Pill Swallowing Tips for Children

It is common for children to have trouble swallowing tablets and capsules, but children over 5 years old can usually master this skill with a little practice.

Teaching your child how to swallow pills requires patience

Set aside a time when you won’t be disturbed and when your child is calm and receptive. Sit down with your child and explain that you are going to help him/her 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/her mouth, your child is ready to start learning to swallow pills.

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.

Swallowing Pills

Practice

The easiest way to teach your child to swallow pills is to practice swallowing very small candy like mini M&M’s or sugar cake decorations as pill substitutes. These decorations are available in the baking department of most grocery stores. Buy about five (5) types, from tiny round sprinkles to large silver spheres so that you have “pills” of gradually increasing size.

Once your child has swallowed water successfully, you can move on to swallowing candy sprinkles. Demonstrate for your child before he tries.

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

Next Step

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 size and so on. If your child is unsuccessful twice with the next size, let him return to the previous size 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&M's, 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.

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.

Alternative Suggestions

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

Pill location

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.
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.
Put the pill right at the back of the tongue rather than in the middle.
Have a few sips of water before trying to swallow the pill, this should help the pill to slip down more easily.

Additional Methods

Straw method: 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.
Stand up: Have your child try swallowing pills standing up rather than sitting down.
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.
Two-gulp method: 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.
Lean-forward technique: Capsules are lighter than tablets and have the tendency to float forward 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.
Different liquids: Try using a milkshake or yogurt drink to take the pills with. Thicker drinks slow down swallowing and make the pill less likely to separate from the liquid.
Food: 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.

Referral

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.