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How to Help the Medicine Go Down

by: Lisa Simmons

I have a confession to make. I'm a 40-year-old adult that cannot successfully swallow pills. Shocking...I know. However, it does give me a tremendous empathy for the many kids with special needs who must take one or multiple medication EVERY day. For many of these families, medication time is a daily struggle if not a daily battle!

For those of you who are already saying, "Oh it's so easy, you just ....". Plese stop. Every adult who has ever learned of my dilemma has shared his or her "no fail" strategy. Needless to say, they can't claim they are "no fail" anymore. I think one of the problems is this -- if you swallow pills easily it's really hard for you to explain how you do it. You just DO it. In an effort to understand and ease my own situation and that of others like me, I went researching. Here are my findings, both the common and the "more creative".

1. Eliminate the non-essential

This tip is high on my list. Any medication I can manage NOT to take is a step in the right direction. Here are a couple articles to help you decide when medications are essential:

** How to Get the Most Benefits with the Fewest Risks http://www.pueblo.gsa.gov/cic_text/health/takemed/medtips.html

** Psychiatric Medications for Children & Adolescents: Questions To Ask http://www.childhooddisorders.com/children_medications.html

2. How to swallow pills

First of all, not everyone CAN swallow a pill. 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 can also be the case in an older child with a developmental delay that affects his ability to swallow or speak. If your 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 aren't sure whether your child has the physical ability to swallow pills, consult his/her doctor or a speech therapist. Once that issue is cleared up ....

Everyone has a theory on how to "teach" pill swallowing.

Dr. William Sears recommends this approach:
"Instead of following the natural tendency and tipping the head back to swallow a pill, have your child bend her head forward. Place the pill near the tip of her tongue. Have your child bend her head forward so that the chin touches the chest. As she swallows, she should lift her head up quickly. The pill will rise to the top of the water (toward the back of the tongue) and wash down easily with the swallow."

A seasoned mom suggested this method:
"Get a couple of packages of those MINI m&m's. They are slightly bigger than many children's pills and taste much better. Talk with your child about how much better they feel on the medication. Explain that you want to help him or her TEACH THEMSELF to swallow meds. Give him/her the M & M's and a glass of milk/water, whatever s/he picks, and a couple of M & M's. Here's the bargain: If s/he can swallow an M & M whole, s/he gets the rest of the package. Let him/her try. Limit your training to 3 chances so you don't reinforce failure. If s/he sincerely tries and ALMOST succeeds, then give a portion of the treat and try again the next day."

And Christy Russell at the University of Kansas offers this idea:
"Sometimes children must take baby steps to master the art of the gulp. In those cases, it helps to sweeten their path. Start by teaching your child to swallow one of those Sprinkles used in cake decoration -- Blue, Yellow, Red, any color will work. Then move up to spherical silver sprinkles. From there, it's a short jump to introducing your child to fragments of red licorice whip snipped to less than half an inch in length. Your final stop before the jump to an actual pill might be a capsule-shaped candy like Tic-Tacs, then a vitamin."

NOTE: Although more than one expert recommends this approach (Dr. Sabine Hack outlines a similar approach in Pill Swallowing Made Easy http://www.aboutourkids.org/articles/pill_swallowing.html) it is important to note that it can encourage some kids to think of medicine as candy. If you are concerned about confusing a child with developmental delays or other cognitive issues, then this approach is probably not a wise choice for your situation.

Here are some other creative methods for getting a pill down:

=> Mix with food - The taste of most medicine is hard to disguise, but sometimes you can help "slide" a pill down or mix a capsule's contents into a food that hides it enough to help. Buttering the pill or burying it in a spoonful of jam can help it to slide down more easily. Other foods to try mixing with include: ice cream (especially flavors that already contain chunks of brownie, fruit, or nuts), whipped cream, cream cheese, cottage cheese, yogurt, apple sauce, peanut butter, pudding, grits, mashed potato, sweet potato pie, Jell-O, the slippery sauce from canned peaches, mashed banana, pancake syrup or chocolate syrup. Remember to use only a small amount of food.

