providing adherence support to children and their families andrea jurgrau, ms, cpnp women and...
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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
InfantsSpecial Considerations
Things change rapidly:• Feeding and sleeping schedule• Level of alertness• Interest in taste• Ability to move and assert self
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……..
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.