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. 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. 
Children’s bodies are different in size, but also physically and psychologically when compared to an adult, so they process medication differently. 
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. Oral liquid formats are the preferred formulation for younger children as they are easier to swallow and allow 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.
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. 
There are some types of medicines which should never be manipulated, these include modified release formulations. 
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 :
- 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 2023.
1. Medicines for Children. Unlicensed medicines. Available at: https://www.medicinesforchildren.org.uk/advice-guides/general-advice-for-medicines/unlicensed-medicines/ Accessed Sept 2023. | 2. Nunn, A J. ‘Making medicines that children can take’, Licensing of medicines, National Library of Medicine, pp.369-371, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1719550/pdf/v088p00369.pdf. Accessed September 2023. | 3. Ferro A. Paediatric prescribing: why children are not small adults. Br J Clin Pharmacol. 2015 Mar;79(3):351-3. doi: 10.1111/bcp.12540. PMID: 25371355; PMCID: PMC4345945. | 4. Statista, Proportion of selected age groups of world population and in regions in 2022, 20/08/22, https://www.statista.com/statistics/265759/world-population-by-age-and-region/. Accessed September 2023. | 5. RCPCH.The use of unlicensed medicines or licensed medicines for unlicensed applications in paediatric practice. Available at: The use of unlicensed medicines or licensed medicines for unlicensed applications in paediatric practice | RCPCH. Accessed Sept 2023. | 6. Prescribing medicines for patients with dysphagia (A Handbook for Healthcare Professionals), edited by Prof. D.J Wright (2011) | 7. Smith L, Leggett C, Borg C. Administration of medicines to children: a practical guide. Aust Prescr. 2022 Dec;45(6):188-192. doi: 10.18773/austprescr.2022.067. Epub 2022 Nov 30. PMID: 36479324; PMCID: PMC9722353. | 8. NHS, ‘Problems swallowing pills’, 31/08/23, https://www.nhs.uk/conditions/problems-swallowing-pills/. Accessed September 2023 | 9. Oxford University Hospitals NHS Trust, ‘Tips to help your child to take medicine’, https://www.ouh.nhs.uk/patient-guide/leaflets/files/11990Pmedicine.pdf. Accessed September 2023.