Providing Adherence Support to Children and

their Families

Andrea Jurgrau, MS, CPNPWomen and Children Care Center

New-York Presbyterian HospitalColumbia-Presbyterian Medical

Center

An Adherence Program

Individual sessions with a health educator Individual sessions with a nurse Pill swallowing readiness training Home delivery of medication if family desires Individualized medication schedules Prepared pill boxes if family desires Medication Reminder beepers and timers Optional participation in an adherence study Behavior modification program with rewards

Define Children!

Infants Toddlers School Age Adolescent/Young Adults And their families!!

InfantsSpecial Considerations

Things change rapidly:• Feeding and sleeping schedule• Level of alertness• Interest in taste• Ability to move and assert self

Helping InfantsLiquid Medications

ToddlersSpecial Considerations

More stable schedule with rituals very important

Asserting independence with anticipatory guidance needed

Dealing with oppositional behavior: special tricks?

School Age ChildrenSpecial Considerations

Meeting children where they are developmentally and helping their families do the same

Beginning to work on disclosure Shared responsibility for

medication taking

AdolescentsSpecial Considerations

Meet them where they are developmentally/ anticipatory guidance

Disclosure and processing diagnosis Becoming more responsible for

own medications Scheduling issues

Potential Problemsand solutions

The adult giving the medication gets sick/ is hospitalized:• Always help the family identify a

back-up• Help family set-up homecare services

before a crisis happens

Potential Problems and Solutions

The medications taste awful:• Work on pill swallowing• Help family find ways to hide taste:

• Big Red Gum, chocolate syrup, M&Ms, other syrups, chocolate milk, peanut butter, peppermint……..

Helping ChildrenPill Swallowing

Conclusion

Understanding where children and adolescents are developmentally is vital to helping them achieve adherence to complex medication regimens.

Working with children means helping them AND their families.

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