Israeli Study Finds Size and Shape Determine How Easily Children Accept Medication

Dr. Yael Shapira Galitz, Vice Chair of the Department of Otolaryngology and Director of the Voice and Swallowing Service; Dotan Shaniv, Clinical Pharmacist. Credit: Clalit-Kaplan Medical Center

The color of a pill may ultimately be of little importance. According to a new Israeli study, it is primarily a tablet's size and shape that determine how easily children are willing to swallow it. These findings could influence the design of future pediatric medicines and improve treatment adherence worldwide.

A team of researchers from Kaplan Medical Center, part of Clalit Health Services, Israel's largest healthcare organization, identified the physical characteristics of tablets that influence children's perception of how difficult they are to swallow. The findings were published in the Journal of Child Health Care and presented at the annual Israeli Congress of Otolaryngology.

A Common Barrier to Treatment Adherence

For many parents, getting a child to swallow a pill can be a real challenge. As a result, families often prefer liquid formulations, which are not always available, or crush tablets, a practice that can alter the effectiveness of certain medications or affect their dosage.

"The first obstacle, and perhaps the most significant one, to medication adherence in children is visual," explained Dr. Yael Shapira Galitz, Vice Chair of the Department of Otolaryngology and Director of the Voice and Swallowing Unit at Kaplan Medical Center.

The researchers recruited 50 children and adolescents between the ages of 8 and 15. Half had already successfully learned to swallow tablets, while the other half had either never managed to do so or continued to experience significant difficulty.

Participants were shown photographs of 44 commonly prescribed pediatric medications featuring different characteristics, including size, shape, thickness, color, and transparency. Without handling or tasting the tablets, they were simply asked to rate, on a five-point scale, how difficult they believed each tablet would be to swallow.

This approach enabled researchers to isolate the impact of visual characteristics alone on children's perception of swallowing difficulty.

Round Tablets Inspire Greater Confidence

Elongated tablets were consistently perceived as more difficult to swallow than round tablets of the same volume. Unsurprisingly, children who had never successfully swallowed a tablet rated all tablets as more difficult than those who had already mastered the skill. However, both groups shared the same preferences regarding tablet shape.

"This also sends a clear message to pharmaceutical manufacturers: when designing medicines for children, they should consider not only the chemical composition but also the physical appearance of the tablet. Smaller, rounder tablets could significantly improve treatment adherence," said Dr. Shapira Galitz.

Pharmacists Can Recommend Alternative Formulations

Clinical pharmacist Dotan Shaniv, a co-author of the study, noted that most medications are manufactured as tablets because they offer greater stability, precise dosing, and lower production costs.

However, many pharmaceutical companies market generic versions containing the exact same active ingredient but with different sizes or shapes.

The researchers believe their findings could help reshape the design of pediatric medicines by placing greater emphasis on the ergonomic and psychological factors that influence children's willingness to take medication.

Caroline Haïat