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Teaching Your Child The Fine Art of Swallowing Pills and Capsules

For any parent, getting children to take their medication can be a frustrating experience. The flavor of a liquid such as Prednisone may be off putting to a child. You worry about spilling liquid medications or dosing accurately. That’s why I find that teaching children as early as possible to swallow a pill or capsule to be a wise idea.

You may wonder “Why worry about teaching my child how to swallow a pill or capsule now?”

First, some medications only come in solid form. To be honest, there aren’t swallow a pill 3many but there are a few.

Second, pills and tablets are much easier to travel with and don’t require refrigeration. Think about toting around that bottle of antibiotic next summer on your next family trip. Not fun!

Third, you will never have to worry about spilling or dripping a liquid again. Plus the dosing on a pill is accurate. How many times have you gotten to the bottom of the bottle of liquid medication and not had the full teaspoon?

In my experience, children as young as age 3 or 4 can learn to swallow a pill. I taught my own daughter who was not yet 3 to swallow pills. While a few teens can’t seem to master the skill, children are quick learners and repetition and patience along with some simple tips can help if you start children young.

It’s also a good idea to teach your child these techniques before they really need them. A sick little child is not great student!

WHAT YOU WILL NEED

  • Multi-colored round candy balls called mixed decors found in the cake-decorating section of a supermarket
  • Tic Tacs (I think the fruit flavor works best)
  • Mini M&M’s
  • Reese’s Pieces or M&M’s

THE TECHNIQUE

  • Start with the smallest candy ball from the cake decorating kit. Explain to your child that you are going to teach him a simple way to learn to swallow pills and that it starts with learning to swallow candy balls. (Now is a good time to explain that medication is NOT candy but that you are using candy because it is an easy substitute. Explain that you should NEVER take medicine without permission of Mom or Dad).
  • Parent should demonstrate by putting a single candy ball as far back on your tongue as possible, use the straw technique, and take three gulps of water.
  • Tell your child it’s their turn. Also tell them that if the candy doesn’t go down the first time, they have to try at least two more times. If it doesn’t go down by the third try, they can chew the candy ball and take a break before trying again.
  • Repeat this until they get comfortable with a candy ball, usually about three successful tries. Then move up to a slightly larger candy (I like to use the bigger cake decorating sprinkles, then move up to mini M&M’s) and repeat the procedure until there is success at this level.
  • After three to five successes with the mini M&M’s, move up to a larger candy like an M&M or Reese’s pieces. After they have mastered that, compare it to a pill size wise. At this point they should be able to swallow most pills with minimum problems.
  • Remember to limit the “session’ to 15 minutes. This will be a Process that requires days, perhaps weeks depending on your child.

SOME TIPS

  • Have your child take a few sips of water before beginning. It is very difficult to swallow a pill or tablet with a dry throat.
  • These tips works best if your child is thirsty. He/She may be drinking quite a bit, practicing their pill swallowing technique.
  • Session should last no more than 15 minutes and be fun.
  • Room should be free from distractions. Leave toys in another room and turn of the television.
  • Stay calm and positive.
  • Be patient, this is a task that will require some time.
  • Demonstrate pill swallowing to your child in matter of fact way. When they see you do it calmly they will want to emulate you.
  • Use lots of Positive Praise! Avoid negativity. This is not going to motivate your child to learn to swallow pills/tablets.
  • Be consistent.
  • Have your child put the pill on his/her tongue. Then using a straw, suck down three big gulps of water. With a straw there is no pill floating around in your mouth like there is if you just try to swallow a pill with a big mouthful of water.
  • If water isn’t working try milk, a fruit smoothie, Pediasure, a milkshake, or fruit juice or nectar. Thicker fluids create more bulk, making it harder for the pill to separate itself from the fluid during swallowing.
  • Always end with a success. If your child has difficulty swallowing a large piece of candy, end by having him swallow a smaller piece or even a gulp of liquid. Always end on a positive note.
  • When swallowing a pill, have your child tilt their head back slightly. With capsules (which float), you do just the opposite. Have your child look down at the floor and swallow the capsule while still looking downward at the floor. The capsule should just float to the back of his mouth and slide down his throat with his drink.
  • Make sure you have your child place the pill or capsule in the center of their tongue rather than to the right or left, especially if they are going to be swallowing an oval-shaped pill. An oval-shaped pill should be placed so that the length is parallel to their throat. Otherwise, the pill may go into the throat “sideways” and create discomfort.

