Clinical Reference Systems: Pediatric Advisor 10.0
Helping Children Swallow Medicines
PREVENTING MEDICATION REFUSAL
- Approaching your child about medicine
- When your child is sick, he may need to take some
medicine. For liquid medicines, a plastic syringe is
easier to use than a spoon (with infants or
struggling children). If you have only a spoon, keep
a towel handy for spills.
- Approach your child in a matter-of-fact way with an
expectation that he will take it without resistance.
Some children respond better to an enthusiastic "Mary
Poppins" approach.
- Put your child in a sitting position and pour or drip
the medicine onto the back of the tongue. Don't
squirt it into the pouch inside the cheek, because it
won't go down when your child swallows. You must
place the liquid beyond the teeth or gumline. Also,
don't squirt it forcefully into the back of the
throat, because of the danger of its going into the
windpipe and causing choking. If you drip the
medicine in slowly, you can avoid gagging or choking.
- Medicines that taste bad - disguising the taste
Bitter medicines often lead to refusal unless some of
the following preventive steps are taken:
- Have your child suck on a Popsicle beforehand to
partially numb the mouth.
- Serve the medicine cold to reduce the taste.
- Mix it with a strong flavor (such as Kool-Aid powder,
chocolate syrup, or pancake syrup) to hide the bad taste.
- Dilute the medicine as much as possible (for example,
one dose mixed in 2 glasses of cold apple juice), if
you're certain your child can drink it all.
- Mix crushed pills with one of your child's favorite
foods that doesn't require any chewing. Consider ice
cream toppings (especially chocolate), honey, maple
syrup, applesauce, ice cream, sherbet, or yogurt.
Before adding the medicine, have your child practice
swallowing the food alone without chewing it (because
chewing would bring out the bad taste of the
medicine).
- Have a glass of your child's favorite cold drink
ready to rinse his mouth afterward - a sort of
"chaser."
- Praise and hug your child for all cooperation.
- The older your child is, the more you can ask for his
or her suggestions.
- Some children respond to being given complete control
of the spoon.
OVERCOMING REFUSAL OF LIQUID MEDICINES
Some children aged 1 to 4 years vigorously refuse to take
medicines even after you have tried to hide the taste. If
the medicine is not essential to recovery (such as most
nonprescription medicines for coughs, colds, and fevers),
stop giving it. If you are not sure of how important the
medicine is, call your physician for advice. If the drug is
essential (such as most antibiotics), use the following
recommendations:
- Be honest and sympathetic ("I'm sorry it tastes bad. We
can mix it with anything you like.").
- Be firm and give a reason ("You have to take it or you
won't get well").
- Give your child a time-out in the corner to think about
it. Every 5 minutes, ask him, "Are you ready yet?" If
15 minutes pass, take action.
- Immobilize your child. Two people are usually needed.
Have someone position your child on the lap, holding the
arms with one hand and the head with the other. You can
use one hand to hold the medicine and the other to open
your child's mouth. If you are alone, first wrap your
child with a sheet. Ask the office nurse to show you how
this is done.
- Be sure your child is not lying flat, to prevent choking.
- Open your child's mouth by pushing down the chin or
running your finger inside the cheek and pushing down on
the lower jaw.
- Insert the syringe between the teeth and drip the
medicine onto the back of the tongue.
- Keep the mouth closed until your child swallows. Gravity
can help if you have your child in an upright position.
However, swallowing can't occur if the head is bent
backward.
- Afterward, apologize and review the alternative: "I'm
sorry we had to hold you. If you cooperate next time, we
won't have to."
- Give your child a hug.
- Forcing your child in this way to take an important
medicine will teach him you mean business and will
eventually bring cooperation.
- Don't attack self-esteem (for instance, by saying,
"You're acting like a baby").
- Don't punish, as with spanking or yelling.
- If your child vomits or spits out the medicine, estimate
the amount lost and repeat it.
OVERCOMING DIFFICULTIES WITH PILLS OR CAPSULES
Some children have difficulty swallowing pills and capsules.
- The easiest approach is to convert the medicine to a
liquid form. Empty out the capsules or crush the pills.
You can do this with any pills except slow-release or
enteric-coated pills. (Check with your physician if you
are uncertain what you can do.)
- Slow-release capsules can be emptied as long as the
contents are swallowed without chewing. Since capsules
usually contain medicines with a bitter taste, the
contents need to be mixed with a sweet food.
- Pills are usually made as a convenient alternative to the
liquid form, and they may not taste bad. Pills can be
crushed between two spoons. Crushing is made easier by
first moistening the pill with a few drops of water and
letting it soften for 15 minutes.
- Place the pill or capsule far back on the tongue and have
your child quickly drink water or Kool-Aid through a
straw. If your child concentrates on swallowing (even
gulping) the liquid, the pill will follow downstream
without a hitch.
- If your child is over age 7 or 8 and unable to swallow
pills, he should practice this skill when he's not sick
or cranky. (Some children can't swallow pills until age
10, however.) Start with small pieces of candy or ice
and progress to M&M's. Try to use substances that will
melt quickly if they get stuck. If necessary, coat them
with butter first. Use the liquid and straw technique.
Once candy pellets are mastered, pills will usually be
manageable. For extra confidence, split the pill into
halves or quarters.
CALL YOUR CHILD'S PHYSICIAN IF:
- Your child vomits the medicine more than once.
- You are unable to get your child to take an essential
medicine.
The next time your physician prescribes a medicine, be sure
to mention that your child has this common problem. Your
physician may be able to prescribe a medicine that tastes
better.
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