A Tough Pill (for kids) to Swallow

Recently, my 10-year-old son had to take a prescription medication for a week. Because he’s getting bigger, his doc said it would be a large amount to swallow if he wanted the liquid, so we decided to try pills. Now, my son brags that he’s swallowed grapes whole (yeah, I know that’s a dangerous choking hazard; trust me, he’s had the lecture), but hand him a pill the size of a Tic-Tac and he gags up a soggy glob of medicinal goo. It’s exasperating for us both. I checked with his doctor and pharmacist and confirmed that the pill could be crushed and mixed with applesauce (not all medicines can be mixed with food so definitely check before doing this); we had that back-up option. Still, I kept thinking that my tween ought to be able to choke down a relatively small and slippery pill (after all, there are kids who swallow pills on a daily basis – kids with cancer, ADHD, mental illness). The question was how to make this happen.  Most experts say kids can swallow pills starting around age 5, so I started searching to see what tricks I could try with my 10 year old. What I learned is that we were making many mistakes like these:

Wrong way: Place the pill as far back on the tongue as possible.

Swallow success: For some reason, pills go down easier when placed in the middle of the tongue.

Wrong way: Tilting head back.

Swallow success: The NYU Child Study Center suggests keeping the head level though it doesn’t say why. My guess was that a backward head tilt could restrict the flow of liquids through the esophagus, but then I read that the head tilt actually opens up your airway. Pills need to go into the stomach via the esophagus, not into the lungs via the windpipe. The same experts also suggest having your kid lean forward if he’s swallowing a capsule because they’re lighter and tend to float forward in the mouth. Leaning forward actually helps move the capsule toward the back of the mouth.

Wrong way: Doing a dry run.

Swallow success: Have your child wet his whistle before he tries swallowing a pill.

Wrong way: Taking sips.

Swallow success: Your kid should take big gulps of water (at least two or three in a row) to help the pill go down. Another idea: place the pill on the middle of the tongue and have your child fill his mouth with water until his cheeks are full. Or have him take big gulps through a straw.

Some other great tips I learned:

  • Practice with sweets. The NYU Child Study Center suggests using round candy decorations found in cake decorating aisles. Buy various sizes and start with the smallest. Once your child’s mastered swallowing it 5 times successfully, move on to a bigger size until the last thing you offer is a Tic-Tac. I think Jelly Belly jelly beans, mini M&Ms (as well as regular ones) and Skittles could all work well too.
  • Try the under-the-tongue method. Place the pill under the tongue (not on top of it) and then have your kid take several big gulps of water.
  • Blow up his nose. Say what? I know… sounds very weird. But according to the experts at North Shore-Long Island Jewish Health System, blowing in your child’s face (specifically up his nose) may smooth the pill swallowing process.

What worked for us was a combination of techniques. Some days he could get the pill down by placing it on the middle of his tongue and filling his mouth with water. Once, the under-the-tongue method worked. The blow-up-the-nose method made us laugh and that didn’t help the pill swallowing process at all. Some days, I just took the spit-covered glob and mashed it up with some applesauce. The important thing was that he got the medicine he needed.

If you’ve been there/done that with your child, tell us how you helped him/her get the medicine down.