=> Use a straw - Have your child put the pill on his/her tongue. Then using a straw, suck down three big gulps of water. With a straw there is no pill floating around in your mouth like there is if you just try to swallow a pill with a big mouthful of water.

=> Use a cookie - When the cookie is chewed and ready to be swallowed, pop the pill in and then swallow the cookie.

=> Add liquid - Dissolve the pill in a tiny bit of warm water and mix it with Cranberry juice.

=> Add a disguise - Take a small bit of Fruit Roll-up and wrap the pill inside it.

=> Try thicker fluids - If water isn't working try milk, fruit nectar, Carnation Instant Breakfast, Ensure, a milkshake, or one of the new liquid yogurt products. Thicker fluids create more bulk, making it harder for the pill to separate itself from the fluid during swallowing. Remember: If you are diabetic, use the sugar-free version of these beverages.

=> Reduce your mouth sensitivity - Spray or gargle with an over-the-counter topical anesthetic (normally used for sore throats) before swallowing or have your child suck on a Popsicle to partially numb the mouth.

=> A little at a time - Crush a chewable tablet between two spoons and add a few drops of water, making a paste of the medicine. Using your finger, place a small amount of the paste on the inside of your child's cheeks and allow her to swallow a little bit at a time.

=> Give it a little squeeze - Liquid medications can often be administered using an oral syringe. Draw the medicine into the syringe and give directly into your child's mouth. An oral syringe has no needle, just a tip to dispense the medicine. When you give medicine with a syringe it is always best to give it on the left or right side of the child's mouth to reduce the risk of choking.
http://www.netdoctor.co.uk/health_advice/facts/oralsyringe.htm

IMPORTANT: Every medication is unique and how you administer it may impact the way it works. It is always smart to check with your regular pharmacist before you decide to use any approach that differs from the instructions you were given with the medication.

3. Consider a pill alternative

I knew I wasn't alone in my struggle when major pharmaceutical companies started to make Adult medication in a variety of formats -- liquid, dissolving pills, sprays, patches, etc. Children's medicines also now come in liquid form, chewable tablets, dissolving tabs, and spray formulas.

=> Oral sprays can deliver vitamins, minerals, and other supplements directly into the bloodstream in a way that is quick, convenient and requires NO special skills.
http://ezwaysprayvitamins.com/

=> Another option is to offer medication in a lozenge or medication stick form. Lozenges are solid preparations that are intended to dissolve or disintegrate slowly in the mouth. They contain one or more medicaments usually in a flavored, sweetened base.
http://pharmlabs.unc.edu/lozenge/text.htm

=> Many medications are available in liquid form. You can talk to your care provider, nurse, or pharmacist about which of your medications can be prescribed in liquid form but here are some tips from Dr. Carol Watkins:

Antidepressants: Several of the Selective Serotonin Reuptake Inhibitors (Prozac, Paxil, Zoloft and Celexa) come in liquid form. Paxil has a relatively palatable orange flavor. It was difficult to find in pharmacies for a while but is now more available. Celexa has 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. Avoid swallowing amphetamines with citrus or other acidic juices.

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 pill works.

4. If all else fails . . .

When 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 custom liquid mixture from a tablet or capsule form of the medicine. Very often, pharmacists can also add a flavoring to the liquid, such as cherry syrup, to improve its taste.
http://www.flavorx.com/default.asp

This type of preparing of medication is called compounding Some pharmacies do compounding and others do not. Children's Hospitals around the country often have outpatient pharmacies that can prepare special doses of medications for kids. Even if you don't live near a Children's Hospital, they may be willing to prepare and mail a special prescription.
http://www.rxsolutionsonline.com/lab.html

As with much in life, the key seems to be creativity and persistence!

Copyright 2003, Lisa Simmons

About the author:

Lisa is the director of the Ideal Lives Inclusion & Advocacy Center supporting parents raising children with special needs. "We provide the tools, resources, and information you need to get results. Our focus is on making support simple and connecting advocates to answers."