Education And Debate

Concordance and children's use of medicines

BMJ 2003; 327 doi: (Published 09 October 2003) Cite this as: BMJ 2003;327:858
  1. Emilio J Sanz, reader in clinical pharmacology (
  1. 1Department of Pharmacology, School of Medicine, University of La Laguna, 38071 La Laguna,Tenerife, Spain

    Doctors are expected to encourage patients' involvement in treatment decisions, but what about children? This article considers the issues

    Concordance is usually established between two people, doctor and patient, but the use of drugs in children always involves a third partner, the parents. Developing concordance with children in their health care raises several questions with no straightforward answers. For example, should children have a more active role in taking decisions about health and drugs than they currently do? Should greater emphasis be placed on informing parents about the disease and its treatment or on direct communication with their sick child? From what age should children be addressed directly about their illness? What is really relevant for them? Do children's and parents' perceptions about the usefulness and risks (efficacy), rules, and use of drugs coincide?

    This article, based on qualitative studies of children's perceptions and attitudes to health, disease, and drug use, presents information that, though by no means providing the “right” answers to the above questions, might be useful when considering the options.


    Most studies of patient compliance and the health education of children refer to the professional view and address compliance with drug use, usually related to specific disease treatment. Few address the general issue of how to improve compliance (or to create concordance). In spite of some outstanding systematic reviews from the Cochrane Consumers and Communication Group,13 few studies have examined patients' perspectives about drugs, and even fewer have studied children. Hopefully, the new Cochrane Qualitative Research Methods Group will address the topic.

    Of particular value are several international studies supported by the European Union that compared healthy and asthmatic children in their knowledge, perceptions, and expectations about health, diseases, and treatment.46 The data presented in this article are based on those …

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