Giving medication to a child can be a difficult part of the job for parents and challenging at times even for nurses and doctors. Luckily, our child life team is here to help make these moments easier and less stressful for all involved. Child life specialists work with patients and families to help minimize stress related to their health care experience and have special training in preparing children for medical procedures. Here’s what they recommend when giving liquid medicine, pills and eye/ear drops to kids:
Lay the ground work
- Let kids practice giving pretend medicine to you or to a toy. This allows you to model the behaviors the child needs to do and let your child know what to expect. Try statements like:
– “Your teddy bear is doing such a good job lying still for his ear drops.”
– “Let’s hold the doll in your lap while you’re giving her the medicine so she can lean against you” (this shows a comfort hold you can do while giving medicine)
– “Are we going to give your teddy bear a little medicine at a time or should we count to three and swallow all the medicine in the cup/syringe in one big gulp?”
– “Does your doll have her drink next to her for after she’s taken her medicine?”
The “medicine” can be imaginary or you can use water or juice in a medicine cup or syringe if your child wants it to be more realistic.
- Talk to your child about WHY they need the medication. Being open with children about how sometimes when we’re sick or hurt we need medicine to help reduce the pain or make bad cells (bacteria, cancer, etc.) go away helps children recognize how important medicine is. Encourage your child to think of taking their medicine as something they can do to get better – even if it tastes bad or makes them feel sleepy/funny/nauseous – and part of their job taking care of their body. There are a number of good books that you can read with kids to help them learn about germs, bacteria, illnesses, etc.
- Avoid saying things like, “Are you ready to take your medicine?” Not taking medicine often isn’t a viable, or safe, choice for your child’s health. Instead say: “It’s time to take your medicine.” Phrasing it this way takes away the idea that taking medicine is a choice.
- If age-appropriate, do, however, offer the child a choice about HOW they take the medication: “You can give yourself your medicine, or I can give it to you,” “You can take your medicine now or in five minutes when the timer goes off,” etc. Giving your child a choice validates their role and importance in their own health care. It also gives them a sense of control in a situation that may seem to be very much out of their control and can make a non-negotiable situation (taking the medicine) more tolerable.
- It may be helpful to ask your child if they want you to count to three before giving the medicine. In some cases, counting can help a child feel a sense of control (“Would you like to count before taking your medicine? “Would you like to count to 3 or to 5?”), although keep in mind that for others counting may heighten their anticipatory anxiety, so be mindful of how your child responds.
- Make medicine-taking part of the daily routine. Kids often delay things they don’t like to do, but if it’s implemented into the daily routine it can reduce stalling. A morning routine might include eating breakfast, taking medicine, 10 minutes of fun time as a treat/reward, then onto brushing their teeth.
- Giving a child a job during medicine-taking can be a helpful distraction. This can be as simple as having the child take a deep breath right before or reminding them that it’s their job to hold still for drops. A child could even give themself the medicine, if age-appropriate, or read a book to you during the process. (Note: Teens may decide they want to do the medication by themselves, and even on their own, but parents still need to ensure they’re taking it on schedule and that they’re taking the correct amount.)
- Relaxation techniques can be helpful as well. Deep breathing, stress balls, distraction (listening to music or a story) and relaxation apps like Relax App, Calm or Color Ripple for Toddlers may help a child feel calm and more relaxed. Infants could feed while drops are put in or play with age-appropriate toys.
- Avoid ANY shaming, blaming, forcing or pressuring the child. Shaming your child for being afraid or unable to take their medicine will likely only increase their anxiety surrounding medicine-taking, creating a dangerous cycle of failure and stress. Yelling, punishing or shaming a child for being afraid of something is strongly discouraged as it can quickly lead to poor self-esteem.
Ready to roll
When it’s time to give medication, always try to work with your child when they’re calm and alert. Turn off any unnecessary distractions, remain calm yourself and keep these specifics in mind:
- Allow your child to pick what they’d like to use to take the medicine. Preferences differ, and they could try a spoon, syringe or medicine cup. Syringes usually distribute the medicine further towards the back of the mouth so fewer taste buds get activated.
- If your child is concerned about the taste, see if your pharmacist or doctor is willing to flavor the medicine or change the consistency for easier swallowing or let your child pick out a special treat to mix the medicine with to help cover up some of the taste. They could mix it in applesauce, pudding, a milkshake, etc. It also helps for the child to pinch their nose closed beforehand as this will decrease the taste input from smell receptors in their nose. Sucking on ice or an ice pop numbs the mouth a bit which can help reduce the taste of the medication and sipping a warm or cold beverage (ideally not carbonated) or chewing a stick of gum, if age-appropriate, helps wash away the taste after they swallow. (Note: Read medication labels carefully as some food items reduce effectiveness of medication and should not be used to mix. Also, if medication is mixed with something, be sure your child drinks or eats the entire portion.)