DON’T

  • Don’t break a tablet in half if it is too large. When you do this the rough edges can be scratchy and even more difficult to swallow than a larger smooth tablet.
  • Don’t take pills with a dry mouth. It’s more difficult to swallow when your mouth is dry, and capsules and tablets may even stick to a dry tongue.
  • Don’t bargain or bribe your child. After all you don’t bargain or bribe your child to brush his or her teeth or comb their hair. This is a skill they WILL learn. It just takes time and patience.

The techniques I shared with you should help you, help your child become proficient at swallowing pills and tablets. This is a skill that is a necessary part of life and when learned early can really be a very handy tool for a child to possess.

Remember to be consistent, patient and use positive praise and these techniques will have your child swallowing pills, tablets and capsules in a reasonably short time!

Pneumonia, Bronchitis and Kids – More Common Than You Think

Pneumonia in kids is probably more common than we all realize. It represents an infection of the lung tissue which can be caused by viral illnesses, bacterial illnesses or a type of organism that is somewhere between a virus and bacteria called mycoplasma. The most common cause of pneumonia is usually viral, but viral illnesses can predispose lung tissue to become infected with bacteria. Other ways of acquiring pneumonia are by inhalation (this is unusual but certain illnesses such as tuberculosis and anthrax may be acquired in this manner).

The best way to diagnose kids with pneumonia is through a thorough history and physical exam that your doctor will perform on your child. Another way that can be used to diagnose pneumonia is through the use of a chest X-ray, but small areas of pneumonia or early pneumonia might not show up on X-ray. Your Doctor will be able to diagnose this early on by piecing together what you tell him and his observation and examination of your child.

One thinks of pneumonia as an illness with high fever and severe productive cough but this is not always the case and sometimes all that is seen are the symptoms created by the body to help compensate for the changes occurring in the lungs. If a large amount of lung tissue is involved and it becomes difficult for the gas exchange (oxygen in and carbon dioxide out) to take place then a signal is sent to the brain to increase the rate of breathing so that more air is forced in and more oxygen can be extracted. When it is even more difficult to breathe the child may use muscles not ordinarily used to help with breathing such as abdominal muscles and neck muscles and one can observe this. With further progression of the disease less oxygen will reach the body and mild blueness or cyanosis will be seen in the skin.

OK we’ve talked about the more severe problems with pneumonia but let’s get back to the beginning and restate that most pneumonia is mild and might very well be a natural progression of a cold. In a considerable amount of children with mild pneumonia the diagnosis might never be made because it is not severe. And because most of these are viral in nature, they will clear up as the cold clears without the use of an antibiotic, and the child never exhibits the signs and symptoms mentioned in the previous paragraph.

If your Doctor pieces together the parts of the history and physical exam and decides your child might have pneumonia, and if your child appears sick or ill, he might very well begin an antibiotic because the exact nature of the pneumonia might be difficult to determine. Most of the time pneumonia can be adequately treated at home without the need for hospitalization and he/she will recover fully without any subsequent problems.

