

[Addie Brown]
It can be a lot harder. You know, from the minute the kids wake up in the morning, there's school, daycare, meals, bath time, etc. So multiple times a day dosing can be difficult for families.

But pharmacists, not to toot our own horns, but can be very helpful in helping providers choose an effective medication with the least amount of dosing frequency. And even speaking with parents about how to best fit their schedule. So, you know, if a medication is dosed three times daily, that might not necessarily mean we have to give it exactly every eight hours or we don't have to wake up sometimes the child in the nighttime.

You know, we might be able to shorten those different durations to still get in the medication three times a day, but not every eight hours. So, I would encourage families to either speak with their doctor or speak with their local pharmacist to kind of see how we can work with their schedule to get all the doses of medication in.

[Dr Mike Patrick]
Yeah, there really is some science here because the number of times you have to take a medicine has a lot to do with how fast your body processes that medicine or metabolizes that medicine. So, you know, we want the blood levels to be high enough that the medicine's doing its job, but not so high that it's causing, you know, undue side effects. So, you know, you could say, well, let's just do it once a day for everything, but then the blood level is going to drop as you metabolize it.

And so, then you're not having that sort of steady state of an adequate dose. And so, there is this kind of conflict between wanting there not to be very many doses during the day but also wanting the medicine in the bloodstream doing its job. And just as an example, you know, a common antibiotic amoxicillin, back in the day when it first came out, it was actually four times a day that the dosing of amoxicillin for like an ear infection, that was standard.

And then we saw, well, there were some studies that showed that three times a day with a little bit bigger doses can be helpful. And in fact, they then changed the concentration to make it so that you were, you know, it was more concentrated instead of 250 milligrams in a teaspoon, it was 400 milligrams in a teaspoon, just because we're going to give bigger doses less often. And there was science to show that it really did help.

And now we've gotten, okay, well, let's do it twice a day instead of three times a day. And there is still science that shows that that is effective. And we can see that, you know, clinically, hey, kids do get better with their ear infections if they only do it twice a day.

And now with a strep throat, we talk about just once a day dosing, but I have seen more failures, I feel. And so, this is just, you know, what we would call anecdotal. I don't have a study to show me, but I almost think once a day is not enough.

That the level of amoxicillin in the bloodstream spikes up, and then you metabolize it, and it comes back down, and then you have hours and hours without any antibiotic in your system. Anyway, these are the things that keep doctors awake at night thinking about. But there is really this sort of fine line between wanting, you know, it to work and giving it enough times during the day but also making it easier for families to only give it once.

So, Addy and Emily, both of you, have you come across that sort of dichotomy?

[Emily Stephan]
So, I can go first. I think that certainly we always try to do like less doses in a day, as Addy mentioned. But yeah, certainly there are antibiotics that I give in pulmonary clinic that need to be given three times a day, and that's a lot of doses to fit in.

You know, but I think as a parent, what you can do is just ask and then, you know, understand that sometimes things do have to be done multiple times a day. And if you are great at rearranging your schedule to make that happen, awesome. But if you're not and you need support from the team that's treating you, I think asking about what that wiggle room is, like Addy mentioned.

I think every drug that we look at, we're always trying, even in science, to get it down to once a day, right? It's really, we know it's more convenient for the patients. But I agree with you.

Yeah, sometimes we just don't still then get the results that we were seeing before.

[Dr Mike Patrick]
Yeah. And if it's something that tastes bad or it's a pill that's difficult to swallow or something, now there's even more times during the day that parents have to set that time aside to get it in. And it just, you know, becomes more and more of a struggle.

So, you can see it from both sides. And I wish there was a magic way to take their medicines a little bit easier.

[Addie Brown]
And I think in primary care, Dr. Mike, we see, you know, I think it's helpful when parents express those concerns while they're still in the office because, you know, there's sometimes an option to give maybe an intramuscular antibiotic and then they're covered and then don't have to worry about it for 10 days of, you know, amoxicillin or something like that. So, communication is key.

[Dr Mike Patrick]
Yeah, yeah, absolutely. And, you know, you can argue, well, okay, those blood levels spike up and then down and you're not really covered all day. But then if you're doing it three times and every day, you're missing a couple doses, then that's not ideal either.

So, there's lots of angles to look at this from. You know, one way to get kids to take medicines is if they can learn to swallow pills. Because once you've got that skill down, it's just so much easier.

