COMMENTARY

Any Kid Can Learn to Swallow a Pill

Katherine Dahlsgaard, PhD

Disclosures

January 21, 2014

Editorial Collaboration

Medscape &

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Hi. I'm Dr. Katherine Dahlsgaard. I am lead psychologist at the Anxiety Behaviors Clinic at Children's Hospital of Philadelphia (CHOP). Today I will talk to you about what to say to your patients when they say, "Oh, but I can't swallow pills." I've worked at a children's hospital for a long time and I am amazed at the lack of information that is out there for healthcare providers on what can we do for children who say that they can't swallow pills. How do we help families, particularly when we have very limited time with them in the office? We have a short amount of time. We don't have time to train them to take pills. What do we do with them?

Fortunately, at CHOP we are working to develop that information and disseminate it so that it will be more easily available for healthcare providers. In the meantime, I will recommend my 2 favorite resources to give to families. It may surprise you to hear that, as a behavioral psychologist, I do not often treat pill-swallowing in the office, despite the fact that I get lots of referrals for these kids. The reason for that is that the 2 resources I am going to recommend are so good and so clear that you can give them to a parent and say, "Go home and follow these to the letter" and there is a high rate of success. I think that is great for physicians who have a short period of time with kids in the office.

The first resource is what I call "the short-and-sweet one." It is 2 pages, downloadable from NYU's Child Studies Center, and is entitled Pill Swallowing Made Easy. This is essentially a treatment manual for a behavioral program to swallow pills via shaping procedures using candies. Children start with the smallest candies -- tiny little jimmies -- and then gradually work up to Tic Tacs®, doing about 5 swallows each until he or she is comfortable.

I like this resource because you can print it out 60 times, have 60 copies in your office, and if this issue comes up you can say to a parent, "Here -- take this home and follow it to the letter." When I do that, it is rare that I have parents and families come back and say that it didn't work, because the instructions are so clear.

However, for families that do come back and say that it didn't work, I up the ante a little bit and I refer them to the "longer and sweeter" option -- sweeter, because, again, the children are swallowing candies but longer [because it takes more time]. This is a protocol developed by Dr. Bonnie Kaplan of the University of Calgary. It is available online for free, but rather than a 2-page written protocol, she provides videos of the training session. Briefly, as seen with the training sessions, Dr. Kaplan found that the position of the head when swallowing -- forward, backwards, down, to the right 45˚, or to the left 45˚ -- made a big difference in pill swallowing comfort. That is presumably because turning the head can open up the upper esophageal sphincter and make it less likely to spasm.

She did a study of 33 kids who followed the protocol and practiced for 14 days straight.[1] The protocol, essentially, is to swallow a candy in all 5 head positions and then the next day swallow a candy in all 5 head positions; eventually children will work up to larger and larger candies. They also find out which is their favorite head position. The researchers found that all 33 children were successful after 14 days of practice. You can direct your parents to go to that Website, as I do. Tell parents to watch the videos by themselves first so they know what is going on. They should buy the candies before introducing the program to their child. Parents should then watch all the videos with their child and then follow the protocol exactly. Bonnie Kaplan is so gracious to put that on the Web. She also made the 14 days of practice sheets downloadable.

Those are the 2 resources. I have rarely had a child or family come back after doing the Kaplan protocol and say, "We can't swallow pills." Usually it is quite the opposite: Children are very proud of themselves and parents are extremely happy.

Resources

Pill Swallowing Made Easy

Better Than a Spoonful of Sugar -- How to Swallow Pills

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