Tips and Techniques for Pill Swallowing

By the age of 6 or 7, most children are able to swallow pills and some children as young as 4 can be taught this skill. There are many different methods and techniques to acquire the pill swallowing skill and no one method is recommended over another one. As a parent, you will need to use trial and error. See what works for your child and experiment with other methods. In all likelihood, you will find the technique that works for you and your child’s individual needs. Before starting, check that your child’s swallowing reflex is automatic and comfortable by asking him/her to swallow an average-sized mouthful of water without having any spill out from the mouth. If your child is able to do this without any coughing, gagging, or vomiting, proceed with trials of some of the most common methods:

Shaping Procedure

Shaping is a behavior modification term which means to teach a child how to do a difficult task by breaking the task down into the simplest task and then increasing the difficulty as the child has success. In the case of pill-swallowing the child starts with very small candy ‘pills’ and then moves to larger ones as she/he masters the technique. Although some of the best non-medication substances to use for practice are cake decorations and candies, experts advise not to refer to these fake ‘pills’ as candy during practice, since swallowing real candy rarely triggers anxiety and the child may not transfer the skill to real medication if he believes he is practicing on candy. In addition, most people typically chew candy and medicine should usually NOT be chewed.

Purchase a series of increasingly larger sized cake decorations, such as round candy balls called “mixed decors”, and candies to be used in the teaching technique, each larger than the next. Cake decorations come in many colors, but consider using only the white decorations, so that they look like medications.
Demonstrate for your child before he tries. (If you find it difficult to swallow pills, ask someone else to teach your child.)
Start by having your child swallow just water.
Next, select the smallest cake decoration, such as the mixed decors (balls).
Place the smallest “pill” on the tongue. Placement may need to be modified based on size, form, and degree of gag reflex. Most should be placed in the middle of the tongue as shown.
Have him take a big sip of water from a cup.
Tell him to keep his head level or, alternately, to tip the head back.
He should swallow the water and the “pill”.
Finally, he should have another sip of water to keep the “pill” moving.
If the “pill” doesn’t go down with the first swallow, encourage your child to keep drinking. More than likely, it will probably wash down with the next gulp of water.
Allow as many trials as needed for success as long as the child’s frustration has not become excessive and praise for all attempts.
If he/she struggles through each try, go back to just swallowing water, praise him/her for this, and calmly suggest that you will try again another time.
When your child has mastered swallowing the first size for a few trials, move on to the next size. Gradually increase the size of the candy—oblong sprinkles used for cake decoration; round, silver cake decoration; round, candy--approx. 1/8- to - inch in diameter; capsule-shaped candy, such as Tic-Tacs, and Mini-M&M’s.
If your child is unsuccessful twice with the next size, have him go back to the previous size before ending the lesson. This guarantees that your child finishes the practice session on a high note.
Sessions should last no more than 10-15 minutes, depending on your and your child’s tolerance level. Subsequent sessions should start with the last size your child was successful with before progressing to the next size. Your child may be able to progress through all the sizes in one session but it is also reasonable to expect it could take anywhere up to 5 or 6 more sessions before the skill is mastered.
When your child can reliably swallow the Tic-Tacs or M&Ms, you can ask him to try swallowing an actual pill. And remember, kids require the opportunity to practice in order to sustain this new skill.
Some children will enjoy tracking their progress through the different sized pills. Click here for a sample chart.

Using Solids or Liquids

Techniques with Liquids

Use cool, never hot, liquids. Washing down a pill with hot or warm liquids may cause it to dissolve before it gets to the stomach where it can be absorbed.
Try carbonated beverages. Sometimes swallowing pills with an ice-cold carbonated beverage (e.g., ginger ale, lemon-lime soda, sparkling water) can aid in transporting pills quickly and help with swallowing.
Drink before attempting to swallow the pill. Taking a few sips of water prior to attempting to swallow a pill can hydrate the throat and make it easier to swallow the pill. Tablets and capsules are harder to swallow when the child’s mouth is dry, which often happens when they are sick.
Let the pill float. Adding a pill to water or other liquid being held in the mouth may make pill swallowing easier.
Try the two-gulp method, which helps to fold down the epiglottis (the flap of cartilage at the back of the throat that protects the airway during swallowing). Place the pill on the tongue. Take one gulp of water and swallow it, but not the pill. Immediately take a second gulp of water and swallow the pill and the water together.
You could give your child different liquids such as a milkshake or a yogurt drink to take the pills with. Thicker drinks slow down swallowing and make the pill less likely to separate from the liquid.
Place the pill or capsule far back on the tongue and have your child use a straw to quickly drink water or juice. If your child concentrates on swallowing or gulping the liquid, the pill should simply follow along without difficulty.

