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.