REHOVOT, Israel โ A new Israeli study has found that the physical design of a pill, particularly its size and shape, plays a significant role in whether children believe they can swallow it, a finding researchers say could improve medication adherence and influence the future design of pediatric medicines around the world.
The research, published in the peer-reviewed journal Journal of Child Health Care, was conducted by investigators at Kaplan Medical Center, part of Clalit Health Services, Israel’s largest healthcare organization. The findings were also presented at the Annual Israeli Conference of Otolaryngology.
Researchers concluded that a pill’s volume and shape are the strongest visual factors affecting children’s willingness to take medication. By contrast, characteristics such as color and transparency had little influence on perceptions of swallowing difficulty.
The findings address a common challenge faced by pediatricians, pharmacists, and parents. Children who are reluctant or unable to swallow pills are often prescribed liquid medications instead, even when tablets may be more appropriate. In other cases, families crush tablets to make them easier to consume, a practice that can reduce effectiveness or alter the intended dosage of certain medications.
Study Examined Children’s Perceptions
The study was led by Dr. Yael Shapira Galitz, Vice Chair of the Department of Otolaryngology and Director of the Voice and Swallowing Service at Clalit Health Services’ Kaplan Medical Center, together with Dr. David Kiderman, Dr. Emanuel Goldman and clinical pharmacist Dotan Shaniv.
Researchers recruited 50 children and adolescents between the ages of eight and 15.
Half of the participants had previously learned to swallow pills successfully, while the other half had either never swallowed a pill or consistently experienced difficulty doing so.
Rather than asking participants to swallow medication, investigators presented them with photographs of 44 commonly prescribed pediatric medications that varied in size, shape, thickness, color, and surface characteristics.
The children then rated how difficult they believed each pill would be to swallow using a five-point scale.
By relying solely on visual impressions, researchers were able to isolate the factors contributing to swallowing anxiety before children even attempted to take medication.
Size and Shape Matter Most
The results showed a clear pattern.
Children consistently viewed larger pills as more difficult to swallow than smaller ones.
They also rated elongated tablets as significantly more difficult than round pills with the same volume.
Children with little or no previous experience swallowing pills perceived every medication as more difficult than those who had successfully swallowed tablets before. However, both groups generally agreed on which shapes appeared easier or harder to swallow.
Perhaps most surprising, researchers found that pill color and transparency had virtually no effect on children’s perceptions.
“Our findings show that the first and perhaps most significant barrier to medication adherence in children is visual,” said Dr. Shapira Galitz.
“Understanding how children perceive different pills can help parents work with pharmacists to identify equivalent alternatives when available. It also sends a clear message to pharmaceutical manufacturers that designing child-friendly medications should include physical appearance, not only chemical formulation. Smaller, rounder tablets could significantly improve adherence and make treatment easier and safer for families.”
Practical Guidance for Parents
The researchers emphasized that the findings have immediate practical implications for parents whose children struggle with medications.
According to clinical pharmacist Dotan Shaniv, many medications are available from multiple manufacturers while containing the same active ingredient.
If a child has difficulty swallowing one version of a medication, an alternative generic product with a different size or shape may be available.
“Many medications are available as different generic products containing the same active ingredient,” Shaniv said.
“If a child struggles with one specific tablet, parents should consult their pharmacist to see whether an equivalent product with a smaller or more comfortable design is available. A simple switch may improve adherence without compromising treatment effectiveness.”
Shaniv noted that tablets remain the preferred dosage form for many medications because they provide accurate dosing, have longer shelf lives and are less expensive to manufacture than liquid formulations.
However, he said their physical appearance can discourage children from taking medicines consistently.
Implications for Pharmaceutical Development
The investigators believe their findings extend beyond individual patient care and could influence future pharmaceutical development.
By incorporating child-friendly design principles into tablet production, manufacturers may improve treatment adherence among pediatric patients while reducing the need for alternative formulations.
Medication adherence remains a longstanding challenge in pediatric healthcare, particularly for children who require long-term treatment for chronic illnesses.
Researchers suggest that relatively simple design changes, including reducing tablet size or producing rounder pills where medically feasible, could significantly improve children’s willingness to take prescribed medications.
The study also highlights the importance of collaboration between physicians, pharmacists and families when selecting medications for young patients.
Rather than assuming that difficulty swallowing is unavoidable, healthcare professionals may be able to identify alternative formulations that improve compliance without altering therapeutic outcomes.
The researchers conclude that understanding children’s visual perceptions of medication represents an important step toward improving treatment success and encouraging pharmaceutical manufacturers to consider not only how medicines work chemically, but also how they are experienced by the children expected to take them.
