Interventions to Improve Pediatric Ability to Swallow Solid Oral Medications: A Systematic Review

Background: Solid oral medications (tablets or capsules) remain the preferred formulation compared to intravenous or liquid medications based on better safety profile, lower cost, better drug stability, and more convenient storage. However, inability to swallow solid oral medications is a common barrier to medication adherence for many pediatric and adult patients. Factors that contribute to a patient’s inability to swallow solid medications include unpleasant taste, rough texture, large size, oral motor dysfunction, fear and anxiety. Prior research has demonstrated that various interventions can minimize or eliminate solid oral medication swallowing difficulties. The objective of this review was to evaluate the published literature on interventions for improving ability to swallow solid oral medications in the pediatric population since 2013.

Methods: We performed a comprehensive search of the PubMed, OVID, and CINAHL databases to identify articles for our review using the search terms “pediatric,” “child(ren),” “swallow,” “deglutition,” “pills,” “capsules,” and “tablets.” Articles included were published in English from January 2014 through March 2021 and included participants aged 0 to 21 years with difficulty swallowing solid oral medications without a co-morbid condition affecting swallowing ability. Relevant information from each article was reviewed, and the quality of each study was rated as “poor”, “fair,” or “good” based on patient sampling, consistent delivery of the intervention, and the strength of outcome measures.

Results: Out of 119 articles identified, 22 were screened by abstract for relevance to the review question and ultimately 7 were included in the final review: 1 randomized control study, 2 nonrandomized cross-over studies, 2 cohort studies, 1 case series, and 1 quality improvement initiative. Interventions included a flavored throat spray, an in situ tablet/capsule coating, behavioral therapies, and a novel type of solid oral medication (minitablets). Quality ratings differed between the studies, with 1 article rated as “good,” 5 rated as “fair,” and 1 rated as “poor.” Studies ranged in size from a case series of 4 patients to a large trial of 372 children and included children as young as 6 months and as old as 18 years. All 7 papers showed the study intervention(s) to be successful in improving a child’s ability to swallow solid oral medications.

Conclusion: Difficulty with swallowing solid oral medications is a barrier that can be overcome with several different types of interventions across a broad range of ages, including very young children. Additional research is needed to define current practices, to determine the lasting benefit of various interventions, and to evaluate the efficacy of various interventions in comparison to each other.