Many children have trouble swallowing
pills. There are a variety of reasons for this
difficulty.
Some
children truly do not have the mouth and throat control to swallow a solid pill.
This can be seen in the very young child. It may also be present in a child with
a developmental delay that affects his ability to swallow or speak. If a child
cannot swallow a moderate mouthful of water without it dripping out of his
mouth, he may have a physical problem with the swallowing reflex. If you are not
sure whether your child has the physical maturity to swallow pills, consult his
doctor or a speech therapist.
Children may also have trouble with
pills for emotional reasons. They may associate pills with frightening medical
experiences. The pill may be a symbol of sickness or weakness. The child may
misunderstand what the pill is supposed to do. He may fear that it will change
his personality or cause frightening side effects. The pill may be the focal
point of a control struggle between parent and child. In such situations the
child may actively refuse to swallow the pill. If the child has mixed feelings
about the pill, he may agree to take it, but will gag and be unable to swallow
it.
Sometimes addressing the mixed feelings
about medication can help with the swallowing problem. A child may not be able
to verbalize all of his concerns.
If your child has mixed feelings about
the pills
- Talk to him about the medication and
why he needs it.
- Ask a member of his health care team
to explain the disorder and the way the medications work. Diagrams and
visual aids help some kids especially if there are take-home handouts.
- Find some kid-friendly books about
the condition or about taking medication. (Otto Learns about His Medication
is good for kids on stimulants.
- If the pill swallowing seems to be
part of a control struggle, take a look at how you and your family handle
conflicts. See if there are other ways for your child or teen to express his
independence.
Some
children are more sensitive to new foods and new textures. They have sufficient
physical control to swallow but need some extra training. They may need specific
instruction to gradually get them used to pills. Go to the baking section of
your grocery store and find the candy decorations. Buy about five different
sizes of items, ranging from the tiniest—the multicolored sprinkles—to
larger—Tic Tacs. Help your child practice swallowing the small candies. Put
one on his tongue and give him a cup of water. Once he has been able to swallow
the candy four or five times in a row, move to the next larger size. Limit each
practice session to about 10 minutes. Do not forget to limit the amount of candy
eaten too!
Not all children need to go through
this gradual process. Sometimes, giving the pill with a semisolid food makes it
go down easier. Applesauce pudding or yogurt make swallowing easier and can mask
a pill’s unpleasant flavor. A few kids may chew up a cracker and pop the pill
in the middle just before swallowing the mass of cracker. Practicing this
maneuver in front of the mirror can be a lot of “gross out” fun.
Liquid and Chewable Medications:
Sometimes we can avoid the pill problem altogether. Many medications come in
liquid, sprinkle or chewable form. . If the child objects to the taste,
pharmacists can often add flavoring. Be extra careful with liquid medications.
It is easy to measure wrong and accidentally give the wrong dose. Do not use an
eating spoon out of your kitchen drawer. When I prescribe liquid medications, I
prefer that patients or parents discuss measuring technique with their
pharmacist.
- Antidepressants: Several of the
Selective Serotonin Reuptake Inhibitors (Prozac, Paxil, Zoloft and Celexa)
come in liquid form. Paxil has a relatively palatable orange flavor but is
not the SSRI we usually pick first for children.
Celexa and Prozac have a mint flavor with a slight medicinal aftertaste.
- Stimulants: Adderall XR and Metadate
CD capsules can be opened and sprinkled on pudding and applesauce
respectively. You probably should not swallow amphetamines with orange juice
or other acidic juices. Methylin now comes as a grape-favored liquid.
- Mood Stabilizers: Lithium comes as a
syrup. Tegretol comes in a chewable form. Depakote comes in sprinkles. Some
antipsychotic medications come in liquid or suspension forms.
Some pills can be dissolved in certain
specific liquids. Years ago, Prozac came no smaller than 20 mg. When patients
needed a smaller dose, we told them how to dissolve the capsule in cranberry
juice—we called it Cranzac. Consult your doctor and your pharmacist before
attempting to dissolve or crush a pill. Dissolving or crushing some medications,
will change how the pills works.
Carol E. Watkins, M.D.
- Don’t give out your name, address, telephone number, school, passwords or other
personal information.
- Don’t buy anything on the Internet unless your parents say it’s OK.
- Don’t ever get together with someone you met online unless your parents say it’s
OK. Some people online may not be who they say they are.
- From “Prevention Online”
Internet sites
change frequently and the sites are written and monitored by many different people. Often
it can be stimulating to read about different points of view. We have included some sites
which present information from different perspectives. We cannot be responsible for the
opinions expressed on outside sites. Diagnosis and treatment should only be done by a
licensed professional. Some of these sites contain technical language and descriptions
which may not be understandable or appropriate for children.
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