Bronchitis is a wastebasket term describing what is thought to be inflammation and mucous collection in the tubes that lead from your nose and mouth down into your lungs due to many causes- again usually viral. Any cold with a significant loose cough probably represents some degree of bronchitis or tracheitis (higher up). Generally, it also does not necessarily need an antibiotic to “cure” it because bronchitis, like mild pneumonia, will also go away as the cold resolves. There are instances, again, when your child’s doctor might very well decide to use an antibiotic for your child and those would include when your child looks sick or ill (because significant bronchitis and pneumonia can look exactly the same) or if your child has any sort of chronic lung condition such as asthma or cystic fibrosis where the chance of bacterial infection is increased.

So, especially during the winter months, if your child is diagnosed with pneumonia or bronchitis, you needn’t panic or assume the worst. Just follow your child’s doctor’s advice and he/she will be just fine.

Childhood Asthma: Part II

In Childhood Asthma: Part I, I presented ways in which Asthma can present and exactly what was the nature of the disease. Today we will deal with the diagnosis and various means of treating asthma.

Asthma may present in early infancy but is very difficult to diagnose for the reasons mentioned in part one. Also the signs and symptoms of asthma in the very young child can be caused by many other issues. So it is when the symptoms are very severe or they continue beyond two to four years of age that one begins to suspect asthma.

Let’s assume for the purpose of this article that all asthma_pt2the other causes have been ruled out and that it appears that your child indeed has asthma. The first thing to realize is that the symptoms may vary from very severe to extremely mild requiring daily close control or only occasional use of medications and treatments to keep your child comfortable and active. The goal in treatment is twofold: first to allow your child to remain active, socially oriented, and happy. The second is to prevent the permanent secondary changes in the lungs from longstanding uncontrolled asthma.

Early in the course of treatment, a child who presented to the emergency room or physician’s office with symptoms of acute asthma usually needed to be admitted to the hospital for a few days in order to get the symptoms controlled. As time went on, newer systems such as nebulizer treatments that could be performed at home were implemented and admissions to hospitals dramatically diminished. Today it is not uncommon at all to see a nebulizer machine in the home of a child with asthma. The other issues that were improved upon were the level of education of a family in which there is a child with asthma, and the greatly improved medications available to treat asthmatic symptoms with fewer side effects and greater efficiency.

As more becomes known about asthma, through research and observation, the efficiency of treatments increases dramatically. Since we know from the previous article that the underlying problems causing symptoms of asthma are related to constriction of the small airways, mucus production and inflammation, there was a body of research that tried to find out which of these causes were more important, and which specific medications could be used for each symptom. At one point or another each of them were implicated but recently the inflammatory process seems to be very important. Also inhaled medications seemed to give the best results without some of the bothersome side effects, both long term and short term.

With the development of better mobile delivery systems for these medications and the increase in knowledge that families now have about the disease, the disease can now be managed very efficiently at home. Fewer and fewer hospitalizations have been the result with a greatly decreased cost of delivering medical care to these children.

Your Doctor is very familiar with the armamentarium of medications available to use for children with various degrees of the disease. The two main issues with the treatment of asthma is the immediate treatment of the acute problem, breathing difficulty, and then the long term control of the recurrence of those symptoms. There are many medications, or combinations of medications, available to gain and maintain control over the symptoms of asthma and your child should be able to live a perfectly normal life style.

You as parents will shortly become, with the help of your Doctor, the “expert” when it comes to asthma in your child.

Are Your Children At Risk for Dehydration This Summer?

Welcome to summer, the kids are out of school, summer camps are in full swing, family trips all over the country have begun and just in case you haven’t noticed, it’s hot outside. It is turning out to be one of the hottest summers on record with temperatures reaching triple digits in many parts of the country. As it heats up, summer safety becomes a serious issue. With all this fun and traveling going on please don’t forget to ask yourself one very important question, “are my children hydrated well enough to handle this heat?” the answer is most likely no.

Thousands of children each year are admitted to hospitals with heat-related illnesses and most go home, but there are the cases every year where children end up overheating and dying because they were not hydrated properly. As I write this, it’s a beautiful 94 degree Saturday here in Miami with all the humidity you can handle and that means one thing for us here at the fire department. A huge increase in the amount of heat illness related calls we are going to run and most of them will be on children.

