“I just can’t do it Mummy”, my son told me while spitting the
soggy capsule leaking bitter medicine into toilet
on his third failed attempt
to swallow the Amoxicillin 500 mg capsule. Laughter of his two elder brothers in
the background was not helping at all. They never had any problem swallowing
pills from a very young age.
My youngest son went to see Doctor with his Dad as I was
working. Prescribing doctor, dispensing pharmacist and his dad did not give a
second thought that swallowing 500mg capsule will be a problem for an 11 year
old. Amoxicillin is one of the medications which have several options available
from liquid to chewable tablets unlike most medication for chronic conditions. I tried to cajole him into swallowing
explaining to him that he just need to put capsule on the back of his throat
and swallow but it turned out to be more complicated than I thought. Each time
he tried he gaged and somehow managed to push it out into his cheeks. I am sure
that the sore throat caused by strep throat he was prescribed antibiotic for played
a part in his inability to swallow the capsule. Other reasons include children
being too sick or they have negative association of swallowing the pill with
the illness. I send my husband back to the pharmacy to get chewable tablets which
my son took happily.
As pharmacist we
suggest different creative ways to help children take pills if they are not
available in liquid or chewable formulations. From crushing tablets and mixing
with apple sauce or soda etc. to getting them specially compounded. Most
pharmacies compound only few commonly
prescribed medication and for other medications patient have to make a special
trip to a compounding pharmacy which is often expensive and inconvenient for
the parents. With personal insight I felt special empathy with the parents
whose children are prescribed medication only available in pills formulations for
chronic conditions. Surprising lack of information to help these parents and
their kids was big impetus to do literature search for useful information.
I was really delighted to find following two excellent
resources:
First resource “Pill
Swallowing Made Easy” consist of 2 pages instruction sheet from NYU’s
studies Center. This is basically a system
to help children learn skill of swallowing the pills using varying sizes of
candies. Children practice swallowing starting from the smallest “multi-colour
mixed décor” gradually increasing size to swallowing tic-tac. In each step kids
practice swallowing same size candy five times until they reach tic-tac level
and after that most children are able to swallow the actual medication. Instructions
are very clear and easy to follow. This protocol can be downloaded and printed
to hand out to parents of children who have difficulty swallowing pills.
Second resource” Better Than a Spoonful
of Sugar -- How to Swallow Pills” was developed by Dr Bonnie Kaplan and her
students at Behavioural Research Unit / Dept of Paediatrics, University Calgary
after more than 5 years of research.
Children learn swallowing the pill with help of five short training
videos and a downloadable 14 days self-report form. This protocol can be learnt
in 30 minutes with Practice recommend for 14 days to master the skill. This
method also uses small hard candies of varying sizes with a glass of water
gradually increasing the size of candy to swallow. Kids practice swallowing with
their head turned in 5 different positions:
to the left 45 degrees, to the right 45 degrees, to the center, up and
chin down. This is because Dr Kaplan found that head turned to different
positions help oesophagus open wider. During 14 days of practice kids learn to
swallow pills in 5 head positions to find and practice in their preferred position.
Language and instruction in videos are tailored to be easily learnt by kids
without the help of healthcare providers. Parents should learn and buy candies
before introducing program to the children. The protocol was successful in
teaching all 33 children who were able to participate in the study after 14
days.
My 11 year old son was proud of himself for quickly learning
to swallow pills with help of these resources. Feedback from most of the
parents I gave hand out or directed to the website has been great too.
Mah Talat, R Ph, B.Pharm, APA, Administer Drugs by
Injections
Pharmacist, OpenDoor Team, www.OpenDoor.cc
LinkedIn: http://ca.linkedin.com/in/mah-talat ,Calgary, Alberta, Canada
Written by Unknown
OpenDoor aims to provide Health Awareness. l OpenDoor is a platform used to Learn and Coach.
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