ILL AT EASE WITH MEDICATION

Kids often have troubled relationship with treatment

A 14-year-old girl is given a life-saving kidney transplant, but within six
months, unbeknownst to her family or her doctor, she stops taking the
medication that was supposed to help her body accept the new kidney.

Now 16, her body has rejected the organ. Once again she faces painful
dialysis treatment unless her father, a prison inmate who donated the first
kidney, is allowed to give her his one remaining kidney.

That story, which came out of California in December, focused attention on
the father who would spend the rest of his life hooked up to a dialysis
machine if he is allowed to become a donor for a second time.

But, what about the girl?

What makes a teen-ager jeopardize her life by dumping the pills that are
helping to keep her alive?

Doctors at the University of California at San Francisco Medical Center
said the girl didn't like the drugs' side effects, which made her feel and
look different from other kids. The medication caused her belly to extend,
made her face puffy, and caused fat to deposit on her back, giving the
appearance of a hump.

Youngsters often can't understand why medications that are good for them
can actually make them feel badly, pointed out Dr. Roger Bibace, professor
of psychology at Clark University in Worcester.

And children lack a concept of time, according to Bibace, failing to
understand that while you might have an upset tummy today because of the
pills you are taking, tomorrow you will feel better.

Even teen-agers have a hard time looking down the road to an age when they
might value their life more than they now despair of certain side effects.

A youngster's view of medicine is often quite different from that of an
adult, said Bibace. He and several colleagues looked at what children think
about medicine in a 1996 study that involved youngsters in Baltimore, New
York City and Worcester.

Because the children talked among themselves in focus groups, "they brought
up issues that adults and professionals were unaware of," said Bibace. And
he advises that parents and physicians shouldn't lecture children unwilling
to take a medication, but instead, ask why they don't want to take it.
"Maybe they have a reason."

Parents can often make a young child take medications, but that can involve
a very unpleasant scene. And overriding a child's objections doesn't erase
the worry that he or she may feel about the pills or liquid they are forced
to swallow.

When older children and teen-agers exercise some control over their
medication, an ill-conceived view can lead to serious and even
life-threatening problems, as exemplified by the California teen.

"National statistics indicate that as many as 10 to 20 percent of
adolescent transplant recipients are lost because the youngsters stop
taking their medication," said Dr. William A. Primack, a pediatric
nephrologist at the Fallon Clinic in Auburn.

"If we have a youngster who must take a medication regularly, we do
whatever we can to encourage them to take the medication," Primack said.
"If they have made up their mind not to take their medication, I challenge
anyone to get them to take it."

And while transplantation is not a common experience, youngsters with
juvenile diabetes, juvenile arthritis and asthma are numerous. And they all
have to take medications to maintain their health and ward off
life-threatening complications.

Dr. Linda D. Sagor, a pediatrician at UMass Memorial Health Care, says she
encourages parents "to be persistent. When parents say they must take it,
they will, although not happily. Some children, however, are very difficult."

Sagor finds that most of the difficulties come from children who need
medication episodically, not from children who take drugs for chronic
conditions. "Those parents and those children usually come to some
understanding and some accommodation about it."

Children often have fears about medicine that can interfere with their
willingness to take medications.

According to the study, which Bibace and his colleagues did for U.S.
Pharmacopeia - a quasi-public national organization that promotes public
health - although children think that medicine is good for them because
"they make you feel better" or because "mom gives them to you," they also
think it can be dangerous.

Medicine that could make you feel better could also kill you, a fear that
sometimes leads children to worrying about whether the medicine has poison
in it.

Other dangers also bother children, according to the study. Some children
worry that the medication is not theirs, because, as Bibace noted, most
prescriptions come in the same brown plastic containers with the same white
tops.

WEIRD OR LOGICAL?

That can cause problems because some children believe that if you take
another person's medicine, you get the disease that the other person has.

This may sound a bit weird to an adult, but think for a moment about the
commercials that feature a prominent athlete or an attractive model,
suggests Bibace. Eat Wheaties and you, too, can be an Olympic competitor.
Use this hair coloring and you, too, can be as beautiful as this model.

If some adults believe a particular product can give you the qualities
exemplified by the ad spokesperson, why shouldn't children believe that
taking someone else's medicine gives you the illness the other person has?

Children often confuse the effects of the disease with the side effects of
medication, Bibace and his colleagues found. That's exemplified, he said,
by a dialogue between two first-graders in Baltimore: one believed that
cancer medications make your hair fall out, while the second child
disagreed, saying it was the cancer that made the hair fall out.

There also can be some confusion between medicines and drugs.

A fourth-grade Fitchburg school teacher experienced this firsthand when one
of her students, a boy who suffers from attention deficit disorder, refused
to take his Ritalin. Asked why, the boy explained to his teacher and
parents, that the DARE officer said taking drugs is bad.

According to Bibace, many children knew that there were "good" drugs called
medicines, and that there were "bad" drugs.

"One way children differentiate between good and bad drugs," said Bibace,
is the place where they are bought. Bad drugs, for instance, are sold on
the streets; good drugs are sold in drugstores.

But children were reluctant to call medicines "drugs," and even the word
drugstore can sometimes confuse youngsters.

And, Bibace noted, perhaps even adults are leery of associating the word
"drugs" with the store where medications are sold. Only a couple of chain
stores in Worcester, according to Bibace, still use "drug" as part of their
name. "All others have changed their names to "pharmacy,' " he said.

Medicine tactics

If your child gives you a hard time about taking medicine, experts offer
these tips to make the experience easier:

Explain why you are giving the pills or liquid. Be pleasant, but firm. Be
persistent. Follow up the medicine with something pleasant-tasting. If your
child still refuses the medication, ask him why he doesn't want to take it.
If the medicine is particularly bitter, ask your physician if there is an
alternative your child can take. If there isn't, see if your pharmacy can
add a flavoring that makes the medication more tolerable