For years, pharmacists have been grinding tablets into smaller doses for children--a dangerous practice that has frequently caused problems. To avoid contamination during the grinding process, Mackay Memorial Hospital started asking parents to grind their children's tablets at home, but many parents found this task very difficult. (Hsueh Chi-kuang)

Most Taiwanese parents may not know much about structural problems affecting the children's healthcare system, but one issue they have come to know intimately from years of bitter experience is the common practice among Taiwanese doctors of prescribing to children medicines made for adult use.

When children fall ill, getting them to take their medicine is even harder than getting them to see the doctor. The child cries, the parent gets angry, pandemonium ensues, and the child ends up throwing up more medicine than she ingests. This scene is played out again and again in families with young children, but few people stop to ask why it is so difficult to get children to take their medicine. Isn't there a solution to this problem?

Did you know that the mortal enmity between children and medicine is avoidable? The simple solution is for clinics and hospitals to prescribe sweet, non-bitter pediatric medications in syrup, liquid, chewable tablet, or suspension (soluble) form. Yet because of an adult-centric outlook and cost considerations, Taiwanese hospitals rarely consider this issue from the standpoint of children.

Because pediatric drugs are not widely imported into Taiwan, for a long time medications intended for adult use have been ground into smaller doses and then given to children. Whenever a pharmacist sees a doctor's prescription that reads "1/6 of a pill" or even "1/8 of a pill" he does not know whether to laugh or cry.

"Accurately splitting a pill in eight is a very difficult thing to do," says Wu Lin Fe-lin, director of National Taiwan University's Graduate Institute of Clinical Pharmacy.

Although not every pharmaceutical drug has a pediatric version, respiratory tract and gastrointestinal drugs for pediatric use were developed a long time ago. But due to cost considerations and restrictions on the types of medications that are covered by the National Health Insurance program, very few Taiwanese hospitals actually use pediatric drugs. In recent years, Wu Lin Fe-lin has managed to persuade National Taiwan University Hospital to import more than a dozen different pediatric drugs. Even so, compared to Japan, where 60% of medications prescribed to children are pediatric drugs, Taiwan lags far behind with its pediatric drug use rate of only 0.2%.