What presentation of medicine is best for paediatric patients?

With so many different variations of medicine available in a range of formulations, it can be difficult to know which is the right choice for your patient. In this blog, we will be exploring medicines management for paediatric patients.

Why aren’t medicines commonly licensed for children?

It can be difficult for pharmaceutical companies to licence new products for paediatric patients as there is a requirement to do clinical trails involving children to assure safety, efficacy and quality of medicines for this group. This can sometimes prove difficult due to ethical, practical and commercial considerations, especially when the illness is rare in children. ^{[1] [2] [3]}

Research has found that children make up 25% of the global population. ^[4] Therefore, it has been recognised that more needs to be done to ensure new medicines are also licensed for children. Over time it is anticipated that availability will improve due to this. ^[5]

What are the impacts of this?

As most licensed oral medicines are intended for adults, they are presented in tablet or capsule form. Solid dose forms don’t provide the flexibility of dosing necessary for treating children due to the variability in dosing required through childhood. In addition, many children are unable to swallow tablets or capsules. ^[2]

Children’s bodies are different in size, but also physically and psychologically when compared to an adult, so they process medication differently. ^[6]

What are the most suitable medicine formats for paediatric patients

When selecting a medicine for a child, it is important to consider the child’s age, swallowing ability, ease of administration and accessibility of the product. It’s also useful to speak to the child’s parent or carer about the child’s preferences in terms of flavour and formulation. ^[7]

There is no established age at which children are able to swallow tablets and capsules, as it is a skill which must be learned. Provided that the liquid medicine is approved for use in children and prescribed by a doctor, an oral liquid medicine is the preferred formulation for younger children as it is are easier to swallow and allows for more flexible dosing. ^[7]

Should you crush tablets for children?

We would strongly recommend against doing this. The NHS website states that you shouldn’t crush pills, open capsules or change medicine without getting medical advice. This could stop the medication working properly.^[8]

Most tablets are not formulated to be palatable, therefore an unpleasant taste resulting from the crushed tablet may impact a child’s willingness to take the medicine. ^[7]

There are some types of medicines which should never be manipulated, these include modified release formulations. ^[7]

For more information on the problems with crushing tablets, visit our page:
Tablet Crushing Issues

How do you give a child medicine that refuses?

There are a few reasons that children may refuse medicine, including not understanding why they need to take it, not liking the taste, or having difficulty swallowing. Here are some techniques that we would recommend implementing in these scenarios ^[9]:

• Role play
  It can help to make giving medicine as fun as possible. You could pretend to give medicine to a doll or teddy bear, which may then encourage the child.
• Avoid taste buds
  Most taste buds are at the back of the tongue. Administering medicine by putting the medicine inside the cheek can help to avoid them. For older children, a drink of icy cold water before taking the medicine can remove the taste.
• Liquid medicine
  Oral liquid medicine may be an alternative to tablets for paediatric patients, as it can be much easier to swallow. For more information on oral liquid medicine and children, visit our blog: The Benefits of Liquid Medicines for Paediatric Patients

ROS000059-010 DOP Sept 2025.

Cancer and Dysphagia

Does your patient have cancer and dysphagia?

Dysphagia is the medical term for swallowing difficulties and can be linked to cancer.^[1] In this blog, we’ll be sharing all the information you need to know about cancer and swallowing difficulties.

Why does cancer cause dysphagia?

Some cancers and their treatments can cause the patient to experience a sore mouth and throat. This can make it difficult to swallow.^[2] Here are some of the ways that cancer can cause dysphagia:

Tumours

Tumours can block or narrow the food passage (especially in head and neck cancers). These tumours can also make it hard for muscles, like those in the tongue and throat, to move food around the mouth.^[3]

Radiation therapy

Radiation therapy is another factor that can lead to dysphagia. Radiotherapy to the chest area can cause the oesophagus to swell, making it hard to swallow.^{[3] [4]}

Surgery

Surgery can cause dysphagia if any structures are removed that would usually help you to pass food and liquids. This includes structures in the head, neck, and oesophagus.^[3] Stents put into the food pipe can also lead to swallowing difficulties.^[2]

Chemotherapy

Chemotherapy can cause a sore mouth or throat, which may make it painful to swallow. This is also the case with targeted cancer drugs and immunotherapy. ^[2]

What kind of cancer causes dysphagia?

