Pill Swallowing help


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President signs Pediatric Research Equity Act into law

On Wednesday, December 3, 2003, the President signed the following bill into law: S. 650, the "Pediatric Research Equity Act of 2003," which authorizes the Food and Drug Administration to require drug manufacturers to test drugs and biological products for their effectiveness and safety on children.

that's the first thing. here's the second:

Pill swallowing tips
by Clare Nugent, Dorie Geraci, Medication Safety Team Leader

According to experts, the recommended treatment for pediatric bipolar disorder is medication management. Most of the psychotropic medications that our children take are in pill or capsule form and even if compliance is not an issue, swallowing the various sizes and numbers of pills can be a challenge for any child regardless of age. Here are some tips, techniques and resources that may help you individualize a plan that works for your child’s specialized needs. By no means is one method recommended over another one. Try what works for your child and experiment with other methods when you need to accommodate a need by making a change in technique.

It is common for children to have difficulty swallowing tablets and capsules, but children over 5 years old can usually master this skill with a little practice. Teaching your child the technique of pill swallowing requires patience, so set aside a time when you won’t be disturbed and when your child is calm and receptive. Work in short intervals. Sit down at a table with your child and explain that you are going to help him learn a new skill. First, check your child’s swallowing reflex by asking him to take a mouthful of water and swallow it. If no water dribbles out of his mouth, your child is ready to start learning to swallow pills. (If your child has trouble swallowing water consult his pediatrician or speech therapist.) If your child has nasal congestion, have him blow his nose or use saline drops before attempting to swallow the medication.

1. The simplest way to teach your child to swallow pills is to practice swallowing candy cake decorations as pill substitutes. These decorations are available in the baking department of most grocery stores. Buy about 5 types, from tiny round sprinkles to large silver spheres so that you have “pills” of gradually increasing size. Also purchase some small candies such as tic-tacs or mini m&ms.

Once your child has swallowed water successfully, you can move on to swallowing candy sprinkles. Demonstrate for your child before he tries. (If you find it difficult to swallow pills ask someone else to teach your child!)

Place the smallest candy sprinkle on the middle of the tongue.
Take a good sip of water.
Keep the head level (don’t tip the head back).
Swallow the water (and the pill).
Have another sip of water to keep the “pill” moving.

If the pill doesn’t go down with the first swallow, just say, “keep drinking” and it will probably wash down with the next gulp. Let your child try as many times as he needs to until he can swallow this tiny sprinkle every time he tries. If he struggles, go back to just swallowing water, praise him for this, and calmly suggest that you will try again another time.

When your child has mastered swallowing the first size, move on to the next (don’t say bigger) size and so on. If your child is unsuccessful twice with the next size, let him return to the previous size “pill” before ending the session. This ensures that he ends the practice session with success. Limit each practice session to a few minutes or less as tolerated.

At the next session, start with the smallest sprinkle size and ask your child to swallow each size 5 times before moving to the next. When your child can reliably swallow the tic-tacs or m&ms, ask him to try swallowing an actual pill. Children need regular practice in order to maintain this new skill, so daily practice is important. Some children will need 6 or more sessions in order to master swallowing pills.

If the above method doesn’t work for your child there are other techniques that you can try:

2. Put the pill under the tongue and take big gulps of water. This will usually wash the pill out from under the tongue and down the throat.
3. 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 .

4. Put the pill right at the back of the tongue rather than in the middle.

5. Have a few sips of water before trying to swallow the pill, this should help the pill to slip down more easily.

6. Put the pill on the tongue then ask your child to take 3 gulps of water using a straw. When he swallows the water he will probably swallow the pill too.

7. Have your child try swallowing pills standing up rather than sitting down.

8. Try the pop-bottle method (This method reduces the tendency to gag on the pill.)

Place the tablet anywhere in the mouth.
Take a drink from a soda-pop bottle, keeping contact between the bottle and the lips by pursing the lips and using a sucking motion.
Swallow the water and the pill.
9. Try the two-gulp method (This method helps to fold down the epiglottis (the flap of cartilage at the back of the throat that folds down and 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.
10. 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.

11. You could give your child different liquids such as milkshake or yogurt drinks to take the pills with. Thicker drinks slow down swallowing and make the pill less likely to separate from the liquid. Some children can swallow pills in spoonfuls of peanut butter, applesauce, pudding or jello. Pills can also be tucked inside mandarin orange segments, and the segments can then be swallowed whole. Chewing a cookie or some crackers and popping the pill in the mouth just before swallowing can also be effective. Always check with your physician or pharmacist before your child takes his medication with anything other than water in order to avoid a medication interaction with food.

12. If your child isn’t ready to learn how to swallow pills explore alternative forms of the medication. Many medications come in liquid, sprinkle or chewable forms and some can be crushed or dissolved. Never crush, break or dissolve tablets or capsules unless your doctor or pharmacist has advised you to. Some specialized pharmacies can make up an elixir that contains a palatable tasting liquid containing the required medication if your child cannot swallow pills or capsules.

13. If swallowing pills becomes essential, e.g. a condition for entering a research study or if the pill only comes in pill form and cannot be cut or crushed, ask for a referral to a therapist who has experience teaching children how to swallow medication. Your child may learn this new skill more easily from a neutral figure than from a parent.

Be sure to reward your child’s efforts with praise even if he is not successful at each try The goal is to help your child succeed with a variety of techniques that will make taking daily routine medication less of a challenge for you both.


Getting Kids to Take Medicine www.kidsmeds.org/tipsfortaking.htm

hope you find these helpful.

kris /importthreads/images/graemlins/smile.gif


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the piece about parents being charged with munchausen syndrome by proxy was pretty scarey...they say that it hasnt been proven that parents can simulate bi polar in their kids...but they are being taken away anyway. sonja