Sunday, July 21, 2013


Dear Goodjoan,

I have kids that can't swallow pills.  They are teenagers now and still can't manage it.  It makes getting them medicine when they are sick pretty difficult. Any suggestions for helping them learn to swallow pills?

In my house, being able to swallow a pill was right up there with the big milestones like walking and talking and graduating to an oral thermometer!  Some kids took to it pretty easily, others had a harder time.  With my brood, the 2 biggest hurdles were coordinating the balance between breathing and swallowing and simply getting past the anxiety that they were going to choke.

I started with the anxiety factor.  For some reason, my kids felt that pills were 'big' even little tiny ones and if they tried to swallow them, they would surely get stuck in their throats and kill them!  I asked them to start to pay attention when they were eating, because they'd realize that they were swallowing pieces of food that were much larger than a pill and without water, or drama, or choking!  I'd offer them pudding and ask them if they were swallowing it, or drinking it?  The same with gelatin, or gummy bears.  Did that have to be a liquid?  Of course not.  We're able to swallow lots of things that are 'bigger' than liquid!  Sometimes, just realizing that on a logical level made it easier to try to take a pill.

The other place we had trouble was the idea that you can have water in your mouth and still breathe!  For some reason, my kids felt like the moment something was in their mouth, they had to hold their breath. Typically, this is a normal reflex so we don't inhale and swallow at the same time and aspirate stuff into our lungs.  As we get older, we learn to control it better.  Kids sometimes don't realize they can control it.  This made swallowing a pill a race to get the pill down before they needed to breathe again.  Then of course, needing to breathe created another level of anxiety that caused the whole situation to escalate.  I asked them to take a sip of water and spit it in the sink. Then I'd move to take a sip of water, wait a second, then spit it in the sink. Moving up to take a sip of water, and hold it in their mouths while breathing in and out through their nose. Once they could do that comfortably, we were past the biggest hurdle.

Once my kids understood that they could hold something in their mouths and not choke, and that they had the ability to swallow lumpy things without choking, we were ready for practice.  I'd give them a glass of water and some of those mini M&Ms. I'd have them try different ways to swallow the M&M whole. Some kids wanted to put it way in the back of their mouths, then drink it down. Some put it on the tip of their tongues and moved it back themselves.  One liked to take  a mouthful of water, tip his head back, drop the 'pill' in and swallow it all in one gulp.  It didn't always go down on the first try, but if it didn't they could simply opt for plan B, chew it and swallow it, and not panic.  I'd have them practice once in a while, when they were not stressed out.  If they got panicked or anxious, we'd stop and try again another day.  Eventually, they could swallow the tiny M&M and I'd move up to regular M&Ms, or smarties, or gummy bears, anything pill sized but not so scary to chew in case they had to go with plan B!  With one kid, who had to take a fairly large capsule, I'd open the capsule, mix the medicine in pudding, then fill the empty capsule with sugar (to make it heavy) and have him practice with that.  The medicine tasted horrible so he was eager to be able to swallow it without tasting it!

I also found that for some situations, water is not the best way to get a pill down. Some capsules and coated pills can get tacky when they get wet and they want to catch in the back of the throat, rather than slip down.  For those pills, sometimes a spoonful of pudding worked better to coat it and let it go down without a fight.

We still have the occasional medicine problem, especially with particularly large or uncoated pills that start to dissolve before you can get them down! But we have our ways around that too!

If they really can't manage it, many medicines are available as liquids, though the amount an adult or teen needs to take to get the right dose is often pretty huge.  Some medicines can be turned into liquids, trans-dermal patches, or even lollipops or gummy bears at specialized 'compounding' pharmacies. Your pediatrician, or local children's hospital probably has a list of pharmacies that provide this service.

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