HIV therapies available today are more powerful than anything that has been available in the past. Drug combinations, especially those that include a protease inhibitor, can prolong life and maintain a child's health. Many of these protease inhibitors are not available in pediatric formulations or are unpalatable, so it is important for children to acquire pill swallowing skills so that they can benefit from these new treatment combinations.

A psychological principle, shaping, a technique that relies on behavior modification, is being used to teach children to swallow pills. The technique starts with a small placebo and quickly advances to the largest pill. The pill training is done without the parent present. The training should be done by a neutral person who can act as a coach and keep the child motivated. The skill should be presented as something new that the child can learn, such as brushing his teeth, tying his shoelaces, and combing his hair -- all things learned on the way to growing up.

When a child is not a good candidate for this technique, a behaviorally oriented psychologist may be able to design an alternative technique tailored to the child's individual needs. In this case, it is better not to make the attempt than to give the child a bad experience.

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