There are several situations that can keep kids from taking their medicine. Maybe your child dislikes the taste or perhaps the particular medicine is only available in pill form, but your child is not able to swallow tablets or capsules, yet!
Here are a few situations that may come up and tips on how to get your kids to take their medicines:
Even medicines specifically formulated for children, in a flavored liquid, can still have a taste your child will not like. Many liquids for children are fruit-flavored, usually grape or cherry, but some are citrus-flavored, such as orange or pineapple, or even peppermint, which many children do not find appealing!
When a child will not take a medicine because of its poor taste, it may be okay to mix the dose in a small amount of juice, formula, or breast milk. Other foods you can try include soft foods such as applesauce, yogurt, or pudding. This can help mask the unpleasant taste. It is important to test the taste yourself to make sure the mixture tastes better than the medicine. For instance, medicines that are salty or bitter do not blend well with sweet foods. You may need to use a pretzel or cracker after the dose of medicine to “chase” the taste away. Do consider what your child likes to eat or drink.
You should check with your regular pharmacist about your child's specific medication to see if mixing medicines with food is okay. Some medicines may not be absorbed by the body or they can lose their strength or their ability to work in the body when mixed with liquids or foods. For example, a dose of some liquid multivitamins may be added to a small amount of formula, milk, or fruit juice before being given. However if the multivitamins contain iron, they cannot be mixed with milk products because the iron will not be properly absorbed. It is important to check with your regular pharmacist for each individual medicine your child takes.
If your pharmacist says it's okay to mix the medicine with another liquid or soft food, be sure to mix into a very small portion of liquid or food-- small enough so you're sure your child will eat or drink the entire amount right away. The child will likely receive the entire, correct dose. Never make up "batches" of medicine mixed with foods or drinks and store the mixture for later use. This can cause the drug to become unstable and less effective.
Another method to help bypass the taste buds is to measure liquid medicines in an oral syringe and squirt the contents onto the side of the cheek. Many times this will help avoid the bitter taste buds on the back of the tongue. Be sure not to squirt liquid medicine onto the back of the mouth or near the throat--this can cause gagging or choking to occur. You can also try numbing the tongue first with a popsicle.
At times, parents and caregivers sometimes forget to shake suspensions (a mixture with particles distributed throughout a liquid) before measuring and giving a dose of medicine to their child. This can affect the taste and result in too much or too little medicine being given. The active ingredients can "sink" to the bottom of the bottle of suspensions. If the bottle is not shaken first, the dose measured may contain mostly water. And when you give the medicine towards the end of the bottle, you may end up giving too much medicine. This can cause unnecessary side effects. So follow the instructions on the bottle and shake suspensions well.
The medication is only available as a tablet or a capsule!
Many medicines only come as a tablet or capsule. Most younger children simply are not able to swallow these large dosage forms. First, check with your pharmacist to see if the medicine your child needs is available in either a liquid or a chewable tablet form. Chewable tablets should only be taken by children who have enough teeth to properly chew the tablet (for example, children over the age of 2 years). Medicines may also come in powder form that can be mixed with a liquid right before you give the dose.
If none of the other options are available, the tablets may be crushed, in some cases, and added to a soft food, such as applesauce or pudding. Some capsules may be opened and either sprinkled or mixed into a soft food or drink. It is important to check with your pharmacist first. Some medicines cannot be crushed, such as sustained-release tablets or capsules. Tablets and capsules with special coatings, such as enteric-coated tablets, should not be crushed or mixed with food, either. Crushing and mixing these medicines can affect the drug's stability, leading to decreased potency and effectiveness.
If a medicine can be crushed and mixed into a food or drink, be sure to mix for each dose individually and give the mixture to your child immediately. Again, do not mix up "batches" of the medicine in a food or drink and store it for later use. This can also affect the stability and effectiveness of the drug. Be sure to mix the dose in a small amount of food or drink -- small enough so you are sure your child will "eat" or "drink" the entire dose at once.
