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Most school-aged children are able to learn to swallow tablets and capsules
In general, children are able to learn to swallow tablets or capsules from approximately age six years, and most master
the technique on their own by age ten years. Some children, particularly those with chronic conditions requiring daily
medicines, can be taught to swallow pills at a younger age.
Parents frequently report barriers for children learning to swallow tablets and capsules, however, these can often easily
be overcome. For example:
Anxiety – Children who fear swallowing pills are likely to be tense when attempting to do so, therefore
making the process more difficult. This tension, particularly in the throat, neck and chest can make the child feel like
they are having trouble breathing which may, in itself, cause further anxiety. Learning strategies to swallow tablets
and capsules effectively, and practicing these techniques, can help to reduce the child’s anxiety and make them feel more
relaxed, therefore increasing their chance of success. Children who are anxious about swallowing medicines often have
parents who are also reluctant or unable to swallow medicines themselves. Therefore it is important that parents lead
by example and demonstrate that swallowing pills or capsules is easy.
Strong gag reflex – Children who are fussy eaters or who gag frequently on food and drink can often
struggle with swallowing medicines. Getting the child to take a deep breath before inserting a tablet or capsule in their
mouth can help them to suppress their gag reflex.
Texture, size and shape – The size and shape of the tablet or capsule, and the nature of the coating
can affect the ease of swallowing. Using yoghurt or a thick drink, such as a milkshake, may help to reduce a child’s awareness
of a tablet or capsule being swallowed.
Techniques for swallowing tablets and capsules
There are many techniques for swallowing tablets and capsules, and it is appropriate for children to find one which
works for them. In some circumstances, such as when a child needs to take ongoing medicines, it may be appropriate to
train them to swallow tablets and capsules, e.g. using lollies (see: “Practice makes perfect”). A
study of 33 children aged 2 to 17 years with pill-swallowing difficulties found that after 14 days practice, all children
were able to swallow tablets or capsules.1
In general, it is best not to throw a tablet or capsule towards the back of the mouth. This is because it can actually
make swallowing more difficult.
A recommended technique for swallowing a pill or capsule is to:
- Ask the child to have a drink of water or their favourite drink to moisten their mouth
- Place the tablet or capsule into the centre of the child’s mouth
- Ask the child to take a big sip of their drink, and then swallow
Yoghurts and thick drinks, such as milkshakes, can help ease tablets or capsules down. Using a straw to drink, with
a tablet or capsule already in the mouth, may also help by getting the child to concentrate on the suction of the straw
rather than thinking about the tablet or capsule going down.
Another technique is to put the capsule into a small spoonful of apple sauce or ice cream. This can help capsules to
slip down the throat more easily.
The physical properties of capsules may cause them to float in the mouth when taken with water. Leaning forward when
swallowing can help the capsule go down.2 This technique may not be comfortable for everyone, but some children
may wish to try this:
- Ask the child look down at the floor instead of up at the ceiling
- Slip the capsule into the centre of the child’s mouth.
- Ask the child to take a big sip of their drink while still looking at the floor. The capsule should float to the
back of the child’s mouth and roll down their throat with the drink.
Other options for administering medicine
When children cannot yet swallow whole tablets or capsules, an option could be to crush a tablet or empty the contents
of a capsule into food or drink. Some tablets or capsules can be compounded into a suspension, but there can be concerns
about stability, bioavailability and dose accuracy.
This is not possible for all medicines, for example long-acting medicines and those with special coatings cannot be
crushed or opened, and some medicines cannot be mixed with certain foods. These options must be checked with a Pharmacist
Practice makes perfect – A training guide for parents, caregivers and children
Teaching children to swallow medicines is all about practice. Using lollies that are easy to swallow can be an effective
way of practising taking tablets or capsules. Children begin practising with small lollies and progressively increase
to larger sized lollies, which are comparable in size to tablets or capsules.
Make sure the exercise is fun and relaxed, and keep sessions short so the child does not become tired or stressed.
Be sure to encourage the child’s successes along the way and be supportive. The child can be encouraged to try different
head positions when swallowing, e.g. head tilted back, slightly forward, in the centre, to the left and to the right.
Let the child find which head position suits them best.
You will need:
- Cake decorating balls or sprinkles
- Mini M&Ms®
- M&Ms® or Smarties®
(or other appropriately sized lollies)
What to do
- Ask the child to take a few sips of water or their favourite drink to moisten their mouth and throat
- Start with the smallest sized lolly (e.g. cake decorating balls or sprinkles) and explain to the child that you are
going to teach them a simple way to swallow pills
- Show them by putting a single lolly towards the back of your tongue, taking a gulp of water and swallowing the lolly.
- Tell the child it is their turn. They should keep trying up to three times if they are unable to swallow, and they
can chew the lolly if the third time is unsuccessful.
- Repeat this until the child is comfortable with a particular sized lolly – this usually takes about three successful
tries. Then move up to a slightly larger size lolly and repeat the procedure until there is success at this level.
- Continue to move up to larger sizes until the child succeeds at swallowing a lolly of a comparable size to a pill
(e.g. M&Ms®, Smarties®). At this point the child should be able to swallow most pills with minimal problems.
For further information see: The University of Calgary website ‘Better than a spoonful of sugar –
how to swallow pills’, which contains videos showing ways to teach children to swallow tablets and capsules:
- Kaplan BJ, Steiger RA, Pope J, et al. Successful treatment of pill-swallowing difficulties with head posture practice.
Paediatr Child Health 2010;15:e1–5.
- Medsafe. Helping medicine capsules go down. Prescriber Update 2003;24. Available from:
www.medsafe.govt.nz (Accessed Aug, 2014)