Inhalers, injections, pills and more pills: For kids with conditions such as asthma or allergies, diabetes or seizure disorders, taking daily prescription drugs is part of the deal. But as medication lists grow longer when current drugs aren’t helping enough, parents are rightfully concerned about possible side effects and added disruptions to school, play and fun with friends — and kids are understandably resistant.
Youthful forgetfulness, potential for drug overlap and parental confusion over which medications to take — and when — can interfere with safe, effective treatment. Find out when you can trim multiple medications, how to manage them safely and smoothly and ways to get kids on board.
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There’s no precise upper limit of medications that kids should take to stay healthy, says Dr. Karen Breach , a pediatrician in Charlotte, North Carolina. “For me, it’s not how many medications they’re on for control — it’s how well their conditions are being controlled,” says Breach, a pediatric regional medical director with Carolinas HealthCare System.
In her practice, Breach says, asthma medications cause the most confusion for parents. “Which ones should be taken all the time? Which ones should be taken as needed?” Not understanding the difference between quick-fix inhalers to relieve asthma symptoms and steroid inhalers to be used regularly for asthma control can mean wheezing episodes that could have been prevented are not.
Parents need written materials they can easily access, Breach says. Medication lists and guidelines generated from children’s electronic medical records and pharmacy printouts are important references for parents. Two-way conversations with health professionals are essential as well. “It’s all about understanding,” she says. “People need to be given the information. They shouldn’t be afraid to ask questions.”
One important question is whether a new prescription is an add-on or replacement. For example, Breach says, “With asthma, you either do the albuterol inhaler or the albuterol nebulizer treatment, but not both. It’s an either-or.” Keeping it all straight is a challenge. “Many doctors will give a list in writing,” she says. “This is what you continue to take. This is what you should stop. This medication is equivalent to that medication, so don’t take them both at the same time.”
If your child’s drug list keeps getting longer, it’s a sign that a change in strategy might be needed. “If a child is taking a lot of asthma or allergy meds and they continue to have symptoms, they need to see a specialist and consider allergy shots,” Breach says. “Or a different treatment regimen.”
Specialists are almost always involved when kids have certain conditions, like juvenile rheumatoid arthritis, an autoimmune disease. Multiple medications are also a given. Chris Nieto, a volunteer with the Arthritis Foundation, has a daughter with juvenile arthritis. “Currently, Mia takes two meds in the morning and one at night daily,” he says. “Every other week, we take her to the doctor for an infusion, which generally last two to three hours.”
Schools must be kept in the loop, whether kids need EpiPens for severe food allergies, glucose gels to treat episodes of super-low blood sugar with diabetes or rescue inhalers for asthma. “Teachers and school nurses need to be aware of the child’s medical condition,” Breach says. In North Carolina, children with asthma need to have an asthma action plan in place. These plans are highly recommended because they spell out children’s symptoms and alert staff to signs that kids need their inhalers.
When specialists such as pediatric rheumatologists and endocrinologists enter the picture, communication among health providers is more important than ever to avoid drug interactions and medication overlap. “That’s where pharmacists are invaluable,” Breach says. “Because most people fill their prescriptions at the same pharmacy.”
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Most parents don’t bring their kids along when they go to the pharmacy — but they should, says researcher Delesha Carpenter, who led a study observing encounters as parents or caregivers picked up children’s prescriptions. Direct encounters, with the pharmacist speaking to and counseling the kid one on one, were the exception. Most of the time, the study found, kids weren’t even there.
That’s a missed opportunity, says Carpenter, an assistant professor in the pharmaceutical outcomes and policy division of the University of North Carolina Eshelman School of Pharmacy in Chapel Hill. “The pharmacist is the health professional who is most well-positioned to educate people when their kid is on multiple medications,” she says, including prescription and over-the-counter drugs.
Kids can understand how to take their medications, Carpenter says, and are able to communicate with health care providers at as young as 7 years old. And as kids get older, for better or worse, they’re more likely to trust information from physicians or pharmacists than from parents.
Pharmacists can engage kids in a number of ways. With iPads to educate kids directly while they’re at the pharmacy, allowing them to learn about their medications using interactive tools, today’s technology-driven kids could use apps to help them take medications properly and track them. That, Carpenter says, can serve as a focal point for discussions with a pharmacist.
For parents, a pharmacy visit also provides a great opportunity to ask pharmacists for a medication review to evaluate a child’s prescription and OTC drugs as a whole, to make sure there are no overlaps and drugs can be taken together safely.
Entrusting Kids
Encouraging kids to take increasing responsibility for their medications helps them do better in the long run, Breach says. “I’m a proponent of children understanding the medication they’re on and why they’re taking it,” she says. “Because you have much better buy-in.” The earlier that buy-in occurs, she says, the less likely parents will have to contend with rebellious episodes and kids refusing to take their medications.
With a 10-year-old, for instance, parents would continue to supervise medications, while letting the child feel more in charge. “I put it to my patients as: ‘Help Mom to remember to give you your medication,'” Breach says.
Forgetfulness is a major barrier to kids taking multiple medications as prescribed and adhering to treatment regimens, Carpenter says. Scheduling apps are a great way to keep older kids on top of their routines, she notes, and take the onus off parents.
“Teens will become sensitive if parents are asking: ‘Did you take your medications?'” Carpenter says. “Because they consider it nagging.” Some apps have syncing ability so parents can make sure kids are taking medications on schedule. “Then, unnecessary reminders don’t have to happen,” she points out.
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Last year, Australian researchers evaluated smartphone apps to boost medication adherence. In their systematic review to identify high-quality apps, the Medisafe app was the standout among those available to U.S. consumers. It was found to be engaging, interactive and customizable, with evidence supporting its effectiveness.
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My Kid Is on Way Too Many Medications originally appeared on usnews.com
