How (and why) to teach kids to swallow pills

Children as young as four can learn how to swallow pills, which is good for them, their parents, and the planet, says a new practice paper in the BMJ. While healthcare professionals often default to liquids when prescribing for children, there’s evidence that pills can be better. The paper suggests children who are 10 and older should be prescribed pills by default and that healthcare providers should ask about their children’s pill-swallowing ability at any age. Children who have chronic diseases that require long-term daily medication or who need to take long-term courses of bad-tasting oral antibiotics are most likely to benefit from it. Some adults also have trouble swallowing pills, which can be helped by the same techniques used for children.Read: Long COVID in kids: What do we know so far?Pills usually have less packaging and come in smaller, lighter packets. There is less wasted medicine from short-term prescriptions since pills can be dispensed in exact doses, while liquids are dispensed in whole bottles. And since they don’t require syringes or spoons, there is less waste. They also have a longer shelf life and don’t need to be kept in the fridge, using less electricity and making them less likely to be tossed because they were stored incorrectly. That likely gives them a smaller carbon footprint, though exactly how much smaller hasn’t been studied. Liquid medications are also more likely to be dosed incorrectly. Two studies cited in the BMJ support this. One, published in 2022 in the Journal of Clinical Nursing, found that healthcare providers in two Dutch hospitals were more likely to make dosing errors with liquids than they were with pills. And parents are even more likely to do so. A randomized controlled trial published in Pediatrics in 2016 that looked at 2,110 U.S. parents asked them to measure out liquid medications. They found that more than 84% made a dosing error, and 21% had at least one dosing error that was at least two times larger than the intended dose. Finally, liquid medications are more likely to taste bad—which can lead to non-adherence to drugs—and can contain sugar, colourings, and preservatives, which can lead to cavities. Modified-release liquids are also rare so that liquids can lead to increased dosing frequency and doses being needed during the school day. Read: Creating kids’ health info targeted for different cultural groupsChildren who don’t have swallowing problems can be taught to swallow pills when they’re four years old or older. Healthcare professionals can help both children and adults learn how to swallow pills.There are several Canadian resources available. The Alberta Children’s Hospital Research Institute and the University of Calgary released a series on YouTube that shows Dr. Bonnie Kaplan, a research psychologist and Professor Emeritus Cumming School of Medicine, explaining how to teach kids to swallow pills. The program centres around teaching children to swallow using small candies, with a focus on head positioning. Hamilton Health Sciences also has tips on swallowing pills, including a video from Heather McKean, a child life specialist at McMaster Children’s Hospital in Hamilton, Ontario. It includes a chart of the five levels of candy that children can practice swallowing, working up from sprinkles to Skittles.Read: Study shows significant risk of major drug-drug interactions in outpatient children

How (and why) to teach kids to swallow pills

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