You know, it's not a large volume of medicine. You don't have to worry about the taste. But, you know, a lot of kids do have difficulty getting their kids to swallow pills.

So, Addy, what advice and strategies do you have to help kids learn to swallow pills?

[Addie Brown]
Great question. I think first and foremost, if you're practicing at home with your child, remove any distractions from the room that you're working on this in. Put away toys, turn off the TV, things of that nature.

And then you can even start just having your child try to swallow larger sips of water, which will be helpful as you're trying to teach this pill swallowing technique. And then we encourage you to get different sizes of small pieces of candy, whether that maybe you'll start with a sprinkle and then increase to a mini M&M if they can do that. And then perhaps a Tic Tac.

Maybe your goal is a Mike and Ike or something like that. But kind of make it a fun, interactive process and start with the smallest available candy. And I think this is an opportunity for parents and kids to do this together, right?

So, you can model this pill swallowing behavior with them. And then also, lastly, I think words of encouragement are super helpful. So, giving them praise for swallowing maybe the sprinkle and then when you move on to the M&M, et cetera, trying to tell them, you know, this is what big kids do or you have to be a big girl or big boy to do this is not very helpful.

It can be hurtful if they're still struggling with the pill swallowing. So, trying to do words of encouragement and praise, though, can be very helpful.

[Dr Mike Patrick]
Yeah, I find kids love stickers. And so, I love like sticker charts, you know, and you get five stickers, we're going to, you know, get something special or go out to dinner or something, you know, kind of make it a game with goals that you're working toward can certainly be helpful. But I love that, you know, don't say, oh, you're a big girl, you need to do this now because that's really making it seem like there's something wrong with them as a person.

And we really have to acknowledge that this is difficult. Now, Addy, you know, sometimes medicine might only come as a tablet or a capsule, or the liquid formulation of medicine just tastes absolutely terrible. Are there situations where you can crush tablets or open up capsules and mix them with something?

I often have a lot of parents ask if that's something that they are allowed to do.

[Addie Brown]
For sure. That's definitely an option with certain medications. So, it's always important to check with a pharmacist or another health care professional before doing so.

So, you could even, you know, call the number on your medication bottle or before you leave the pharmacy, ask the pharmacist about that. In general, extended-release medications usually should not be crushed or tampered with because it might mess with the medication's mechanism of releasing over time throughout the day. Alternatively, though, if a medication has a score line down the middle or something like that, usually that's an indicator that you can split it in half or crush it.

But again, it's always important to check before doing so.

[Dr Mike Patrick]
And even if it is something that you can crush or open up and sprinkle, you still want to make sure that whatever you put it in, that they're getting all of that. And so, then it becomes kind of, you know, difficulty with if it's too little of a thing, then they're still going to taste it, perhaps. And if it's too much, they might not eat all of it.

And so, there's still frustrations that come even when you're trying to crush and mix things, right?

[Addie Brown]
Oh, for sure. And we, us pharmacists, have some tips and tricks, you know, like the best, you know, some medicines taste the best in chocolate syrup or things like that. So, we could help with some tips, too, if that's needed.

[Dr Mike Patrick]
Yeah, yeah. Yeah, because chocolate, especially chocolate syrup, because it's kind of viscous and kind of coats the inside of the mouth a little bit. And then, you know, then you're tasting the chocolate instead of the medicine.

Hopefully, you know, unless there just happens to be a big bunch of the crushed stuff right on your tongue, and then now it's stuck on your tongue and you're tasting it even longer. So, there may be some, you know, trial and error and experimentation with all of that, for sure. The liquid medicines, of course, are common.

And we try to make them, I don't know, do the drug companies try to make them palatable? I'm not sure that they do. But are there strategies that help kids take medicines that don't taste very good?

[Emily Stephan]
Yeah, it's funny that you say that Dr. Mike. I actually have one company who made a drug and there was one version that tasted good with a sweetener, and then they made another version without a sweetener. And then the next time they chose to make it with the sweetener again, because the little kids did not like the unsweetened version, understandably.

[Dr Mike Patrick]
Yeah, yeah. I mean, I remember there was one, I think it was, it was either, and I'm using brand names here because these are the names that parents know, just so everyone knows, I don't get any kickback from any of these things. But like Augmentin and there was another one called Vantan back in the day that was just really bad tasting.

