Getting Kids On Board With Treatment

By Linda J. Brown

You started your child on her treatment plan with the best of intentions. Anxious for her to feel better, you followed her doctor’s orders precisely — every appointment, every pill, every exercise right on time. In medical speak, you adhered to her treatment plan.

But over time, sticking with the plan got tougher. Perhaps you missed a physical therapy appointment or forgot an occasional pill or two. Or maybe on days he was feeling better you wondered, “Does he really need to do the exercises today?” or “Do I really need to put him through another needle stick?”

If this sounds familiar, you’re not alone. Michael Rapoff, PhD, chief of behavioral pediatrics at the University of Kansas Medical Center led a study that found a 70% adherence rates among pediatric patients at first but after a year those numbers dropped to about 50%.

But sticking with the treatment plan is key to a good outcome.  “Overall, the outcome for arthritis is related to compliance with the medication which controls the inflammation,” says Carol Lindsley, MD, chief of pediatric rheumatology at the University of Kansas City Medical Center. “If we control the inflammation, then we prevent complications from arthritis in the majority of children.”

And if a child’s symptoms can be controlled for a significant period of time, she may be able to reduce the amount of medication or take a drug holiday. Also, exercises keep joints mobile and preserve range of motion.

So how do you and your child keep on track ? Experts offer this important advice for overcoming common obstacles to adherence.

Understand Why
If you don’t know why your child takes a certain pill or does a certain exercise, you may be more likely to forget it or let her skip it. Both you and your child need to understand all the components of the treatment plan. A close partnership and open communication with your child’s doctor are critical so you can ask for explanations or feel comfortable enough to tell him when something is not working.

Get Organized
Treatment regimens can be complicated, so make things as simple as possible with these tips: 

• Take notes at appointments so you can track medication changes, when to schedule a test or how to do an exercise. 
• Put the pills in a hard-to-miss spot, maybe on the kitchen counter or on the bathroom sink next to your child’s toothbrush. 
• Have your child take pills at the same times every day, after breakfast or after dinner, so it becomes routine. 
• Use weekly pill boxes. Try different colored strips for pills taken at different times of the day. 
• Consider pill containers with electronic monitors or set a personal digital assistant, cell phone or digital watch to beep when it’s pill time. 
• Administer injections the same time each week, as the doctor prescribes.

Make It Interactive
Keep track of medication taken by your child by putting a check or a sticker on a calendar after he’s taken his pills. Depending on your child’s age or maturity she may be able to do this herself. As an incentive or to help a child who resists taking medicine, Rapoff suggests a reward system where a child accumulates a certain number of stickers or poker chips, which can be traded for a special activity or privilege once they accumulate an agreed upon amount of stickers or chips.

Teens can typically take on an increasing amount of their care, but parents need to assess a teen’s readiness to do so based on several factors, not just based on their child’s age, says Rapoff. “Sometimes parents withdraw their supervision or monitoring too quickly with teens,” he says. 

Make Movement Fun
Therapeutic exercises aren't fun, and a survey conducted by Rapoff and colleagues found that kids and parents had more difficulty with exercises than with pills. But the benefits are worth it. Suzie Wright, an occupational therapist and research assistant at University of Kansas City Medical Center finds kids will do a limited number of exercises if she links them to an activity they want to do.

“If they want to play basketball, then they need to have ankle range of motion so they’ll do those exercises,” explain Wright. Passing a driving test requires neck mobility and applying mascara takes wrist movement. Smaller kids often like soccer or dance. Try to do exercises at a set time, perhaps when watching TV in the afternoon.

“I tell them every time there’s a commercial, the TV goes mute,” says Wright. “Do 10 repetitions very slowly, and the sound is turned back on. If you don’t, it stays mute.” That’s effective motivation especially for kids with siblings.

Complying with your child’s treatment plan is hard work that requires time and effort, but the payoff — staying active and perhaps avoiding a lifetime of joint damage —  is well worth the effort.