It would be hard to overlook the overwhelming number of gummy vitamins available to both adults and children. Over the past decade, the availability of these gummies has exploded as an easy way to take vitamins and supplements. Recently, however, the suitability of these dosage forms has come under scrutiny, with their sugar content and reliability in delivering accurate doses being questioned. The FDA held a meeting in October to discuss the benefits and concerns of these “candy-like” drugs.
One of the issues highlighted at the conference about drugs and vitamins that taste and look like candy is that as they become more desirable to children, there is a potential for overdose and addiction. Fortunately, most available vitamins and over-the-counter medications are not highly toxic, but children can easily ingest enough amounts to cause gastrointestinal symptoms. In particular, multivitamins containing iron can be especially toxic to children.
I would also like to ask you another question. have How to “candy” medicine and give it to children? I have two children, her 10 year old and her 12 year old, and the only options I have found on the market for multivitamins are chewable tablets and gummies. My 12 year old daughter has been able to swallow solid oral dosage forms (tablets) for at least 4 years. she is not alone. In one study, the majority of children between the ages of 6 and 11 were able to learn to swallow small pills.
So why does it take so long to teach children to swallow solid oral dosage forms? Why do we rely on oral liquids, chewable tablets, and gummies? Why do children Do they think they won’t take it unless it’s in liquid or candy-like form? Children should be encouraged to try the standard “pills” before turning to alternatives.
In my role as a pediatric pharmacist, I meet patients at a pediatric kidney center and these children have a hard time learning to swallow tablets and capsules because liquid tablets and capsules taste very awful. You learn early on that is best.
My 12 year old son currently has braces, so gummies aren’t an option (he never really liked the taste of them anyway). She also doesn’t like the taste of chewable multivitamins. But there is no other choice. There are no children’s multivitamins available (as far as I can find) in pill form. I am having trouble having to split half of the adult multivitamin and give it to her because many of the vitamins are too high in the adult multivitamin. (I consulted with the pediatric dietitian I work with to make sure she doesn’t exceed the recommended daily intake for her daughter’s age.)
I propose that we proceed from the assumption that children must have candy in order to get their vitamins. Let’s change the status quo.
In recent years, there has been increasing interest in pediatric solid oral dosage forms for prescription drugs. This is due to its longer shelf life and increased dosage flexibility. Multiparticulate dosage forms, including mini-tablets, pellets, granules, and sprinkles, are gradually entering the market. Their smaller size makes them more acceptable to children, and most medications for children are dosed based on weight, which helps with the dosing flexibility needed. Studies have shown that a 2-day-old infant can swallow her 2 mm mini tablets without choking. Clearly, solid oral dosage forms can be ingested by children of any age if they are appropriately sized.
In the world of commercial products for children, we can do better. Move away from candy-like dosage forms and return to tablets, capsules, or mini-pills for younger children. While we wait for the FDA to decide the next steps in defining and regulating candy-like products, we can work with patient parents to teach their children to swallow solid oral dosage forms.
I still have things to teach myself. My girlfriend’s 10 year old daughter hasn’t learned to swallow pills yet. When she was diagnosed with the flu a month ago, she complained about the taste and quantity of the medicine. She told me she wanted to learn how to swallow pills and capsules so she wouldn’t have to take those pesky drugs again. Even at the young age of 10, she knows what’s best.
Rachel Myers, PharmD, is a pediatric pharmacist and clinical professor at the Ernest Mario School of Pharmacy at Rutgers University in New Jersey.