And both of those were labeled as they were banana flavored. I'm like, whose idea of a banana is this? Because this does not taste like a banana.

[Emily Stephan]
Yeah, for sure. Even for my own kids, I had to give amoxicillin one time. And generally, I think in medicine, we think of that as like a fairly good tasting antibiotic compared to some of the other ones that we have to prescribe.

And my kiddo was not into that at all. So, in that situation, the things that were really helpful for me were finding something that it could be mixed with, as Addy mentioned, for the tablets, but doing that with liquids as well. Again, you need to check with your pharmacist or healthcare provider what it can be mixed with but also letting him then have choices.

So, thinking about if there are multiple things that he could mix it in for him, he really wanted to mix it in blue Gatorade, which in my mind probably wouldn't taste good, but he loved it. And because he picked it, that was what he liked. And then giving other choices as well.

So where can you sit to take this medication? For me, I was okay with him sitting on the couch because I have an old couch that's maybe not in the best shape, but if you have a really nice white couch, you might not want your kid taking pink amoxicillin on the couch. And then also letting them make other decisions.

So, do they want to sip it out of a cup? Do they want to drink it through a straw? As you mentioned, Dr. Mike, when we mix medications with other things, it's important to make sure we're just only mixing it in a volume that the child can finish. So obviously they need to take the whole amount of the medicine, but then whenever we add in, if we do a large amount, can double it. So, we typically say, please don't mix your child's medication with their whole cup of juice or their whole bottle of milk, because if they don't finish that, then they're not getting the whole dose of medication.

[Dr Mike Patrick]
When my kids were young and taking liquid medicine, we'd always have a chaser ready. So as soon as they swallow that medicine, then they get a spoonful of the chocolate syrup. One of those peppermint mints, not the hard ones, like the soft ones, that seemed to work really well because it was a really strong masking taste.

And so those pink ones that you get, you know, like in bulk candy, that was like our little trick that worked for our kids. Your mileage may differ, but that's the key, is like finding out what works, you know? And for you, there's the blue Gatorade, and you never would have necessarily thought to do that.

But if that's what works for your kiddo, man, take advantage of that, right? For sure. Now, what about adding flavoring at the pharmacy?

So sometimes you hear about this, like, can they make it a different flavor? Is that something that is still done? Does that alter the medicine at all?

What's the practicality of a parent saying, can you make this taste better at the level of the pharmacy?

[Emily Stephan]
Yeah, so here at Nationwide Children's, we've never added flavors, just as really a safety practice, because while we don't want the medications to taste terrible, we also don't want kiddos to think of them as candy or anything like that. I haven't recommended flavoring at the pharmacy in a long time. I know from what I've heard that most pharmacies were getting away from it because they think it's now kind of considered along the lines of compounding.

Addy, I don't know if you encounter that more in primary care, if any pharmacies are still doing that.

[Addie Brown]
I think a few retail pharmacies still use the FlavorRx flavoring option, but I think it's few and far between.

[Dr Mike Patrick]
Yeah. And that's good for us to know, because I do get that question a lot. You know, like, can they add something to this to make it taste better?

And I usually just say, I don't, you'd have to ask your pharmacist. I'm really not sure. So, and it does make sense of, you don't want it to taste too good, especially for those younger kids who, even though you do your best to make childproof caps and to keep them out of reach and out of sight and all of those things, you know, accidents still happen.

And you certainly, you know, don't want a situation where you have an overdose that can be, you know, can be life-threatening in some cases, depending on, you know, the particular medicine that we're talking about. You know, another strategy that I've heard is a popsicle before. And this is not something that I had tried before, but it does make sense that the cold might numb your taste buds a little bit.

Have you seen that work in practice?

[Emily Stephan]
Yeah, we do recommend that. I think definitely giving them, you know, it with a minute or two ahead of time so that they can get to that point where the ice is numbing their tongue. Obviously, your kiddo needs to be old enough that it's not going to create a choking hazard or anything like that.

But then they get to have a little treat. Other thing that I have found sometimes helps mask the taste if your kiddos don't like popsicles or you don't have them on hand is plugging the kiddo's nose before the dose. So sometimes the smell of the medication, just like how, you know, food smells good to us, the smell of the medication can make us not want to take it.