In some cases where a medicine cannot be crushed and mixed with food, or when your child still refuses to "eat" or "drink" the mixture, a pharmacist may be able to prepare a liquid mixture from a tablet or capsule form of the medicine. Very often, pharmacists can add a flavoring to the liquid, such as cherry syrup, to improve its taste. This type of preparing of medication is called "compounding". Some local pharmacies do compounding and others do not. Children's Hospitals around the country often know of outpatient pharmacies that can prepare special doses of medicines for kids. Even if you don't live near a Children's Hospital, they may be willing to prepare and mail a special prescription.
Help! How do I teach my child to swallow tablets and capsules?
Getting kids to swallow tablets and capsules can be a daunting task!! Some children can master the task after only one try, and others will need to practice for a while before they get the hang of it. The children who have difficulty often become frustrated with the process and give up. Children who are under 5 years old may have trouble swallowing pills. They are also at greater risk of choking.
As a parent, there are things you can do to make learning to swallow medicine a little easier. Here are a few tips that might be helpful:
One method involves:
1. Have your child place the pill (tablet or capsule) in his mouth and have him fill his mouth with water until his cheeks are full.
2. Encourage your child to swallow the water in as few swallows as possible.
3. The pill should go down his throat without him even knowing.
A second method involves:
1. Have your child place the pill under his tongue gently (without holding the pill down).
2. Have him drink water in gulps from a cup. Often the pill will slip out from under the tongue and go down the throat without the child realizing it has occurred.
It is recommended that most medicines be taken with water to help flush the drug down the throat and to help dissolve the medicine once it is in the stomach. However, water is often the most difficult liquid for children to swallow. Water is so "thin" and it rushes through a child's mouth so quickly that the epiglottis (the flap of cartilage at the back of the throat that covers over the windpipe when you swallow) may not have time to close fully. This could lead to choking. Rushing water in the mouth may also leave the pill behind when a child is trying to swallow.
Thicker liquids, such as milk, milkshake, or liquid yogurt can slow down the swallowing mechanism and may push the pill along more easily. Because some medicines should not be taken with thicker liquids or food, and only taken with water, it is important to check with your pharmacist first to find out which beverages can be used for your child's specific medicine.
Be creative. One doctor at a children’s hospital in Connecticut teaches his patients to use bread to make “pills” to train children to swallow pills.
Your child's posture can also affect how easily a pill is swallowed. Standing up is the best position to be in. Sitting down is also acceptable. Be sure not to give your child a tablet or capsule right before going to bed.
The ability of a child to swallow pills sometimes is affected by his medical history. Children who have had a lot of dental work often don't like the feeling of pills in their mouths. Children with a history of gastroesophageal reflux disease (GERD) also may experience more difficulty. Children with nasal congestion are also using their mouths for breathing which makes swallowing pills more difficult. In this case, blowing the nose or using saline drops or nasal decongestants before giving the dose can help make swallowing the pill easier. If your child suffers from one of these problems, ask your child's pediatrician or other health care provider about swallowing pills before trying to teach him on your own.
Children can be encouraged to take medicine by explaining how it can help them stay healthy or make them feel better. The ability to swallow medicine is a very "grown-up" thing to do, such as whistling or chewing gum, something they can continue to work on over time. Such an idea is often just what children need to encourage them to try and try until they succeed. Be sure to reward them with lots of hugs and kisses!
References:
Bates RD, Nahata MC. "Medication Administration: The Correct Way", Children's Medications- A Parent's Guide, Harvey Whitney Books Company, 1996,p. 6.
Isaacs, J. "Helping the Medicine Go Down", American Druggist 1999;216(6):37-41.
Peirce, A. "Giving Your Child a Medication", Parent's Guide to Childhood Medications, American Pharmaceutical Association, 1996, pp.13-24.
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Article written by pharmacists at KidsMeds, Inc. (June 2000)
http://www.kidsmeds.com Revised June 2008
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