Sixty-four online fora discussion threads and four blog posts, representing 464 unique sender names, were identified (Appendix 1). Most postings were from mothers, many using pseudonyms, the earliest posting was 2004. The three major themes identified; administration difficulties, administration techniques and role of health care professionals (Table 1) are discussed in detail below.
Child’s resistance to administration. Most young children resisted eye drop administration with age appropriate psychological and behavioural responses. They expressed distress and fear, fought, screamed and cried, shutting their eyes tight to resist eye drops instillation.
‘Every time it's her screaming and crying murder! I bet someone walking by would think we are beating her!!! For eye drops!!!!’ (F2, C)
‘It is such a nightmare to get her to take them she fights us and scrunches her eye so tight there is no way the drops go in.’ (F8, A)
Parents often reported how the immediate discomfort of the eye drops contributed to the child’s reluctance.
‘The drops burn and hurt, so he will instinctively fight those drops. Plus they take a while to work which means a prolonged battle.’ (F14, AZ)
Parents’ reluctance to administer. Many parents also discussed their own discomfort as the administrator of eye drops; they alluded to feeling ‘horrible’ and ‘cruel’, and were reluctant to perform this task. One parent said,
‘I'm having to employ the pin-her-down and use ‘prise eyes open’ tactic now. It's horrible, I hate having to do it!’ (F3, M)
Parents similarly expressed fear that they might hurt their child, for example:
‘We feel terrible about that and worry that she might get hurt thrashing about as she does. It is just horrible and we still have some more days to go.’ (F15, E)
Using force and restraint. Parents described utilising force to administer eye drops. The methods of restraint employed were numerous; they described techniques that enabled administration when single-handed or when assisted by another adult. For unaccompanied administration the ‘leg-over-child’s arms’ method was frequently used:
‘I put him on the floor (I was alone most of the time) and kneel over him, with his legs through mine and my knees pinning his arms to his side. I then had both free hands to use - one to hold eye open and one to put the drops in! … I felt like a real bully!’ (F8, MK)
‘With great bloody difficulty I sit on the floor ….., lay him back with my legs over his shoulders, holding his eye open with one hand and doing the drops with the other. Walah! Worst experience ever. *Bows*. I have tried every other way and it’s not as effective, so I’m stuck with the mean mummy way.’ (F5 , LS)
There were other, more sophisticated, methods of restraint described, including the ‘burrito method’ to swaddle the child so that their arms are trapped. One parent said,
‘I started wrapping him up in a bath towel like a giant baby burrito. Then, I lean over him, slide my arm under his head, and put the drops in the corner of his eye.’(F15, AZ)
Show and tell. Some parents suggested gentler approaches to facilitate of eye drop administration, such as demonstrating on toys and getting the child to role-play giving medication.
‘So far the demonstration has fascinated him but doesn't stop his panicking when we put the drops in him. He even "gives" Daddy, Mommy, and Elmo the drops. Oh well, even if not all of the medicine gets in there it seems to be working.’ (F7, AY)
For a child at the age of understanding parents might try to explain why the eye drops were needed. One parent wrote,
‘I'm finding more and more that [Child] understands what I'm saying even if she can't communicate back very well and if I explain exactly what is going to happen in advance … then she usually has no problem at all.’ (F3, FY)
Other parents recommended praise or reward when the child cooperated.
‘Try giving him a lollypop as a reward and to distract him from the pain and taste. … Or let him pick a treat after he does the drops.’ (F3, JM)
Minimize child’s distress and awareness. Parents used distraction of many sorts (entertainment, games and play) to minimize the child’s immediate reactions to eye drop administration. Some encouraged the child to watch TV so they would not see the eye drop bottle approaching. Others achieved compliance by putting the drops on closed eyes, as described here:
‘Did you try letting him lie down with his eyes closed? Incline his chin back a bit and put the eyedrops in the corners of his eyes...then tell him to open his eyes … It helped that they couldn't see the drop coming!’ (F14, JH)
Alternatively, parents waited until their child was asleep then lifted the eyelids and inserted the drops.
Other management strategies. Some parents ‘gave up’ (their own words) on instilling the eye drops to their child because of the inherent difficulties as well as believing their child’s eye problem would ‘clear up on its own’ within a few days.
‘We gave up. [Child] had pink eye with his last ear infection and the urgent care doc prescribed eye drops that we were supposed to give every 4 hours. I called my regular doctor and asked if it was really necessary. And pink eye with drops will, on average, clear up in 3.4 days and without will clear up in 4.5 days.’ (F2, SK)
Other parents adopted alternative treatments, for example cleaning with ‘breast milk’, or bathing the child’s eyes with ‘salt water’, ‘warm water’, or ‘cold tea’. Others recommended asking for ointment rather than drops, or keeping the eye drops warm to reduce stinging.
‘I expressed breastmilk into a clean bowl, dipped in cotton wool and then wiped over each eye several times a day. Cleared up in around 3 days if I remember rightly.’ (F4, FT)
‘It did help to use warm drops. I kept the bottle in my pocket or bra so it was body temperature.’ (F15, BT)
Role of healthcare professionals
Parents rarely reiterated any professional advice they had received on eye drop administration, instead they shared their own experiences and the solutions they had devised unaided.
Diagnosticians and prescribers. Parents mentioned health care professionals mostly in the context of diagnosis or prescribing treatment.
‘[Child] has mild conjunctivitis in his eyes. The doctor gave him some eye drops to use 2 times a day for 5 days.’ (F8, FF)
‘Go back to the doctor say it is impossible and ask for Fucithalmic it is more of a cream than an eye drop, so easier to apply but also only needs to be applied a few times a day.’ (F16, A)
Guidance on eye medication administration methods. Rarely were health care professionals cited as a source of advice on eye drop administration. When professional advice was shared it emanated from a range of professionals; doctors (general practitioners and specialists (ophthalmologist, paediatricians), nurses, paramedics and pharmacists.
‘A recent advice from an eye specialist for giving eye drops to my toddler - if you put enough drops onto the eyelashes of a close eye, when the eye is opened, the drops will wash in …’ (F16, NE)
Unlike accounts of advice from other health professionals, the advice form nurses combined advice on administration with tips on restraint, perhaps reflecting their greater professional involvement in giving treatments.
‘The nurses in the NICU showed us how to do it. You have to kind of pin the baby's head so they can't move, hold the eye drops in one hand ready to use them, use your thumb and index finger of the other hand to open their eye lid and hold it open while you squeeze the eye drops into the inside corner of their eye.’ (F2, TJ)