- Try to make the medicine-taking process enjoyable if you can. Play a fun song while the child takes their medicine and follow with cheering or a dance party. Have special stickers or small prizes that the child can earn by taking their medicine. If you give the medicine through an oral syringe, use the empty syringe for water play once your child takes their medicine. (Safety reminder: Always keep medicine out of reach of children and throw away the empty oral syringes once you’re done playing with them.)
- Practicing can help a child learn to comfortably swallow a pill. You can start small, like with a sprinkle or a grain of sugar to build your child’s confidence in their ability to swallow. (Decorating sugar works well since it’s a larger grain and more colorful.) Work up to a larger chewable piece of candy: mini M&M’S, for example, then regular M&M’S, Skittles or Tic Tacs and aim to have the candy be about the same size/shape as the pill that needs to be swallowed. If they take capsules, use a Tic Tac, for example. If they take round pills, use an M&M. While some children may be developmentally ready to learn to swallow a pill as young as age 3, age 5 is a good age to start practicing as children in this age range have better control of their gag reflex and are better able to understand why they need the medication. Either way, by the time a child turns 10 they should be able to swallow pills as it can be difficult to find medication in liquid form for this older age group. (Note: Stress the difference between candy and medication so that your child does NOT think medicine is candy and always keep medicine safely stored and locked away.)
- Many children fear choking on the pills and if your child is fearful ensure them to trust their body. Our gag reflex protects our bodies from swallowing anything too large or harmful. It can help to remind your child that they swallow bites of food that are larger than the pill almost every time they eat anything. Take breaks if you need to and don’t expect to necessarily have 100 percent success right away.
- Be sure your child keeps their head in a natural position (sitting up with head facing forward) when swallowing a pill as it can be more difficult to swallow while looking up.
- Giving children options may lead to increased cooperation. As long as you check with your doctor/pharmacist to make sure it’s safe for the medication to be taken with food, let them pick what they would like to swallow the pill with (applesauce, juice, chocolate milk, a milkshake, etc.).
- If they’re having trouble swallowing, a pharmacist may be able to cut the pills. If the pill seems to be too large, talk with your doctor or pharmacy to see if the pill can be cut in half or changed to a different form (liquid, chewable, etc.). There’s no specific shape that’s known for being easier to swallow, but the smallest options are typically easiest as are coated versions (like a liquid gel or easy glide option). Sucking on ice or an ice pop to numb the mouth a bit can help make swallowing easier.
Creating a calm environment is helpful when eye or ear drops are needed. Pick a song your child likes or part of a movie or story and encourage them to stay lying down – and lying still – until the end of the song, scene or book.
For eye drops – Have the child lie flat on their back and close their eyes. Let the child pick which eye you do first and have them take a deep breath and let it out slowly as you place the eye drops in the inner corner of their closed eyes. When your child opens their eyes, the eye drops will run into their eyes naturally. Encourage your child to remain lying down and to blink to work the eye drops in. They can also slowly turn their head to the side to work the drops in. (If they’re turning their head, do one eye at a time.) Lying flat can be difficult for some kids, so it can help for you to lie next to your child once you’ve put the drops in and cuddle if they find comfort in this.
For ear drops – Lying on their side is the easiest position for ear drops. A child can play an iPad game or read a book while lying there. Let them pick which ear you do first, place the dropper/nozzle above your child’s ear canal, then:
For children under age 3 – Gently pull the outer flap of the affected ear DOWNWARD and backward to straighten the ear canal and look for the ear canal to open.
For children over age 3 – Gently pull the outer flap of the affected ear UPWARD and backward to straighten the ear canal and look for the ear canal to open.
Squeeze the dropper slowly to give the proper dose of medicine on the side of the ear canal. Ask your child to remain lying down for about 1-2 minutes so the medicine will be absorbed. Gently rub the skin in front of the ear to help the medicine flow to the inside of the ear. With some medications it’s OK to put a cotton ball in the child’s ear so they can sit up after the medicine is given. Check the medication label to find out if this is OK with the type of ear drops you are giving your child before doing this.
Finding what works
Keep in mind that everyone has a trick that ends up working for them. It may be using a baby spoon, making a “pill sandwich” (sandwiching the pill between two layers of ice cream or peanut butter), using a straw to drink cold water or taking a deep breath to relax before starting. It may take multiple trials to find what works but stay confident! And always keep it safe – make sure all medications are kept away from children and only given with parental supervision or oversight.
By Siri Garrett and Schoni Marchio, certified child life specialists