So, I think plugging the nose sometimes helps as well. But again, in that situation, giving your kid a choice when you can, you know, do you want to plug your nose? Do you want me to plug your nose?

Whatever choices and control they can have but just reminding them that it's not a choice. They do have to take the medication. It's something that needs to be done.

[Dr Mike Patrick]
Yeah, the choice is whether your nose is plugged or not. But taking the medicine is not the choice. What about those littler kids who you can't really, yeah, I mean, I'm talking even like a 10-month-old baby, you know, sometimes parents will say, I can't get them to take medicine, that they just spit it right back out.

You know, they fight it, then they make themselves vomit because they're so upset that they have this in their mouth. What advice do you have for parents of those little kids that you cannot reason with because they're just, you know, from a cognitive standpoint, they're not ready for reason?

[Emily Stephan]
Yeah, I think one thing, you know, is if you are struggling, again, going back to your provider and seeing if there's another option. Like one of my favorite products is the vitamin D for infants that comes as just one drop that you give that you could put on the breast or on the nipple of the bottle, rather than trying to get them to take like a whole milliliter of vitamin D, for example. I think that's an easy solution.

But if it is a bigger volume that you have to get, you know, giving just a little bit at a time, not, you know, right at the back of their throat so that they choke on it, but more towards the side of their cheek. And then similarly, you know, adding in a chaser if it seems like they're spitting that up again. So, you know, can sip of their bottle or breast milk be the chaser for them.

[Dr Mike Patrick]
Yeah, yeah. Something that's they're used to having in their mouth and that the taste is comforting and hopefully helps them forget what just happened. In terms of the older kids, then we did talk about some behavioral strategies.

What, you know, if those, if the good things aren't working, so, you know, you've tried the sticker charts, you've tried reasoning that this is important, you've done the chasers, all those things. What is, what are next steps really in helping kids that are really resistant to taking their medicine? Emily?

[Emily Stephan]
So, I think for older kids, kind of going back to what we said at the beginning, like making sure they understand why we're doing what we're doing. Like, you know, our goal of treating your asthma is not just so we can put you and your kid on some chart that we treated their asthma well. It's so we can, you know, your kid can run and play soccer, keep up with their friends, and they don't have to stop.

So, keeping in mind kind of like the big picture and making sure for older kids that they're aware of that, and then thinking of other like rewards that are good for them. You know, like maybe you can have a couple more minutes of screen time when you take your dose of medication, or we can play a game together. You know, if it's an older kid, you know, maybe when you take your medications well for a week or two, we can, you know, go get a coffee together or something.

So just thinking about what the things are that would motivate your particular child.

[Dr Mike Patrick]
Yeah, and that's really going to be different from one kid to another and from one family to another and what is practical for your family, what motivates your kids. So, it really does take some creativity. My wife and I used to say our lives were lies, threats, and bribes when our kids were little ones.

So besides, you know, getting the kid to actually take the medicine, I did want to spend just a little time on techniques and strategies for helping parents remember to give their kids their medicine. And we talked about busy schedules and, you know, mom versus dad who's given the medicine. What are some strategies for helping us remember to stay organized and to get the medicine in our kids?

[Emily Stephan]
Yeah, so I like to think of it in kind of steps. So, the first step that we really need to take to make sure our kids can take the medication is making sure we have the medications with us. So that sounds easy, but, you know, really understanding how your personal pharmacy works.

Are they going to text or call you when the refill is due or is that something that you need to do? Even if really your pharmacy is managing it for you, you should remember that it's your responsibility as the parent. So, you know, putting it in your phone as a reminder, writing it on your calendar, and then trying to get those refills at least a week in advance of when you're going to run out of medications.

I think on the back end, there's a lot of things that people don't think about at the pharmacy in terms of like there might be an issue billing your insurance, you know, maybe they've changed the product that they prefer. And getting those things switched over by contacting the physician or other prescriber can really take a lot of time. And so that's why we want, you know, you to order those a week in advance so that if those do bubble up, then you can have some time to get that resolved.

And certainly, don't hesitate to call your office either. If you've been working on that for a couple of days and it doesn't seem like it's getting resolved, we're definitely happy to help. And then additionally, Dr. Mike, you mentioned using a pill box. I use one too. And so, I always fill mine on Sunday. I try to say the same day or same day every week so that I'm on a schedule with that.