As parents when we think of dehydration, we think of our children being sick and having a bout of diarrhea and or vomiting, and the doctor tells us to keep them hydrated with plenty of fluids. That is all well and good and as good parents we make sure our little campers get plenty of fluids and are back healthy A.S.A.P., But the kind of dehydration I am talking about is the kind we as parents tend to overlook in the rush of our day to day lives and that is the everyday dehydration of our very active children. By the time a child says he is thirsty, he is already dehydrated, and with studies finding that 50% of children participating in sports activities were already dehydrated we need to be hydrating our children before, during, and after physical activity as well as keeping an eye out for the signs of heat-related illnesses.

Recommendations for hydrating children ages 6 to 12 include:

  • 4-8 ounces 1 to 2 hours before activity
  • 5-9 ounces every 20 minutes of activity
  • After activity, replace lost fluids within 2 hours

Recommendations for hydrating young athletes ages 13 to 18 include:

  • 8-16 ounces 1 to 2 hours before activity
  • 8-12 ounces 10-15 minutes before activity
  • 5-10 ounces every 20 minutes of activity

Being able to recognize the signs of heat-related illnesses is critical and should be done by us the parents as well as the coaches. A basic awareness of the signs of heat-related illnesses could make all the difference, so here are some key points to be on the lookout for as recommended by Susan Yeargin, PhD, ATC.

Types of heat illnesses

Athletes who exercise in hot or humid weather are particularly at risk of heat illnesses:

  • Heat cramps
  • Heat exhaustion
  • Heatstroke

Symptoms of impending heat illness

In addition to educating young athletes about both the importance of hydration and the dangers of heat-related illness, ensuring that they are drinking enough fluids, and taking precautions to reduce the risk of heat injury in children in hot and humid weather, you need to watch your child for symptoms of impending heat illness:

  • Weakness
  • Chills
  • Goose pimples on the chest and upper arms
  • Nausea
  • Headache
  • Faintness
  • Disorientation
  • Muscle cramping
  • Reduced or cessation of sweating

A child continuing to exercise when experiencing any of these symptoms could suffer a heat illness.

Heat cramps

Symptoms:

  • Thirst
  • Chills
  • Clammy skin
  • Throbbing heart
  • Muscle pain
  • Spasms
  • Nausea

Treatment:

  • Move child to shade
  • Remove excess clothing
  • Have child drink 4 to 8 ounces of fluid with electrolytes (sports drinks) every 10 to 15 minutes

Heat Exhaustion

Symptoms:

  • Nausea
  • Extreme fatigue
  • Reduced sweating
  • Headache
  • Shortness of breath
  • Weak, rapid pulse
  • Dry mouth
  • Rectal temperature less than 104?F.

Treatment:

  • Move child to cool place
  • Have child drink 16 ounces of fluid containing electrolytes for every pound of weight lost
  • Remove sweaty clothes
  • Place ice behind child’s head
  • Seek medical attention, if no improvement

Heat Stroke

Symptoms:

  • No sweating
  • Dry, hot skin
  • Swollen tongue
  • Visual disturbances
  • Rapid pulse
  • Unsteady gait
  • Fainting
  • Low blood pressure
  • Vomiting
  • Headache
  • Loss of consciousness
  • Shock
  • Excessively high rectal temperature (over 105.8F.)

Treatment:

  • Call 911
  • Remove sweaty clothes
  • Immediate and continual dousing with water (either from a hose or multiple water containers) combined with fanning and continually rotating cold, wet towels on head and neck until immersive cooling can occur.

As parents we tell our kids to study and do their homework so they will be prepared, well we as parents need to do our homework as well when it comes to recognizing the signs of heat-related illnesses and staying on top of hydration. Luckily for those parents who live and breathe on their iPhone there is help. iHydrate is an app that reminds you to hydrate yourself and your children before, during and after activities. App or no app, stay alert, keep those children hydrated and please remember, when in doubt call 911.

