Sep 3, 2008

How to Administer Medicine to a Resistant Child



from wikiHow - The How to Manual That You Can Edit

If your child takes medicine daily, it can be challenging. Here are a couple tricks from to help you through.

Steps


  1. Tailor your approach to the age of the child. You can approach a 7 year old much differently than you can a 2-3 year old. Unless the 7 year old is behaving like a 2-3 year old. Reason with your older child, medication is important. Rewards are good for good behavior. The odd case of bribery is not out of the question either.
  2. Stop using liquid oral medication or chewables! They taste nasty and has too much saccharine and red dye to be good for anyone. Teach your child to swallow pills. This can and should be done as early as 4. (See tips)
  3. Have your liquid medication flavored. It costs $3.00 at most pharmacies and is well worth the money if it saves the fight. There are many kid friendly flavors.
  4. Use a chocolate chaser. For a child over the age of 1, you can give them a chaser of Hershey's Syrup on a spoon following the bad tasting medicine. Have it ready on the spoon so there is minimal lag time. The chocolate syrup is thick enough to coat the mouth and hide the bitterness of certain medicines. You can also use a softened Hershey's kiss.
  5. Find out why the child won't take the medicine (if your child is 5 or older). The child may have a legitimate reason that they are unable to effectively verbalize. Children may have innate reactions to ingredients without knowing why - MSG, nitrates for instance in food. The medication may well have a side-effect that makes your child feel bad - see Tips.
  6. Use this method as a last resort (only use this technique if not to take the medicine would result in potentially immediate, harmful possibilities):
    • Lay the child on the floor (this may require 2 people once the child gets wind of what's coming) with their head between your knees and their legs facing in front and away from you.
    • Use your knees to hold the child's head still. Be careful, do not squeeze, just hold. This gives you both hands to administer the medication.
    • Pinch the child's nose closed with one hand and squirt the medication into the mouth with the other. Don't let go until they swallow. When you pinch the nose they will have to open their mouth to breath, no choice. With the nose plugged they have to swallow or choke. Again, this is a last resort, temporary until better arrangements can be made.
    • Do not praise the child after using this technique - make it a non-plus situation. Giving it any credit will only encourage a repeat episode.



Tips


  • Begin when your child is not sick. A 4-year is perfect for this, physiologically their jaw is changing shape making swallowing adult food easier. Psychologically they want to do everything big, not be a baby.
  • Make it a game, working on it a little at a time. Start by showing the child a quarter and explaining that this was the size of your throat when you were a baby. Crawl around on the floor and find anything smaller than a quarter. This gives them reinforced images of the size. Never tell a child that a tablet is too larger for them to swallow, they may be more difficult due to shape or texture, but they are not too large. Unless it is bigger than a quarter, it will go down (exception is elderly people, or people with certain throat or thyroid conditions.)
  • Next trip to the store engage the child by asking them which they like better, Skittles or regular M&Ms. Let them pick them out and buy them a pound bag. Dump the candy into a special bowl just for them. Help the child separate all of the green candies and put them into a separate container. Put the original container away. Explain that they're learning to take grown up medicine so they won't have to have baby medicine anymore. Use the green candies for practice and when they swallow all of them they can have the remaining candy as a reward.
  • Practice over several days so they get the hang of it. Show them how to put the "pill" on the back of their tongue, take a drink of water and swallow. Go Easy they are actually teaching the tongue to do something different. When a child nurses or drinks from a bottle they push the tongue to the roof of the mouth to force the milk out and swallow. When they do this with a pill, it sticks, melts and tastes horrible. They have to learn to hold the tongue down when they swallow. Never push or berate them, praise them for trying and assure them that with practice, this will work. Follow through on your promise to give them the rest of the candy, they earned it.
  • You may find some resistance from the pediatrician to write for tablets or capsules. Most seem to be programmed to write for liquid forms. Most dosages can be converted or are already equivalent. Example: Amoxicillin suspension is 250mg per 5ml (teaspoonful), Amoxicillin capsules come in 250mg each. This is exactly the same and will have no therapeutic difference. Depending on the state, your pharmacist can convert the dose from one form to another (I have also done this, in reverse, for the occasional adult with Strep Throat.) If the state law does not allow a pharmacist to make a form change, they can and should call your doctor for you. However, this may take time, it is better if you have the prescription written for tablets or capsules to begin with (learn to read prescriptions.) Don't let the doctor tell you it makes no difference how they write it, because it does. Your pharmacist can also put a comment in the child's file as to preferences for medication form.
  • Imagine how much easier this will make it for you, no measuring spoons, no refrigerators, no fights because of bad tasting medicine, no more spills.
  • If your older child is not taking medicine and you suspect an underlying reason besides bad taste, do your homework. Ask your pharmacist for the package insert from the medication. This is different from the Patient Information Sheet you are given with each new prescription. This is a small paper attached to the medication by the manufacturer. You can also go to the Public Library and look it up in a PDR (Physician's Desk Reference.) This paper will give you all of the side effects and interactions with other medications, food etc. along with more information than you probably would ever care to know. Read this document with caution, it is written for the medical professional so don't let the information frighten you.
  • All medications have side-effects, some good, some bad. That is the point. Again with the example of Amoxicillin the good (desired) side effect is that the medication actually causes the infection to grow too quickly, (bacteriostatic) making it weaker, allowing our bodies own immune system to beat the bug. It does not kill the bug on its own. Some of the bad (less desirable) side effects it may cause are nausea, diarrhea, hives, yeast infection, shortness of breath, swelling of the throat and anaphalaxsis. These do not happen to everyone, they are only possible.
  • If you read this insert before taking medication, you may never take anything again. The same side effects rules apply to homeopathic medications as well. If the insert says that there is a 2% chance of a given side effect, don't discount it. Frequently patients are allergic or sensitive to an inactive ingredient in the medication IE a preservative or a dye. If your child has ADHD and is sensitive to red dye, then the red dye in the Amoxicillin suspension may bother them.
  • If you discover a possible side effect or interaction, contact your pharmacist and discuss it with them. They are the experts. They have the knowledge and experience to help determine if what you have discovered is likely, and offer any alternatives. I recommend taking notes so you can clearing communicate to the doctor in his or her own language.
    Only after having spoken with the pharmacist, contact your doctor. Be persistent, but be patient, doctors can not possibly have all of the side effect and interaction information in their head. A low incident reaction may require some research on their part. Do not be deterred by them discounting what you say. They may feel you are questioning their judgement and prescribing ability. Doctors are trained to be confident in their decisions which often flies in the face of making "the right decision." If you do not get satisfaction, consider changing doctors, or at the very least, get a second opinion.
  • Pharmacists carry the title Pharm D, doctor of Pharmacy. Their training specifically relates to you and your medications.
  • The correct medication, at the correct dose, at the correct time, for the appropriate condition, for the correct patient.
  • Counting pills and sticking stickers is only the beginning.


Warnings


  • Never break, crush, or dissolve a capsule or tablet without talking to your pharmacist. More and more new medications are in a delayed release form. This can become unstable if the structure of the pill is changed.
  • The result could be dangerous either due to too much medication too quickly or the medication never gets into the system at all.


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