A Tough Pill to Swallow: Helping Children of All Ages to Take Supplements or Medications

If you’re reading this, you’ve likely been there: perched dutifully next to your child, rubbing their back with one hand, tilting their head with the other, and reciting your own personal comfort mantra in an attempt to coax that pill down their tiny throat.

Though some kiddos find learning this new skill easy, many do not. And odds are that after several failed attempts, your poor kiddo is left with only a chalky mouth and tear-stained cheeks to show for their efforts.

There has to be a better way….

We promise – there is.

Luckily, there are a whole host of tips and tricks for helping your child to take their supplements or medications. As a Pediatrician and father, I have been through this many times. I have put together a list to help your children be successful, no matter what their age.

For Children 5 Years & Under 

If your child is under the age of five, you’ll want to ease them into this process. Whenever possible, we recommend administering supplements or medications in liquid or powdered form, or mixing them into food or drink.  Here are a couple of tips that may make the experience smoother for both parents and children.

The Syringe Method. Purchase a needleless oral syringe. Oral syringes are a safe, effective way to administer correct doses of supplements and medications. They can be ordered online or purchased at most local drugstores and pharmacies. What’s great is that they are large enough to handle with ease but small enough to fit comfortably in your child’s mouth. To administer, follow these easy steps:

• First clean your hands and the syringe with soap and hot water and place your child in a comfortable and secure seat.
• Fill the syringe with a much lesser dose of the supplement/medication than is recommended. (This way if your child doesn’t swallow all of the liquid, there’s less waste!)
• Gently work the syringe into their mouth, letting the tip rest in the back corner of their cheek. If necessary, you may squeeze their cheeks together to encourage their lips to open.
• Slowly squirt the medicine into the cheek area. Never squirt anything directly down their throat as it can cause gagging and choking. 
• It’s not uncommon for children to detect a flavor that they don’t like. This may result in a pout or whine but with the liquid that far back in their mouth, the chances of them spitting it out are less likely. Wait for them to swallow and then administer the remaining amount in portions that are appropriate for your child’s ability.
• If your young child is having trouble accepting the oral syringe, you can give them a pacifier to initiate a sucking sensation and then try again. If that still doesn’t work, poke a small hole in the nipple of a pacifier and slowly inject the liquid through it.

Crush or Open It Up. Most tablets can be crushed except those that are enteric coated or labeled as “time-release”, “extended-release” or “long-acting”. Crushing coated or time release pills can release medication far too quickly into their body. Either way, be sure to consult with your doctor or pharmacist and read the bottle carefully before you crush – or let your child chew – any pill! Here’s how to do it:

• There are many kinds of simple pill-crushing devices that you can use to turn your child’s pill into a fine powder. Amazon has a bevy of products ranging from under $10 to over $75. We recommend starting with a basic one like this one from Ezy Dose – it’s under $10 and gets great reviews.
• If you’re of the DIY mindset, grab a plastic baggy, place the pill inside, remove all the air and seal it up. Place the bag on a hard cutting board and use something heavy and flat that you have at home – like a flat meat pounder – and give the pill a few good knocks.  Then apply some downward pressure and twist the object in circular motions to break up any clumps into finer powder.
• For capsule supplements, simply work the two sides of the capsule apart and empty the powdered contents into your child’s drink or food.
• Once the supplement is opened or the pill is crushed, simply choose a beverage or food that your child loves most and mix it right in. Make sure to use a small volume of liquid so the child can easily finish it all. I have found that since many medicines and supplements can be chalky and bitter tasting,  mixing them into something with a thicker consistency and stronger flavor works best. Pre-made smoothies like Naked Juice and Odwalla have been most convenient and successful with our kids for this type of thing.  Although water or juice will dilute it, sometimes it won’t mask the taste or texture enough.
• If your child is generally more cooperative when food is involved, try adding the medicine or supplement to his or her favorite food.  Applesauce, mushed bananas, or avocado are options that have stood the test of time.  Again be mindful of how much volume you are expecting them to ingest.
• If the medicine or supplement is particularly unpalatable but still necessary to give, as a last resort we have had success mixing it into a teaspoon or two of honey (for children over 12 months old), chocolate pudding, or chocolate sauce.

Sandwich It.  Many supplements for young children are sold in “chewable” form. The problem we have found is that this does not mean that your child will necessarily like the taste or texture when they chew them! Here’s what we’ve done at home:

• Make a supplement “sandwich” by placing a chewable supplement between two small items that your child likes the taste of (such as 2 large chocolate chips or 2 small apple slices).
• Have them place the “sandwich” in their mouth and chew everything all together, which will help minimize the flavor or texture of the chewable supplement.

