Twitter Facebook RSS Feed Print
Daily Dose

Teaching Kids How To Swallow A Pill

1.15 to read

I received a question via our iPhone App from 16 year old Steffi. She writes: “I take 4 pills a day and can not swallow them! When I try, my tongue pushed the pill to the roof of my mouth. HELP!”

 

I am continually reminded about the number of kids and teens that don't swallow pills, and ask, "does that medication come as a liquid?" Even some of my "adult" patients (code for friends over 40) call and ask if their cholesterol lowering medication is available as a liquid as they just can't swallow a pill! These are people that can run companies!

 

So...due to that fact, I am convinced, like many things in life, the younger you learn to do something, the easier it is. The old adage, "can't teach an old dog new tricks" is true, young children are excited about trying new things and accomplishing milestones, so put pill swallowing on the list.

 

I started teaching my own children how to swallow pills when they were around four-years-old. It really came out of necessity when we were on a trip and one of them developed a fever and I did not have any liquid Tylenol with me. Being the novice "parent pediatrician" at the time, I thought I could just "push the pill down their throat", like the dog. Guess what? It doesn't work, as they just gagged and threw up all over me! Lesson learned.

 

I have found the best way to teach a younger child to swallow a pill is to make it a game. I took the boys to the nearest 7-Eleven where we bought their favorite tic-tacs (coated on the outside like a caplet so won't stick) and then let them pick their favorite sugary horrible never allowed drink. I think it was a Coke or 7-Up at the time (forbidden fruit at home).

 

We went home with candy and drinks in hand (mini M&M’s also work well) and began the tutorial. It helps to have a little friendly competition too. Show your child how to put the tic-tac on the back of their tongue (not on the tip) and then have them "GUZZLE" the drink.  That is why you need to use their favorite drink so they really want to drink it robustly. You can't learn to swallow a pill with a small amount of liquid, you need a "big gulp" to wash it down.

 

When kids are younger they usually don't worry about "choking" or gagging, but once they are older they start analyzing and worrying about how the pill will get stuck or gag them and their anxiety gets in the way. Look at it like going down a slide for the first time, or jumping into the pool, younger kids are usually less fearful (not always a good thing).

 

For many children it will take several tries before the tic-tac is miraculously washed down!! They are so proud and excited and want to show you that they can do it again and again (therefore practice with candy and NOT real medication). By the time they are really becoming proficient they will often say, "look, I can do three at a time!!).

 

Once they are swallowing it is very easy to use junior strength Tylenol or Motrin, which are smaller and coated. Again, once they are swallowing pills the size of the pill really doesn't matter as they all "wash down" the same way. I use the analogy of learning to ride a bike, once you can do a two-wheeler, you can probably ride your friends bike that may have a little bigger tires, if need be. They all pedal the same way and require balance. Pills are pills, just pop and swallow!

 

I also jokingly tell all of my young patients that it is "Dr. Sue rule" that they are able to swallow a pill before they can drive a car!! Come on, putting a teen behind the wheel of a car is HUGE, and swallowing a pill seems much easier compared to learning to drive. I must say that the majority of my patients can swallow a pill by early elementary school, and many even younger.

 

Learning to swallow a pill is a right of passage during childhood. Make it fun and cross this off of the "to do list"!

 

That’s your daily dose, we’ll chat again tomorrow.

Daily Dose

Good Grades Pill

1.15 to read

There is a lot of pressure placed on students to succeed and many of them are turning to what teens call the “good grade pill”.  What is it?  Prescription stimulants that are commonly used to treat children with ADHD.  Teens that have not been diagnosed with ADHD have figured out that with the help of these drugs, they can focus and improve their grades.  

I see a lot of kids who have attentional issues and I evaluate and treat children for ADHD. With that being said, I also spend a great deal of time with each family looking at their child’s history, report cards, teacher comments, educational testing and subjective ADHD rating scales. 

While many families would like it if I just “wrote a script for a stimulant”, I feel it is my job to try and determine to the best of my ability, which children really fit the diagnosis of ADHD. (There are specific criteria for diagnosing ADHD). 

But in the last 3-5 years I personally have seen more and more teenage patients coming to me with complaints of “having ADHD”. These are successful teens who are now in competitive schools. 

In most of the cases there have never been any previous complaints of difficulty with focusing or inattentiveness. All are typically A and B students but are now having to work harder to keep their grades up, and to also keep up all of their extracurricular activities. They too all want to go to “great colleges” and their parents expect that of them as well. 

When I see these teens, I point out to them that there has never been mention of school difficulties throughout their elementary and middle school years. I also tell them that ADHD symptoms by definition are typically evident by the time a child is 7 years of age, and often earlier.  So what do you do? I don’t take out the script pad. 