Techniques with Soft Food

Some kids do well by gulping the pill straight down with a spoonful of soft food, such as pudding, yogurt or applesauce. Just drop the pill into the food and have your child swallow the whole thing without chewing. Another option is peanut butter. Place the pill in the middle of a spoon of peanut butter and let your child swallow it all at once.
A very popular choice is flavored gelatin, such as JELL-O. Take a spoonful with the pill, and it should slide right down your child’s throat. If this works, you can purchase pre-made JELL-O snack cups, which can be convenient for practicing.
Some parents have had luck by having their child first chew a cookie or cracker. When the cookie or cracker is chewed and ready to be swallowed, you can place the pill in and then the child can swallow the cookie right along with the pill. Don't have your child tilt his head back too far when swallowing as this can sometimes make it more difficult for the pill to go down.
This technique is sometimes accomplished with a small piece of bread. Have your child chew a small piece of bread, and just before he swallows it have him put the pill in his mouth and swallow it with the bread. This gets around the feeling he might have that he can't swallow without chewing. If he still feels the need to chew, he can chew the edges of the wad of bread prior to swallowing. Make sure the wad is not too big to be a choking hazard.
You can have your child practice swallowing mandarin orange segments. The texture of this fruit is ‘slimy’ which may help. Once he is able to do that, you can try to tuck the pills inside the mandarin orange segments and the segments can then be swallowed whole — with the pill embedded.

Caution: Parents should consult their child’s health care provider about any possible interactions between the medication and the type of soft foods they are using. Parents should also be careful to monitor the amount of food being used. Consuming too much of the soft food at one time could lead to choking.

More Tips and Techniques

Take pills while standing or sitting up. This can help the medication quickly pass through the throat and esophagus and into the stomach. If possible, parents should have their kids avoid lying down for 30 minutes after swallowing pills.
Do not rush while swallowing pills. Being relaxed can make pill swallowing easier. Having your child take a deep breath prior to attempting to swallow pills may help. Keep a calm and positive attitude and always be patient. Some children can't accomplish pill-swallowing until their late teens—and even some adults have trouble.
Eliminate distractions during the time when your child is taking his or her medication.
Be sure to heap plenty of praise on your child’s efforts, such as "Wow, you swallowed that right down. Good job!" Avoid negative comments like “You are such a baby. Only babies take liquid medicine.” These comments will not motivate children to try harder.
Chose where to place the pill:

Put the pill under the tongue and take big gulps of water. This will usually wash the pill out and down the throat.
Place the pill on the middle of the tongue and fill the mouth with water until the cheeks are full, then swallow the water. The pill should slip down too.
Put the pill right at the back of the tongue rather than in the middle.

Try alternate head positions:

Have your child take a mouthful of water and hold it in his mouth. Then he should look up at the ceiling. Next, put a small candy “pill”, such as a tic tac, in through the corner of his mouth, and swallow the water by taking a large gulp while continuing to look up at the ceiling. The candy should go right down since, like a real pill, it is dense and will go down first (it will sink to the back of the mouth). Once your child has mastered this technique with the candies, he might be ready to try this with his actual medication.
For children with a sensitive gag reflex, having the head back opens the trachea, which causes anxiety. These children may benefit from holding their chin to their chest and relaxing/breathing before tipping their head back when they are ready to swallow.

If your child’s medication is in capsule form, try the lean-forward technique. Capsules are lighter than tablets and have the tendency to float forwards in the mouth during swallowing. Leaning the head slightly forward while swallowing causes the capsule to move towards the back of the mouth where it more easily swallowed.
Blowing in his face, more specifically up his nose, causes him to swallow. Make sure you alert the child as to what you will be doing. Some children may be uncomfortable with the option.
Coat the pill with butter or cooking oil, or something to make it "slippery, although this can obviously produce an "oily" taste, which might be unappealing to kids.

Web Design and Development by Studio J

Disclaimer