Pill-Swallowing Training in Very Young Children With Cancer

Children with cancer are often required to take different types of medication. Some clinical trials demand that patients be able to swallow pills. Other treatment plans may require the management of multiple medications.

In these cases, patients can benefit from learning to swallow pills, regardless of their age.

The problem? There isn’t a clear, empirically supported study showing the benefits of pill-swallowing training (PST) for patients under the age of six. Pill-swallowing training (PST) is a behavioral intervention, typically delivered by psychologists or child life specialists, that teaches children the art of swallowing pills.

We have developed deep expertise in this behavioral intervention at St. Jude Children’s Research Hospital, where children are treated for catastrophic diseases. I’d like to share with you some of the lessons learned.

My St. Jude colleagues Jennifer Harman, Amy Scott, and Niki Jurbergs have published a case series where they employed pill-swallowing training in children under the age of six.

“We know pill swallowing training and interventions are empirically supported for kids over the age of six, and we know it works with them,” says Dr. Harman, an Associate Member of the St. Jude Faculty and Assistant Clinic Director in the Department of Psychology. “We also know how to take a developmental lens and tailor things for the early childhood brain.”

When working with childhood cancer patients, my colleagues improved families’ experiences with disease and treatment. They identified the unique challenges children faced. Then, they explored and tailored solutions to meet the patient's individual needs.

Interventions included:

• Novel modifications, such as using picture representations
• Positional interventions, like using flexible straws and holding a cup of water upward to help patients be properly positioned to take their medicine
• Relaxation training for anxiety
• Behavior management

Patients were rewarded for both effort and success after each intervention. This case series showed that young children with cancer could learn to swallow pills successfully, even when emotional, behavioral, and developmental difficulties are present.

“We have allowed children to have access to the treatment they wouldn’t otherwise have had access to,” said Dr. Jurbergs, an Associate Member of the St. Jude Faculty and Clinic Director in the Department of Psychology. “We have given families agency in making medical decisions for their children. We've helped to give them at least options to make sure they are able to choose what is best for their children by offering these interventions.”

Parents noticed improvements in their children’s treatment, quality of life, and parent-child relationships.

Pill-swallowing training is just one example of a safe intervention for young children. The case series reminds us of the importance of being flexible. Providers should continuously think about new ways of introducing helpful interventions.

“It gave concrete information for other clinicians,” Harman explained. “If you work with them, then you can probably teach them.”

We at St. Jude hope that by sharing the learnings from these cases, and the successful outcomes of this case series, other providers can help children take their medicine.