at Silvia Turin
Swallowing pills is a life skill that can be learned early, as early as age 4, safely. A safer, cheaper way of treating yourself, with less packaging and wasted doses and more sustainable for the planet than the use of liquid medicines
Learning to swallow medicine in pill form is good for patients, parents and, surprisingly, the environment. A scientific article recently published in the British Medical Journal An English team carries out an analysis of the benefits and costs of medicines in pill format, compared with the same medicines in liquid format.
Almost all parents make dosage errors
The benefits for patients and families derive from better performance, greater ease in adhering to therapies, in dosing the medicine and in avoiding some travel. In a single-center US retrospective study of 150 pediatric discharge prescriptions, it was estimated that switching to pills could save $200,000 per year.
In fact, pill packs can be divided to deliver a specific number of doses, while liquid formulations must be dispensed in whole bottles, which often means wasting excess doses (for example in the case of short-term prescriptions, such as antibiotics). For long-term prescriptions, pills can be dispensed in larger quantities than liquids, reducing the number of patient trips.
At home, parents themselves make mistakes in dosing liquids, mistakes that are more common than you might think: an American study of 2,110 parents found that more than 80% made at least one dosing error with liquid formulas and 21 % of parents made at least one dosing error greater than double the intended dose.
Finally, adherence: some liquid medicines can be unpleasant and contain sugar, colorings and preservatives to improve the taste, but additives increase the risk of dental decay. A bitter taste in medicine was the second most frequently cited reason for nonadherence to short-term antibiotic therapy in a study of 414 patients in Saudi Arabia.
The benefit for the environment
Surprisingly, the environment would also be grateful for the use of medicinal pills over bottles: the exact impact on the carbon footprint has yet to be calculated, but there is some evidence.
A life cycle assessment of medicines conducted in India found the carbon footprint of producing paracetamol pills 15 times lower than that of an equivalent dose of liquid.
Pills typically come in smaller, lighter packages than liquids, taking up less space in trucks and creating less packaging waste. Liquids also require syringes or measuring spoons, contributing to more plastic waste.
Finally, the pills have a longer shelf life and can be stored outside the refrigerator, so they have a lower energy requirement during their use and are less likely to be wasted.
It is taught from age 4: here’s how
The fact that is not reflected upon enough, we read in the English study, is that swallowing pills is a life skill that can be learned early. Children with normal swallowing can be successfully taught to swallow starting at age 4. By the age of 10, children should be prescribed pills as standard, the authors write and point out that in some countries strategies have been developed to facilitate this learning.
One of these in the UK KidzMed, a six-step technique illustrated with videos, cartoons and a quiz, to teach professionals, parents, children and young people how to swallow pills. In summary he recommends:
1. Find a comfortable place without distractions.
2. Let the child choose their own drink.
3. Start with the smallest pill or treat.
4. Place the sweet pill or trial medicine in the center of the tongue.
5. Offer three sips of liquid to drink.
6. Try another pill or sweet following the same steps (always the next one, not the biggest one).
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January 13, 2024 (modified January 13, 2024 | 08:11)
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