Whether it’s life-saving medicines, drugs that can improve life for children who have chronic conditions or medications to treat bacterial infections, pharmaceutical companies that focus on pediatrics all face the same problem: Palatability. If the drug is not palatable, drug acceptance suffers. And no matter how effective the formulation is, if a child refuses to take it, it doesn’t do any good.
When treating children who have been diagnosed with autism spectrum disorder, achieving medication acceptance is even more challenging.
Although many parents who are struggling to give their child medicine might assume that the drug’s palatability is all about its flavor, there is actually more to it. Palatability is influenced by three things: taste, smell and texture.
Smells are important because of the way that odors influence the perception of flavor. Although taste and smell are separate senses, messages about taste and smell converge in the brain to create the perception of flavor. This is why foods seem to taste different when your nose is congested.
Children have a high level of sensitivity
When it comes to detecting tastes, smells and chemical irritants, children have very well-developed sensory systems—and, often, strong opinions, likes and dislikes. A child’s palate is different than an adult’s. In general, children have a greater level of sensitivity to sweet and bitter flavors than adults do and can be quite vocal regarding their aversion to bitter tastes.
Unfortunately, many Active Pharmaceutical Ingredients (APIs) taste bitter and/or irritate the mouth and throat.
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Although adding sweeteners to medications can increase their palatability and acceptance, this can be problematic because excess sugar intake is associated with dental disease, and some children need to limit their sugar intake altogether. Plus, making the medicine too delicious can lead to overconsumption—a problem that is often seen with adults and children alike when formulations are made into candy-like gummies.
Children with autism are even more likely to reject medication
Approximately 40% of children who have been diagnosed with autism spectrum disorder also have anxiety disorders. These anxiety disorders can result in medication refusal. Introducing medication also represents a change in routine—something that is often quite difficult and stressful for these youth.
The high sensitivity to taste and smell that is common in all children is often even stronger in those with autism. Plus, because autistic individuals experience the world differently than others, a taste or smell that is pleasant to you may be extremely unpleasant to them.
Encapsulation can mask undesirable tastes and odors
For pediatric formulations meant for all but the youngest children, encapsulation can help reduce problems with taste, smell and irritation.
However, many children find pill swallowing difficult—this challenge can be amplified for children with autism. Pill swallowing is a complex process requiring coordinated movements, and children with autism often have motor and movement difficulties in general.
Luckily there are proven methodologies that can be used to teach pill swallowing to most children over the age of about seven as well as to many children who have autism. While the details of these methodologies are beyond the scope of this article, they involve gradual introduction, breaking the process into small steps, positive reinforcement and modeling.
The use of flavored gelatin capsules can further increase acceptance
CapsCanada®’s flavor capsules address the taste and smell aspects of palatability in a unique way that appeals to children. These gelatin capsules are available in a variety of the sweet flavors that children tend to prefer, including berry, strawberry, grape, orange, mixed fruit and bubblegum. To make them more memorable and acceptable to kids, the capsules’ colors match their taste. Grape-flavored capsules are purple, berry-flavored capsules are red, etc.
In addition, the smell of these empty capsules also matches their taste. This means that pharmaceutical companies do not have to just rely on the encapsulation process to mask unpleasant odors; the capsule itself has a pleasant smell. This also means that when pediatric medications are encapsulated in flavor capsules, the child’s odor stimuli and the taste stimuli will work in concert to increase the perception of palatability and, therefore, acceptance.
Another way that flavor capsules can increase medicine acceptance in pediatrics is to reduce anxiety. Children who struggle with pill swallowing know that it often takes them multiple tries to swallow a pill. If they know that the pill tastes bad, they get anxious worrying about having that bad taste in their mouth for an extended period of time. This anxiety can be even worse for children who have autism. However, if the child knows that the capsule tastes good, they can relax because that concern is eliminated.
The novelty factor can also play a part in acceptance. If a child is aware that most medications do not have special flavors, the use of flavor capsules might make the medicine seem more “special” and “exciting” in the child’s mind.
It is well known that in pediatrics, a drug’s taste and smell can be significant barriers to medication acceptance. Masking the medication’s unpleasant taste and odor in a gelatin capsule that has a kid-pleasing flavor and smell is one way to help overcome this problem for both the general population of children and for those who have autism.
To request samples of CapsCanada®’s flavor capsules or to speak with a formulation expert about using these in your pediatric application