But if you fill that, you know, at the beginning of the week, then you'll easily realize like, oh, I'm running out of pills for this medication. So, for pills, that's a helpful way to do it.

[Dr Mike Patrick]
Yeah, you would know ahead of time that I'm going to run out. This is this is my last load on the box.

[Emily Stephan]
Yeah, for sure. And then once you have the medications on hand, doing other things to help you remember them. So, storing the medications in a place that you're going to see them, which is obviously more challenging with kids or pets, because you need to make sure that you're still keeping the medications safe from them getting into when they shouldn't.

And then pairing a medication with things you do. So, Dr. Mike, you mentioned next to your toothbrush. That's a good twice daily activity.

You know, if it's something that needs to be taken with a meal, maybe you put it, you know, somewhere in the kitchen where you're going to see it where you're prepping breakfast and dinner and things like that. Other ways to keep the medication with you is like having a pill case or a pill fob that goes on your keychain. That way, even if you use those other tools, I think those are good backups, kind of if it's something that you need to have out when you're out to eat, like, oh, maybe I forgot to pack my whole bottle of medication, but I have this extra dose in my keychain.

So now I'm not going to miss that dose. And then we talked about maybe using an alarm to remind you, a calendar, a medication checklist, any of those can be helpful. And if you have a pharmacist at your doctor's office, a lot of times they're able to help you set up a medication checklist or even an app that they can help you with setup.

So, they can help you figure out the best schedule when to give each medication that works best for your family and take some of the burden off of, you know, setting that stuff up for yourself if you're not quite sure how to get started. A few apps that I like, I wanted to mention here. So, My Med Schedule Plus is a good one.

And the thing I really like about this app is that it's available in so many languages. So, I think oftentimes we only see resources in our community available in English, Spanish, maybe Somali, but this one also comes in French, Portuguese, Haitian Creole, Simplified Chinese, Traditional Chinese, Korean, Arabic, Tagalog, Vietnamese, Somali, Russian, Swahili, and Hmong. And so, I think that's really nice for our community since we do have such a diverse population to have something where maybe, you know, I as the pharmacist could put it in in my native language, but then it's an option for the patient to then view it in their native language.

And I think that can remove barriers for a lot of people.

[Dr Mike Patrick]
Yeah. And we'll put a link to My Med Scheduling Plus in the show notes so folks can find it over at pdacast.org. And there are other mobile apps out there as well, right?

[Emily Stephan]
Yeah. So Medisafe app is another one that I recommend. That and My Med Schedule Plus have a lot of the same features in terms of like tracking your medication, setting reminders, documenting things when things are given, and tracking multiple family members.

So that's really great. And then one other app that I recommend, it's a little less geared towards medications, but I found it helpful for me when I had new babies, it's called the Baby Feed Timer. And here you can track like feeds and diapers for your infants.

And you can also document like when you gave vitamin D, for example. So, it's not going to necessarily send you an alert for when a medication is due, but you can at least record it and kind of see like, oh, did dad already give that today? Or do I still need that?

[Dr Mike Patrick]
Yeah. Yeah. Especially if the app syncs between both parents' phones.

Oh, that's a great idea. We'll put links to all of those apps that you mentioned in the show notes over at pediacast.org so folks can find them easier. So, one last question that I wanted to ask Emily is vacation.

So, a vacation, taking your medicine with you, making sure you have enough of it. These are sort of unique challenges. Does it need to be refrigerated or not?

A lot of things to think about. What advice do you have for parents to prep for their kid taking a medication while they're away from home?

[Emily Stephan]
Yeah, I think so planning ahead, you know, if you already use a pill box, you just have pills, it's an easy thing to kind of, you know, grab and take with you. But as you mentioned, it might not always be that easy. So, if you have something that needs to be refrigerated, you know, thinking about do you have a little cooler?

Do you have ice packs that you can take with you? Or if you have a lot of refrigerated medications, you know, how big of a cooler do you need to have? And how are you going to fit that in your luggage?

Those kinds of things. And I think also thinking about how long are you planning to be gone? And so, you know, if you're going to be gone for a whole month, for example, or a couple weeks, and your whole supply of medication would be used up in that time, maybe you could fill it where you're going.

But consider, you know, if you have Medicaid or a different kind of insurance, and you're going out of state, that insurance may not work where you're going. So that can be a barrier. And then also, I think just in terms, like the refrigeration and things, a lot of the medications that we typically refrigerate can be left at a room temperature for a certain amount of time.

