Looking at Oral Chelation in Young Children
November 15, 2010 – A commentary article in a recent issue of Pediatric Blood Cancer discusses the use of oral chelators in young children.
Entitled “Oral Chelation: Should It Be Used With Young Children?,” the article raises many interesting points. Authors Lauren M. Mednick, PhD, Jennifer Braunstein, PNP and Ellis Neufeld, MD. PhD, all of Children’s Hospital Boston, state that their “experience with families of children aged 2-5 years…indicates that oral chelation may not increase adherence in this population, and in fact brings unique challenges which can negatively impact adherence.”
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Discussing barriers to adherence, the authors state that adherence for children in this age group can be “especially challenging as they may exhibit oppositional behavior in order to assert their independence” and that for a young child “the necessity to strictly adhere to schedules and routines for taking medications and eating is unlikely to mesh well with characteristics common of this age group.” In addition, the common practice of taking oral chelation medication very soon after waking up can be particularly hard, and feelings about the taste and texture of the medicine is also a barrier. One result of this last barrier is that a patient may not swallow the entire dose of prescribed medicine and “not taking the complete deferasirox dose (or only a fraction of monthly doses) could mean the difference between adequate chelation and rising iron burden.”
Due to these barriers, the authors recommend that hematologists and parents consider starting young children on chelation with deferoxamine and waiting until they are older to initiate deferasirox. They also make several suggestions for addressing these barriers, including:
- Providing choices when appropriate (e.g., ask the child if s/he wishes to take his medicine in a red cup or a blue cup) so that the child feels more in control.
- Trying to make taking medicine fun (e.g., playing a board game so that the child takes a sip of medicine each time it is his/her turn).
- Creating a behavioral plan with contingent rewards (e.g., a sticker for taking medicine).
The authors also state that having a consistent routine around medications and praising positive behavior are important strategies.