Children 6 & Up

In general, this is a good time to begin introducing your child to the concept of physically swallowing a pill. Whether your child is sick and in need of medicine or you are starting them on a supplement-based regime for overall health, swallowing pills can make life a lot easier.  Additionally, this gives us many different and higher quality options when it comes to natural medicines.

Start Small & Sweet. Because most children enjoy sweets,  your kids are likely to try this one willingly! Swallowing food is clearly natural and something children are accustomed to already so it’s a good transition step before swallowing pills.

• Get a package of small chocolate chips, organic jelly beans, natural “M&Ms”, natural breath mints, or very small pieces of cut up fruit such as mango or melon. Try to get younger kids excited by telling them they are about to do something really fun that big kids can do. Explain that this is how we learn to swallow medicine and other pills.
• Demonstrate for them first by placing the food into your mouth – ideally further back on your tongue. Show them exactly how you’ve done it. Then, take a big sip of water, slightly tilting your head back and swallowing.
• Now explain that it’s their turn to try. It’s very important to emphasize that they don’t chew the sweet treat, but instead try to swallow it whole. If it’s easier, tell them that they can suck on it for a few seconds to first taste the flavor.
• Then hand them their sippy or regular cup (straw optional) and ask that they take a sip – not so big that their mouth is completely full but big enough that it feels like “the pill is swimming in a pool”. Ask them to slightly tilt their head back and try to swallow.
• Reassure them that it’s no different than when they swallow liquid or food they’ve chewed and to imagine that the treat is not there at all.
• If they’ve tried, unsuccessfully, to swallow more than 3 times, they may be a bit frustrated. Have them take a break and try again later or another day. Maybe even let them have a piece of the treats to raise their spirits and reward their efforts.  Reassure them that you know they can do it because they swallow bites of food every day that are larger than this sweet treat.
• If you’re one of the lucky ones whose child takes to it quickly, then it’s time to move on to real pills.

Cut Them Up. Much like how you simulated the act of swallowing pills using small sweet treat, cutting up your child’s pills (when possible) into like size pieces can make the process that much easier. Let’s walk through the steps:

• Purchase a pill cutter. This is much safer and more accurate than using a knife on a cutting board. Depending on the size of the pill, either halve or quarter it.
• Now explain to your child that the time has come to try swallowing a real pill. Be as enthusiastic about the experience as you can be. Your child will realize pretty quickly that this is not a piece of chocolate but it’s still important to remind them. Establish the rules of not chewing and not sucking on (unless sugar-coated).
• Now repeat all of steps from the section above.

Swallowing Whole Pills. Once your child feels ready to swallow whole pills, we have two final tips that may help this process along.

The “Floaties or Sinkies” Method is one that we came across courtesy of our colleague John Douillard. Identify whether your child’s pill is a “floatie” or a “sinkie”. According to John, “Floaties are those capsules that will float in water” while “Sinkies are those heavier pills that will sink in water”.

• Put the floatie pill and some water in your mouth. Then, tip your head forward and the floatie pill will “float ” to the back of the throat, making it easy to swallow. At that point, you can either just swallow, or quickly tip the head back and swallow.
• Put the sinkie pill and some water in your mouth. Then slightly tip the head back – the sinkie pill will “sink” to the back of the throat. Then, just swallow.
• The main value, in each of these techniques, is that they both allow the pill to travel to the back of a child’s throat as quickly and easily as possible, making swallowing it that much simpler.

The “Water-vs.-Pill-First Method” helps you determine the way your child prefers to take his or her pills. Experiment with both techniques to discover whether the water or the pill more comfortably comes first.

• First, have your child place the pill on the back of their tongue and then ask them to take a sip of water (or juice). Do they swallow the pill easily or not?
• Next time, ask them to experiment again and take a sip and then have them tilt their head back slightly. Then have them place the pill into their mouth and encourage them to swallow. Does this way work better?
• As with most things, there is no right or wrong – it’s about discovering what works most easily for your child!

At Mindful Pediatrics, we believe that when it comes to swallowing pills, every child is different. Each one develops his or her own level of comfort when they are ready and in a way that suits them.

For that reason, don’t be discouraged if your 7-year-old refuses to swallow his fish oil capsule. Likewise, don’t be alarmed if at 4, your child is able to easily swallow their prescribed medication. There’s no right or wrong age or way to do it. The only thing that is necessary is your loving support and encouragement along the way.  Try to keep it light and fun.

Good luck and be well!