And so that's not true for all of them. But if you're going on a short trip, like a week, maybe the medication will be fine while you travel. And then you might want to put it back in the fridge when you get there.

Because oftentimes, if it's one of those medications that can go back and forth, the reason we put it in the fridge is because it tastes better. And then lastly, in terms of how long your trip is going to be, think about like, what will you do if your trip ends up being longer than you anticipated? So, do you need to pack extra medications?

Some of the medications that my patients are on cost over $30,000 a month. And so, they're not going to be able to just like, go down to the corner pharmacy and get another supply. They need to prepare for those kinds of delays.

[Dr Mike Patrick]
I did also want to mention controlled substances are going to take a little extra planning, especially if you're going on vacation. You had mentioned, you know, getting your medicine refilled a week early. Depending on your insurance, they may have an issue with that.

But if you are going on vacation, we've, when my kids were on a controlled substance for ADHD, and we were going to go on vacation, there were times that the pharmacist could call someone at insurance company and get like an approval to get a little bit more because we were going to be going out of town. So, there are flexibility options, but you really do have to talk to your pharmacist about that. And then one last thing I really want to point out is the proper person to ask these questions of is the pharmacist.

Because like when parents ask me, like, does this really have to be refrigerated? I don't know. And it's going to be more difficult for me to find out.

But your pharmacist is going to have that information, you know, readily available. And they are definitely the go to person for all questions, medicine related in terms of the, you know, the mechanics of taking it and having it available and all of those things. All right.

Well, once again, we are just so glad that you guys were able to come and talk. Hopefully parents are going to have some new strategies and tools. I feel like I do already, like the popsicle thing, for example, you know, in terms of advising patients and families that I see in practice.

We are going to have lots of links for you in the show notes. Here at the hospital, our teaching handouts are called Helping Hands, and we have ones on tips and tricks for swallowing pills and liquid medications. It kind of sums up some of the things that we have talked about.

How to give by medicine by mouth and coping with medicines. We'll have links to all of those resources in the show notes and then those mobile apps that we talked about as well. So once again, Addie Brown and Emily Stephan, both clinical pharmacists at Nationwide Children's Hospital.

Thank you so much for stopping by and chatting with us today.

[Addie Brown]
Thanks for having us. 

[Emily Stephan]
Yeah, thanks so much for having us. I hope everybody feels more comfortable talking about medicine with their doctors and pharmacists. We are here to help.

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[Dr Mike Patrick]
We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. We really do appreciate your support. Also, thanks again to our guests this week, Addie Brown and Emily Stephan, both clinical pharmacists at Nationwide Children's Hospital.

Don't forget you can find our podcast wherever podcasts are found. We're in the Apple Podcast app, Spotify, iHeartRadio, Amazon Music, Audible, YouTube and most other podcast apps for iOS and Android. Our landing site is pediacast.org.

You'll find our entire archive of past programs there along with show notes for each of the episodes, our terms of use agreement and the handy contact page if you would like to suggest a future topic for the program. Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show and we love connecting with you on social media.

You'll find us on Facebook, Instagram, Threads, LinkedIn, X and Blue Sky. Simply search for PediaCast. If you are a pediatric provider, we also have a podcast for you.

It's called PediaCast CME. It is similar to this program. We turn the science up a couple notches, and we do offer free continuing medical education credit for those who listen.

And that's not only for physicians. We also have credit for nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers and dentists. And it's because Nationwide Children's is jointly accredited by all of those professional organizations that we can offer the credits you need to fulfill your state's continuing medical education requirements.

Shows and details are available at the landing site for that program. It's PediacastCME.org. You can also listen wherever podcasts are found.

Simply search for PediaCast CME. And then a third podcast that I host is a faculty development podcast from the Center for Faculty Advancement, Mentoring and Engagement at The Ohio State University College of Medicine. If you are a teacher in academic medicine or a faculty member in any of the health sciences, then this is a podcast for you.

It's called FAMEcast and you can find it at Famecast.org. Also, wherever podcasts are found by searching for, you got it, FAMEcast. Thanks again for stopping by.

And until next time, this is Dr. Mike saying, stay safe, stay healthy and stay involved with your kids. So long, everybody.

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