Many children have difficulty in swallowing pills. They may be unable
to perform the necessary reflex, they may be feeling too sick, or they
may have unpleasant associations with pills and illness. Many desperate
parents have coaxed, wheedled, cajoled and bribed their children to
take their pills. They’ve mashed pills in apple sauce or bananas, diluted
them in soda, and tried other creative ways to disguise them. But sometimes
pill-taking becomes a battleground and compromises the child’s health.
Parents, however, can help children learn to swallow pills automatically.
The secret lies in patience and in a system that teaches the skill by
using gradual steps with candy “pills” of different sizes.
Multi-colored round candy balls
called mixed decors found in the cake-decorating section of a supermarket;
Be sure your child is capable of an automatic swallowing reflex.
To assess this, make sure that the child is able to swallow small
amounts of water without difficulty. Have the child take a mouthful
of water (not so much that his cheeks are full) and attempt to swallow
it without having any dribble out.
If there are no problems with swallowing water, have the child swallow
one of the multi-colored round candy ball “pills.” Some children may
not need to start with the smallest size. The child should begin with
the appropriate size candy “pill” that he can comfortably swallow.
Starting with a bigger size enables the child to move up more quickly
without wasting water swallowing nothing. Tell the child to place
one ball as far back on her tongue as possible, take a drink of water
from a cup (not a fountain) and swallow the “pill.” The child can
have as many practice trials as she needs. Most children find swallowing
these balls surprisingly easy, so the first attempt is almost always
a positive one. Praise the child for both effort and success.
After five consecutive successful attempts, the child may move on
to the next size candy “pill.” The candy pill levels are:
the multi-colored mixed decors
small silver decors
larger silver decors
1/2 of a cinnamon or fruit décor
whole cinnamon or fruit décor, and
Practice trials should be given at each level.
If the child is unable to swallow a candy “pill” five times in a
the procedure using the same size candy pill (even if the child has
swallowed the candy four times in a row and then failed on the fifth
try). Sessions generally last 10 to 15 minutes. However, it’s not
advisable to prolong the sessions so that the procedure becomes aversive
to the child. Consider the following factors:
If the child moves to another size candy pill and is not successful,
return to the previous size pill before ending the session, so that
the session ends with success.
In subsequent sessions always begin with the first size candy pill
used at the first session. If the child swallows it easily on the
first attempt, progress directly to the next size, and so on. If the
child is unable to swallow the pill, move to the size below that.
Give practice trials, using a criteria of 5 successes before trying
the size that the child was unable to swallow again. Some children
move through all the sizes easily in one session. Others may have
more trouble and move up slowly over 2 to 6 sessions.
Progress from the candy pills to actual medication. It is rare that
a child progresses through the shaping program through the tic-tac
level and then has difficulty in swallowing the medication.