Although cancer treatments can lead to swallowing difficulties, there are a variety of cancers that often cause a direct problem with swallowing. The types of cancers most likely to cause dysphagia are cancer of the: ^[2]

• Voice box (larynx)
• Thyroid gland
• Mouth and tongue (oral cancer)
• Throat (pharynx)
• Nasal cavity and sinuses
• Melanoma or other skin cancer on the face
• Salivary glands
• Oesophagus

For more information, visit this page: What Causes Dysphagia?

What are the signs of dysphagia?

When it comes to cancer and dysphagia, there are a few signs to look out for. These include: ^[1]

• Coughing or choking when eating or drinking
• Bringing food back up, sometimes through the nose
• A sensation that food is stuck in your throat or chest
• Persistent drooling of saliva

Can cancer and dysphagia be treated?

Most cases of dysphagia can be aided with treatment.^[1] This includes:

• Speech and language therapy to learn techniques
• Changing the consistency of food
• Alternative forms of feeding, for example through the stomach

Dysphagia can also make it hard to swallow tablets or capsules. As many cancer patients must take medication, this can be an issue. Rosemont provides a wide range of oral liquid medicines to help with dysphagia.

ROS000048-012 DOP June 2026

The Link Between Alzheimer’s Disease and Dysphagia

Dysphagia and Alzheimer’s disease are often linked.^[1]

Rosemont is dedicated to providing healthcare professionals with accurate information to aid in the management of patients with these conditions.

What is dysphagia?

Dysphagia refers to a difficulty with swallowing. People with dysphagia can find it hard to swallow certain foods and liquids or cannot swallow at all. Indications that a patient may be experiencing dysphagia include coughing or choking whilst eating, regurgitating food and weight loss. ^[2]. For our full list of symptoms, visit our webpage: Swallowing Difficulties Symptoms

Does Alzheimer’s disease cause dysphagia?

Alzheimer’s disease is the most common cause of dementia in older people, affecting memory and cognitive abilities. The high prevalence of dysphagia among patients with dementia is a result of the neurological changes caused by the disease. The prevalence of dysphagia in moderate to severe Alzheimer’s patients is estimated to be between 84-93%. ^[1]

What happens when Alzheimer’s disease patients can’t swallow?

As Alzheimer’s disease progresses to the later stages, dysphagia may manifest. Without appropriate interventions, this can lead to unintended weight loss, dehydration, and malnutrition. ^[3] Read on to learn more about how to provide support to individuals experiencing Alzheimer’s disease and dysphagia.

How do you help someone with Alzheimer’s disease?

People with Alzheimer’s may need some assistance with eating and drinking. You can help them by following these steps:

1. Simplify meals. Always cut food into small pieces and encourage patients to sip from a cup, rather than drinking through a straw or taking large gulps. Serve soft foods or blend dishes.^[4]
2. Be patient. Never hurry the patient. Encourage them to take their time and make sure they swallow each mouthful before taking another bite. ^[4] Additionally, maintain mealtime as a distraction-free environment, for example, avoiding television or music. ^[5]
3. Choose the right time. Ensure that your patient is always sitting upright, including up to 20 minutes after eating. ^[4] You should serve food when they are most rested, which may mean they need to rest 30 minutes before eating. ^[5]
4. Keep good oral hygiene. Encourage your patients (or their carers) to clean their teeth twice a day and recommend that they visit the dentist regularly. ^[4] Painful teeth or dentures can make it difficult to chew, affecting swallowing. ^[5]

Rosemont offers a range of oral liquid medications that might present a more manageable alternative to solid-dose medications for patients experiencing dysphagia and dementia.

ROS000036-010 DOP Sept 2025

The Benefits of Liquid Medicines for Paediatric Patients

Are you caring for a patient who is an infant, child, adolescent or young adult? In this blog, we will be discussing the benefits of liquid medicines for paediatric patients with dysphagia.

How do you give a child liquid medicines?

