4-20 pill tongueAs adults, many of us take or swallow pills out of necessity to manage or prevent a chronic health condition. From a vitamin to even a life-sustaining medicine, you probably don’t hesitate or panic when swallowing the pill, even the biggies. But knowing how to swallow medicine isn’t something that just happens, often it’s a learned skill that may vary widely in regards to timing. During my education I was trained to think that once children hit double digits (age 10 years) it’s appropriate to think of them as “capable” of swallowing pills. But new findings published in Pediatrics cite research demonstrating that learning how to swallow a pill may be easier for younger children to master before they’re facing anxiety that can come from having to swallow something whole. Bottom line in the research: although many children struggle with swallowing pills, five studies reviewed find various techniques to support children with pills really do work! Mastery is possible here, but anxiousness about pill-taking spans childhood for some. Unease about pill taking can be a real barrier in treatment adherence both for children and teens with chronic health conditions.

Pill-swallowing may not come “naturally” to your child. A 2008 survey found more than 50% of children, by parental report (children from birth to age 26), were unable to swallow a standard size pill at some point. This complexity in pill-swallowing or refusal of medicines can be a once-in-a-while battle or a daily barrier at home. Many important medications are taken orally and the illness experience for parent and child is much more stressful when this challenge pops up.

Interventions Do Help

Five interventions were reviewed in the research and all of them proved beneficial for children:

  • Two behavioral intervention studies saw 58% success & 95% success respectively when teaching and coaching children through education on how to swallow a pill.  These studies used techniques starting with tiny placebo pills followed by incremental increases in size until they reached regular-sized tablets. Children learned proper sitting up, tongue placement and using a gush of water to swallow the pill.
  • A separate study gave children instructions with the cup they would be taking the medication with. This had a success rate of 83%.
  • A lubricated flavored spray used in the throats of one group of kids had a 63% success rate in overcoming challenges swallowing.
  • Even teaching children the different positions in which they can hold their head while taking the pills had a success rate of 80%.

Tips For Parents For Supporting Pill Swallowing

  • Start early! Studies have shown success in teaching children as young as 2 years-old how to properly swallow medication. Some of the behavioral studies mentioned above found that younger children (4 – 5 years-old) needed less training to nail down the technique than their older counterparts. It may not behoove you to wait until the kids are in “double digits” to ween them off chewables & liquid medications if daily medicine is an important part of their health care and support.
  • Keep the experience positive. One of the reasons it may be harder for older children to learn how to pill swallow is the anxiety they have around the action. A negative experience or negative reinforcement with pill swallowing (belittling, punishment, threats) can stick with a child for life and may do little to improve confidence in the skill. I have a particularly wretched memory of not being able to head off to a day of downhill skiing with classmates until I was able to swallow a horse-sized pill at the breakfast table.
  • Consider practicing with candy. Before you need the medicine, it can be helpful to get your child ready using different sized candy pieces. My friend, Dr. Natasha Burgert, wrote an article on this a few months back leveraging Halloween candy for education. Just be careful medicines in your home don’t get confused for candy and of course keep medication up and out of reach around the practice sessions.