Time to choose tablets over liquids when prescribing for children, GP argues

Doctors should consider prescribing tablets rather than liquids for children over the age of four who can swallow, a leading GP has argued.

For many children tablets ‘are not only possible, but preferable’, reducing cost, providing a more accurate dose and often easier for parents to manage, a paper in the British Journal of General Practice has concluded.

It is rare for GPs to prescribe tablets for young children, despite evidence that with brief structured coaching, many children can learn to take them from pre-school age upwards, said Dr Rebecca Payne, former RCGP Wales chair and an honorary clinical senior lecturer at Bangor University.

Yet it is common for children to spit liquid medicines out, swallow only part of it or refuse it altogether, says Dr Payne, who also wrote about the issue for The Conversation.

She gives the example of a child prescribed antibiotics in liquid form to be taken four times a day that tasted revolting and most of it coming straight back out and the course not completed.

It means treatment is less effective and can contribute to the development of antibiotic resistance. Liquids also cost a lot more and have a heavier carbon footprint, she adds.

Speaking with Pulse, Dr Payne said this not an issue that can be solved by GPs alone, it has to be a ‘societal shift’.

‘We do need schools and other organisations and parents to think about this too because ideally you don’t want to introduce kids to take tablets when they’re poorly.’

There is more awareness of the issue since the Strep A outbreak in 2023 when GPs were asked to reduce their threshold for prescribing which led to a surge in demand and antibiotics shortages, she believes.

‘Perceptions are changing but certainly my computer defaults to prescribing liquids. The system is set up for you not to think about it.’

Now may be the time for GPs to consider a ‘pragmatic’ tiered approach, where liquid suspensions remain the main option for neonates and infants but for children over the age of four, tablets are considered instead, the BJGP article concludes.

This is particularly the case when small tablets or minitablets or licensed or dispersible tablets are available.

In addition, many practices have embedded pharmacists who may be able to provide coaching, check compatibility of crushed or dispersed products, and advise on reconstitution, it adds.

When there is no solid dosage form of a tablet and there is no liquid option available, crushing tablets or opening capsules can be considered but this is off-label, and ‘so should only be done where there are no suitable alternatives’, the co-written paper stresses.

‘Liquids will remain necessary for infants and those with complex needs, but they need not be the default.

‘By prescribing tablets rather than liquids, GPs can support safer, simpler, and more sustainable prescribing for children,’ it concludes.

Dr Payne added that GPs can help by being aware of and sharing resources on how to take tablets and NHS guidance for all healthcare professionals on teaching children to take solid medicines.