Is My Child’s “Barky Cough” CROUP and How Can I Help?

Croup, or laryngotracheobronchitis, is caused by many viral infections and falls into the category of upper respiratory infection along with the common cold. Croup tends to occur in the autumn and early winter months. In croup, the major areas affected are the ones referred to in the long name of this illness (above); the larynx, trachea and bronchi, which are all structures that convey air from the mouth and nose down toward the lungs. As with all colds or upper respiratory infections there is inflammation of the mucosa (most superficial covering) of the inside of the nose, mouth, throat and upper respiratory tract, leading to mucous production and irritation of those sites.

In croup, the area of the upper respiratory tract most prominently affected is the larynx, or the voice box area located very close to the firm lump in the front of your neck, the “adam’s apple”. When vocal cords are irritated and swollen, adults merely get hoarse or raspy talking and a “normal” sounding cough. Children have a much narrower windpipe and therefore with even the slightest swelling of their vocal cords, there is less room for air to get by and they also get hoarseness along with a cough and raspy breathing. There is also a characteristic barky (yes sounds like a animal barking) kind of cough and occasional difficulty breathing. All symptoms tend to be worse at night, a time when all illnesses seem to worsen.

For the most part this illness remains mild and the only treatment needed is a cool mist humidifier, fluid intake, elevated head at night and reassurance for the child and parents.

Rarely a child may progress to real difficulty breathing, with a characteristic whooping noise when taking a breath in versus a wheezing sound when breathing out found more commonly in those with asthma. So if your child exhibits difficulty breathing along with the above symptoms, call your doctor for further instructions.

Once a child has had croup, parents seldom forget what the barky cough sounds like and can make the diagnosis themselves. Usually, as with other upper respiratory viral infections there is a mild amount of fever and the child is not real sick.

If there is sudden high fever with the onset of “croup” and your child is drooling, cannot swallow or speak, and is very anxious, you must call your doctor immediately or call 911.

This symptom complex describes a rare but life threatening illness called epiglotitis which can be very dangerous. I stress that this is a rare illness which used to be far more common before we were able to vaccinate against the bacteria which causes this illness.

Study: ADHD Meds Given More Often to Youngest Kids in Class

“Youngest children in class more likely to get ADHD medication, study says,” The Guardian reports.

The results of an Australian study have caused concerns that, in some cases, immature behaviour may be misinterpreted as evidence of a behavioural disorder.

In a brief report, researchers found nearly 2% of 6-15-year-olds in Western Australia received a prescription for attention deficit hyperactivity disorder (ADHD) medication in 2013. Those born in the last months of the school year intake were more likely to have had a prescription than the oldest children in the year.

The gap between the oldest and youngest children in the class had a small, but significant, association with the increased use of ADHD medications. The researchers say their findings compare with those of other international studies.

It’s possible the youngest children in a school year may find it harder to keep up in lessons than children almost a year older than them, and may be more likely to have problems with concentration.

But it would be a big assumption to say ADHD is being overdiagnosed and overtreated on the grounds of this study alone.

The use of ADHD medication for under-16s in the UK is far lower than in many other developed nations – 0.4%, compared with Australia’s 1.9% or the US’ 4.4% – so the potential problem of inappropriate treatment may not be as much of an issue in this country.

Where did the story come from?

The report was authored by four researchers from Curtin University, Murdoch University and the University of Western Australia, all in Australia.

The study was published in the peer-reviewed Medical Journal of Australia, and the researchers declared no conflict of interest or study funding.

It’s available to read online on an open access basis, so you can download the study for free.

The UK media coverage was accurate, but does not point out the limitations of this brief report.

What kind of research was this?

In this brief one-page report, the researchers say four international studies found the youngest children in a school year are more likely to be receiving ADHD medication.

