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.

  1. 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.
  2. Demonstrate for your child before he tries. (If you find it difficult to swallow pills, ask someone else to teach your child.)
  3. Start by having your child swallow just water.
  4. Next, select the smallest cake decoration, such as the mixed decors (balls).
  5. 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.
  6. Have him take a big sip of water from a cup.
  7. Tell him to keep his head level or, alternately, to tip the head back.
  8. He should swallow the water and the “pill”.
  9. Finally, he should have another sip of water to keep the “pill” moving.
  10. 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.
  11. Allow as many trials as needed for success as long as the child’s frustration has not become excessive and praise for all attempts.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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

Techniques with Soft Food 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

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