Before administering a medicine it is important to fully read the patient information leaflet which accompanies the medicine. If you have any questions following this, refer these to your healthcare professional. Please use the measuring device provided with the medicine or by your Pharmacist as this is the most appropriate option for the medicine the patient has been prescribed.

Oral syringe ^[1]

For small children, an oral syringe is often the best option. When using an oral syringe, follow these steps:

1. Wash your hands and ensure the child is sitting upright
2. Shake the bottle unless otherwise stated
3. Remove the top from the bottle and insert the bottle adapter if necessary.
4. Insert the top of the oral syringe into the bottle adapter.
5. Turn the bottle upside down and pull the plunger until the medicine reaches the volume required.
6. Gently remove the oral syringe from the bottle adapter.
7. Put the top back on the bottle.
8. Once the liquid is in the oral syringe, put the tip of the syringe inside the child’s mouth, between the gums and the inside surface of the cheek
9. Squirt a small amount into the side of the child’s mouth and allow them to swallow, before administering more medicine
10. Give the child a drink to wash down the medicine
11. Wash the syringe with warm, soapy water and leave to dry away from heat and sunlight

Cup or spoon ^[1]

Another option is to administer the medicine using a cup or spoon. This may be suitable for older children. To do this, you must:

1. Wash your hands and ensure the child is sitting upright
2. Shake the bottle unless stated otherwise on the label.
3. Carefully pour the medicine into the medicine cup or medicine spoon according to the dose on the label.
4. Give the dose to your child
5. Give the child a drink to wash down the medicine
6. Wash the cup or spoon in warm, soapy water and leave to dry away from heat and sunlight

What are the benefits of liquid medicines?

Easy to swallow
There is a concern at what age children can safely swallow tablets and capsules, it is generally thought to be around 6 years old ^[2]. An oral liquid medicine may be an easier to swallow option and therefore a more appropriate option for younger patients. ^[3]

Palatable
Rosemont’s oral liquid medicines are designed to palatable to ensure acceptability, aiding adherence to medication regimes^[3].

The most appropriate dose is received
A liquid medicine allows prescribed doses to be much more flexible, ensuring the dose is age appropriate. Dose titration also allows for identification of effective dosages for an individual, based on patient response. ^[4]

For more information on liquid medicines for paediatric patients, visit this page: Children’s Medicine.

ROS000027-011 DOP May 2023

How Does Dysphagia Affect Eating?

When caring for a person with dysphagia, it’s important they receive adequate nutrition. In this blog, we’ll be listing what you should and shouldn’t serve to a person with dysphagia.

Why does dysphagia affect eating?

Many people with dysphagia struggle to swallow or cannot swallow at all. Signs of dysphagia include coughing or choking when eating, bringing food back up and unexplained weight loss. ^[1] If you think you or someone you care for may have dysphagia, see our full list of symptoms at liquidmedicine.co.uk.

How do you eat with dysphagia?

Many cases of dysphagia can be improved with treatment, but a cure isn’t always possible. To make eating and drinking easier, you can change the consistency of foods, such as pureeing, to make them safer to swallow^[1]. Another technique is to choose foods that are already soft in consistency, allowing for a soft food diet ^[2].

What foods should you avoid with dysphagia?

You should avoid giving a person with dysphagia any hard or dry foods. Some of these include ^[3]:

• Bread
• Cereal with lumps
• Cakes and pastries
• Seeds or nuts
• Fresh fruit and vegetables
• Fried or hard-boiled eggs
• Whole meat

What kind of food is good for dysphagia?

Moist and soft foods can be much easier to swallow. Some of the best foods to eat include^[2]:

• Mashed potatoes
• Porridge
• Pancakes with syrup
• Minced or finely diced meat, served with gravy
• Tofu
• Soft, cooked vegetables diced to around 1cm
• Ripe bananas
• Pudding with custard
• Jelly

Additionally, the International Dysphagia Diet Standardisation Initiative has provided a common terminology to describe food textures and drink thickness. They recommend that each patient should be tested by a healthcare professional and then advised the food and drink that is suitable to them, personally. Their framework is as follows^[4]:

• Level 0 (Drinks)- Thin
• Level 1 (Drinks) – Slightly thick
• Level 2 (Drinks) – Mildly thick
• Level 3 (Drinks) – Moderately thick
• Level 4 (Drinks) – Extremely thick
• Level 3 (Food) – Liquidised
• Level 4 (Food) – Pureed
• Level 5 (Food) – Minced and moist
• Level 6 (Food) – Soft and bite sized
• Level 7 (Food) – Regular and easy to chew

For more information on the framework, visit the IDDSI website: IDDSI Framework

Does dysphagia affect drinking?