I believe that stimulant medications are useful when used appropriately.  I am also well aware that these drugs are overprescribed and are also being abused. I have had parents (and teens) be quite upset with me when I decline to write a script for stimulant medication for their teen.  

I think that this problem is growing and (we) parents need to stop pressuring our children and (we) doctors need to be vigilant in deciding when stimulant medications are appropriate. 

It is a slippery slope, but the number of teens obtaining stimulants illegally is on the rise.  Why? They hear that this is a quick fix to getting good grades. It may help their grades for the short term, but what does their long term future look like? 

That's your daily dose for today. We'll chat again tomorrow.

Daily Dose

Treating Migraines in Children

What is the best way to treat a migraine in children?So, we have discussed migraines and looked at how to diagnose in the pediatric population. Now it’s time to decide how to treat the headache. Just like diagnosing the headaches, it is important to individualize treatment for each child, with the goal being fast relief, no rebound or re-occurrence, with minimal or no side effects to the medications.

When I see a patient who has a history compatible with migraines, I not only have the child and parents keep a headache log, but I spend a lot of time discussing early treatment of the headache. One of the first things you learn in medical school about treating pain is “get ahead of the pain”.  This means that you need to be aware of your symptoms and begin therapy earlier than later, as pain that has gone on for some time is much harder to treat.  I find that one of the best ways to explain this to a parent and also an older child is to talk about surgery. When you have a surgical procedure, the anesthesiologist does not wait for you to “wake up” and tell him that it hurts, they have already given you pain medication to “keep ahead of the pain” before they wake you up. If you have ever had surgery you know this to be true. The same pain principles apply to treating headaches, especially migraines. At the first sign of a migraine, with or without an aura, I usually prescribe an ibuprofen (Motrin, Advil) product.  In studies, ibuprofen was more effective for headache relief than acetaminophen. I use a “generous” (10mg/kg/dose) dose and repeat it once in 3 -4 hours if the headache has not resolved. You do not want to use ibuprofen more often than several times a week or you may find that your child actually gets rebound or overuse headaches.  Ibuprofen is available in liquid, chewable and pill form so can be used in a young child with suspected migraines.  I also like to use naprosyn (Aleve) in older children who can swallow pills.  It too is a non-steroidal anti-inflammatory  and is available over the counter. The most frequently used medications for childhood migraines are called triptans.  This class of drugs has been around for more than a decade now, but they are not FDA approved for use in children and adolescents because of the difficulty in designing a study (this is true of many different medications.)  Regardless, they are frequently used to treat childhood migraines with good results, tolerability and a good safety profile. There are many different drugs, with names like Imitrex, Zomig, Maxalt, Frova, and the newest drug Treximet (a combination of a triptan and a non steroidal drug), and all have a similar safety profile. Once a child has “failed” therapy with an over the counter non-steroidal drug, I typically use these drugs as “rescue” medications.  Just like many other medications, each person seems to respond differently, so it may be a bit of trying different medications to see which one works “best” for each migraine sufferer. When a patient seems to find the best triptan, it is important to start the medication at the earliest onset of a migraine. I also try to help adolescents distinguish between “different” types of headaches, so that they are not using this class of drugs too frequently (max 3 headaches a week).  Not every headache is a migraine! If these medications do not relieve the headaches within 48-72 hours more aggressive therapies need to be used, and preventative treatments and strategies should be considered.  There are many studies underway looking at the combined effects of biofeedback therapy and cognitive behavioral therapy in combination with medications. These are discussions that each parent/child should have with their own physician as it relates to their headache frequency and pain level. That's your daily dose for today.  We'll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

Monitor Your Child For ADHD Medication Abuse

Are teens abusing their ADHD medications? A new study reveals the answer.I read an interesting, albeit somewhat alarming article in an issue of Pediatrics. The article is entitled “Adolescent Prescription ADHD Medication Abuse is Rising Along with Prescriptions for these Medications”.