They aimed to see how Western Australia compares by analysing data from the Pharmaceutical Benefits Scheme – a scheme similar to the NHS, where the cost of medicine is subsidised by the Australian government – to see how many children were receiving ADHD medication.

This brief report provides very limited information about the authors’ methods, making it difficult to critique.

And we don’t know how the authors identified the four international studies they reported, so we don’t know whether this is a fully comprehensive look at the subject.

This means the report must largely be considered to be the opinion of its authors.

What did the researchers do?

The researchers compared the proportion of children born in the first and last months of a “recommended school year intake” who were recorded in the Pharmaceutical Benefits Scheme as receiving at least one prescription for ADHD medication in 2013.

The study included a total of 311,384 children, covering two age bands: those aged 6-10 (born July 2003 to June 2008) and those aged 11-15 (born July 1998 to June 2003).

The researchers looked at the number of children receiving medication and the patterns by time of birth.

What did they find?

The researchers found 1.9% of the full study sample (5,937 children) had received at least one prescription of ADHD medication, with more boys than girls being prescribed for (2.9% versus 0.8%).

In the 6-10-year-olds, they found those born in the last month of the school year intake (June) were nearly twice as likely to have been prescribed medication as those born in the first month (the previous July): relative risk (RR) 1.93 for boys (95% confidence interval [CI] 1.53 to 2.38) and RR 2.11 for girls (95% CI 1.57 to 2.53)

The same pattern was seen for 11-15-year-olds, but the risk increase was less, though still significant (RR 1.26, 95% CI 1.03 to 1.52 for boys; RR 1.43, 95% CI 1.15 to 1.76 for girls).

The authors say similar effects were also seen when comparing those in the first three to six months of intake with the last three to six months.

What did the researchers conclude?

The researchers say at 1.9%, their observed prescription rate is comparable to a recent Taiwanese study, and both this study and three North American studies observed the effects of birth month on prescription rates.

They describe a professional from the American Psychiatric Association who feels ADHD is overdiagnosed and overmedicated, saying that, “Developmental immaturity is mislabelled as a mental disorder and unnecessarily treated with stimulant medication.”

The authors say the findings indicate that, “Even at relatively low rates of prescribing, there are significant concerns about the validity of ADHD as a diagnosis.”

Conclusion

Overall, this study suggests that in Western Australia – and reportedly in other countries, too – the youngest children in a given school year are more likely to be diagnosed with and treated for ADHD than the eldest in the year.

However, it’s important not to draw too many conclusions from this brief report. The authors provide very limited information about their methods, so it’s not possible to critique how they conducted their study.

We don’t know why they selected the 2013 school year, for example. It was said to be recommended, but we don’t know why. It could be it was known there were an unusually high number of prescriptions noted in the Pharmaceutical Benefits Scheme that year, which means it might not be representative.

Also, this database can only tell us the number of children that filled out at least one prescription for ADHD medication. We don’t know how the children were diagnosed, how long they had been diagnosed or treated for, or whether they actually took the medication.

The authors also point out the possible limitation that they didn’t know how many children may have entered school outside of their recommended starting year – although this was thought to be few.

We also don’t know how the researchers identified the international studies, and we don’t know that these reported findings give a comprehensive look at ADHD diagnosis and treatment worldwide.

It would be a big assumption to say ADHD is being overdiagnosed and overtreated on the grounds of this study alone. And, as no UK studies were reported, we don’t know what the true situation is like in this country.

It’s possible the youngest children in a school year may find it harder to keep up with lessons than children almost a year older than them, and so could be more likely to be distracted – though this is clearly a big generalisation and is not always going to be the case.

However, it does perhaps highlight there is a need for children who are struggling or finding it difficult to concentrate at school to be recognised, and get the additional attention and support they need – something both teachers and parents of the youngest children in a school year may need to be aware of.

Analysis by Bazian. Edited by NHS Choices.

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