Thicker liquids that flow slowly can often be easier to swallow^[5]. It is crucial to also ensure that a person with dysphagia is sitting upright whilst they take a drink or eat^[3].

Managing dysphagia and food

It is very important to ensure that the person with dysphagia enjoys the food that you make for them. In some cases, pureeing food can alter the taste and therefore the enjoyment of eating. Ensure that you or the person that you care for has a balanced diet, whilst also serving delicious food and drink options. For more information about swallowing difficulties and dysphagia visit www.liquidmedicine.co.uk.

Liquidmedicine.co.uk is provided as a service to medicine by Rosemont Pharmaceuticals Ltd.

ROS000023-010 Date of Preparation May 2023

How Does Dysphagia Affect Eating?

When caring for a person with dysphagia, it’s important they receive adequate nutrition. In this blog, we’ll be listing what you should and shouldn’t serve to a person with dysphagia.

Why does dysphagia affect eating?

Many people with dysphagia struggle to swallow or cannot swallow at all. Signs of dysphagia include coughing or choking when eating, bringing food back up and unexplained weight loss. ^[1] If you think you or someone you care for may have dysphagia, see our full list of symptoms at liquidmedicine.co.uk.

How do you eat with dysphagia?

Many cases of dysphagia can be improved with treatment, but a cure isn’t always possible. To make eating and drinking easier, you can change the consistency of foods, such as pureeing, to make them safer to swallow^[1]. Another technique is to choose foods that are already soft in consistency, allowing for a soft food diet ^[2].

What foods should you avoid with dysphagia?

You should avoid giving a person with dysphagia any hard or dry foods. Some of these include ^[3]:

• Bread
• Cereal with lumps
• Cakes and pastries
• Seeds or nuts
• Fresh fruit and vegetables
• Fried or hard-boiled eggs
• Whole meat

What kind of food is good for dysphagia?

Moist and soft foods can be much easier to swallow. Some of the best foods to eat include^[2]:

• Mashed potatoes
• Porridge
• Pancakes with syrup
• Minced or finely diced meat, served with gravy
• Tofu
• Soft, cooked vegetables diced to around 1cm
• Ripe bananas
• Pudding with custard
• Jelly

Additionally, the International Dysphagia Diet Standardisation Initiative has provided a common terminology to describe food textures and drink thickness. They recommend that each patient should be tested by a healthcare professional and then advised the food and drink that is suitable to them, personally. Their framework is as follows^[4]:

• Level 0 (Drinks)- Thin
• Level 1 (Drinks) – Slightly thick
• Level 2 (Drinks) – Mildly thick
• Level 3 (Drinks) – Moderately thick
• Level 4 (Drinks) – Extremely thick
• Level 3 (Food) – Liquidised
• Level 4 (Food) – Pureed
• Level 5 (Food) – Minced and moist
• Level 6 (Food) – Soft and bite sized
• Level 7 (Food) – Regular and easy to chew

For more information on the framework, visit the IDDSI website: IDDSI Framework

Does dysphagia affect drinking?

Thicker liquids that flow slowly can often be easier to swallow^[5]. It is crucial to also ensure that a person with dysphagia is sitting upright whilst they take a drink or eat^[3].

Managing dysphagia and food

It is very important to ensure that the person with dysphagia enjoys the food that you make for them. In some cases, pureeing food can alter the taste and therefore the enjoyment of eating. Ensure that you or the person that you care for has a balanced diet, whilst also serving delicious food and drink options. For more information about swallowing difficulties and dysphagia visit www.liquidmedicine.co.uk.

Liquidmedicine.co.uk is provided as a service to medicine by Rosemont Pharmaceuticals Ltd.

ROS000023-010 Date of Preparation May 2023