As a pediatrician and a mom raising five kids, I've had plenty of experience giving medications to children. Most children take their medicines. Some children may need cajoling or snuggling, or a dose of sternness or rewards (read: bribes). But the stuff usually gets where it needs to be.
But with some children, it's a different story. Medicines are met with firmly clenched teeth, or spill — or spray — out of the mouth because the child won't swallow. And that's assuming you can catch the child and get him to hold still. My daughter Elsa was the worst: after catching her and struggling to get the medication into her, she'd look at me angrily and vomit every last bit as if summoning it from her stomach.
So what do you do if you have one of those children? Here are my tried and true suggestions.
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At the Doctor's Office
Before you leave the doctor's office with a prescription, let your doctor know you have a problem child when it comes to taking medicine. There are actually several things your doctor can do to help, such as:
- Only give an antibiotic if truly necessary. Wait for the throat culture instead of taking antibiotics "just in case." Many ear infections go away without antibiotics. Talk to your doctor about delaying treatment for a few days. (Some researchers suggest parents be given a prescription to either fill or rip up, depending on the child's symptoms.) Many prescriptions are not completely necessary, so ask your doctor if there are other ways to treat the problem besides medication.
- Choose a medication that is given less frequently. Wouldn't you rather fight with your child once or twice a day instead of three or four times? Often, especially with antibiotics, your doctor has some choice of medications.
- Choose a medication that doesn't taste horrible. There are a few that are reminiscent of eating garbage, or worse. (The antibiotic clindamycin comes to mind.) Doctors don't always know how things taste, and there isn't always a choice of medications, but it's worth asking about this.
- Prescribe a more concentrated version so that you give a smaller amount. Many medications come in different concentrations. For example, if your child is being prescribed 200 milligrams of amoxicillin, that could either be a full teaspoon of the 200 milligram version, or a half-teaspoon of the 400 milligram version. Getting a half-teaspoon in is easier — but chances are your doctor won't think of doing this unless you ask about it.
- Consider other forms of the same medication. With children, we tend to think liquids — but sometimes crushing a tablet or opening a capsule and mixing the contents with a little bit of pudding or applesauce works better. Rectal suppositories obviously avoid the mouth entirely, but not many medications come that way.
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At the Pharmacy
When you get to the pharmacy, let the pharmacist know about your problem too, because he or she might be able to:
- Flavor the medication. Some pharmacies can add flavors (you get to pick) to make things taste a little better. Not all of them do it, and it doesn't always come out tasting exactly like bubble gum, for example, but it's worth a try if they offer it.
- Suggest a formulation your doctor didn't consider. Doctors know medications, but they don't always know all the different forms (capsules, pills, different concentrations of liquid) available, or whether the capsules can be opened or the pills easily crushed. Pharmacists have been tremendously helpful to me over the years. If the pharmacist has an idea that you think might work better, together you can call the doctor's office.
- Give you a medication syringe, if you didn't get one already at the doctor's office. It's the best way to give liquid medications in general, and especially important if you have a problem medicine-taker.
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Here are some tips for actually giving the medication.
- Use the right utensil. Using a regular spoon is asking for trouble. That's why a medication syringe is your best bet for giving liquid medication, especially for babies and small children. It gives the best control.
- If mixing a crushed tablet or capsule contents with food, use just a small amount of food. Chances are the food is going to taste at least a little bit (probably a lot) like the medicine, and you're not going to get more than one to two spoonfulls in your child. Aim for one.
- Take control of the situation. Exude calm and a no-nonsense attitude.
- Think chasers. Often it's the aftertaste that is the worst, so if you quickly follow the medication with a little bit of something really sweet — chocolate syrup is one of my favorites — it helps.
- When giving liquid medications to an infant or toddler, don't:
- Aim straight back. That increases the chance of gagging. Aim to the side instead.
- Give everything at once. Do a small amount at a time, waiting for swallows in between.
- Reward your child for taking her meds. I recommend hugs, hurrahs and extra nighttime stories, not necessarily toys.
If you have a baby or toddler who is a real struggler, here is a hold a nurse taught me. It's not pleasant, but it gets the job done:
- Sit down and hold the child across your lap with the head firmly in the crook of your left elbow. (Reverse all this if you are left-handed.)
- Put the child's right hand behind your back, and hold the left hand against his body with your left arm. Tuck his legs between your legs. You now have him immobilized.
- Squirt the medication into the mouth little by little — in between screams, if necessary. Remember to wait for swallows. If teeth are clenched, work the syringe between the teeth to the side. If your child is particularly strong-willed, you may need to reach up with the left hand (still holding the child's left arm down) and "fish-face" the cheeks so they are less likely to spit it out.
- Speak in a calm, soft voice throughout. Give lots and lots of hugs and snuggles afterward. Let your child know that you only did it because he really needed the medication.
If nothing works, call your doctor. Never, ever stop a medication without letting your doctor know. And be patient with your child; with time, it will get better. (Elsa stopped the vomiting well before kindergarten.) Of course, by then you will be fighting about something else...but that, after all, is parenthood.
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Claire McCarthy, M.D. is an assistant professor in pediatrics at Harvard Medical School, an attending physician at Children's Hospital of Boston, and medical director of the Martha Eliot Health Center, a neighborhood health service of Children's Hospital. She is a senior medical editor for Harvard Health Publications.