In a retrospective study of calls to the American Association of Poison Control Center’s National Data System, for the years 1998 – 2005, the authors noted a sharp increase in calls related to prescription ADHD medication abuse, out of proportion to other poison center calls. While attention-deficit/hyperactivity disorder (ADHD) is thought to affect between eight to 12 percent of children, there continues to be a significant increase in the diagnosis and treatment of ADHD with stimulant medications. Over the 8 year study period, estimated prescriptions for teens increased 133 percent for amphetamine products (one trade name Adderall), 52 percent for methylphenidate products (trade names such as Concerta, Ritalin, Metadate, Focalin), and 80 percent for both together. With the increase in prescriptions there is potentially greater use of these drugs for non-medical purposes. The Office of National Drug Control Policy and National Institute on Drug Abuse found that next to marijuana, prescription medications are teenagers drugs of choice for getting high. A study by The Partnership for Drug Free America found that nearly one in five (19 percent) of teenagers reported abusing prescription medications, at least once, that were not prescribed to them. In another study, nearly 30 percent of adolescents reported having a friend that abuses prescription stimulants. In the study in Pediatrics the authors found that amphetamine exposures and calls to Poison Control rose faster than amphetamine sales. In contrast, methylphenidate calls fell as sales rose. Amphetamine exposures were more frequently classified as moderate to severe than methylphenidate calls. It is inferred that there may be a shift toward amphetamine abuse and more severe side effects, with the greater availability of this medication. It is also noted that 42 percent of amphetamine stimulant ingestion cases presenting to the ER are girls, while the ratio of ADHD diagnosis is three to one boys to girls. All of these statistics are disturbing, alarming and plain scary. While stimulant medications do have a place in the treatment of ADHD, over diagnosis and availability of these medications may be leading to more abuse of these medications by teenagers. These drugs are used to produce a high, or to help with concentration or increase alertness. These drugs are also being taken with alcohol, which compounds the danger. The topic of abuse of prescription drugs among teens who have not been prescribed a medication seems to be another dinner table conversation. The consequences for taking another person’s medication are real. If your child takes a stimulant prescription there also needs to be a conversation regarding “sharing” medication. Parents should also monitor their child’s medications and refills. With increased availability there may continue to be a problem with abuse of these medications. That’s your daily dose, we’ll chat again tomorrow. Send your question or comment to Dr. Sue!

Daily Dose

The Need to Stay Calm During Swine Flu Season

I have found myself sounding like a broken record for the past week, and feel certain that the record is going to continue to “skip” as the confusion over the use of antiviral for H1N1 (swine flu) continues.

In the last week I have not only been to the office, but also to a school board meeting and several social engagements after work, all which were opportunities to discuss the continued H1N1 outbreaks and anxiety associated with “swine flu”. I guess the good thing is that no one is discussing the economy; it is all chatter about flu. It is important to reiterate that H1N1 is another flu, really no different than seasonal flu which we experience every year in the U.S. The difference is that this is a new or novel flu virus and it has managed to spread, quite effectively, throughout the spring and summer months, and into the early fall, with a clear predilection for school aged children. With that being said, now that schools are back in session and our children are all together in close quarters, we are seeing an increase in H1N1 activity throughout the country. Because of the previous concerns about swine flu last spring and the uncertainty of how the population as a whole would handle this virus, there has been a great deal of anxiety associated with this particular virus. Fortunately, over the last five months, the data is showing that H1N1 has not caused more pediatric deaths than we see each year with seasonal influenza (which is still yet to come this winter). The MAJORITY of children with this virus are doing well, and are recovering within two to seven days, even without the routine use of antivirals like Tamiflu and Relenza. The CDC has reiterated that routine testing for influenza and use of antivirals is not necessary for the school aged child, without underlying chronic illness, who is not seriously ill. That is most of our children. Younger children, under the age of five, and especially under the age of two, needs to be evaluated and may or may not need antiviral treatment. That is a decision for their pediatrician to make. Despite these ongoing recommendations parents are frantically calling the office requesting that antivirals, like Tamiflu, be prescribed for their family, “in case” they are exposed to flu, get sick, feel like they might get sick, or as one mother actually said, “I’ll feel better if my son is just on Tamiflu all winter.” This is not going to help anyone. The exposures are going to continue throughout the winter. Not just at schools, but also at the grocery store, cleaners, church, after school events and the list is endless. We need to try and keep a level head and not horde a medication that others may truly need, or spend unnecessary valuable health care dollars on medicine that will be thrown out in a year, or have people start and stop Tamiflu and Relenza as they feel better. Just like antibiotics, overuse and indiscriminate use of antiviral medication will lead to resistant influenza strains. When we really need these drugs, we all want them to work, for our children, for ourselves and for all of those that may get seriously ill throughout this flu season. This “swine flu frenzy” is reminiscent of the hording of Cipro during the anthrax scare. I wonder how much Cipro was hidden away, “just in case you opened your mail and found a white powder.” As I recall, there were shortages of Cipro for months, and the same might happen with antiviral medications. It is easy to write prescriptions, but it is much harder to do the right thing and try and teach patients and families why doctors are not routinely prescribing antiviral medications. If things change and recommendations change doctors will let you know, but in the meantime, keep sick children home until they are fever free, read the information about those who might need to take an antiviral medication and keep washing hands. That’s your daily dose, we’ll chat again soon.

Daily Dose

The Need to Stay Calm During Swine Flu Season

I have found myself sounding like a broken record for the past week, and feel certain that the record is going to continue to “skip” as the confusion over the use of antiviral for H1N1 (swine flu) continues.

In the last week I have not only been to the office, but also to a school board meeting and several social engagements after work, all which were opportunities to discuss the continued H1N1 outbreaks and anxiety associated with “swine flu”. I guess the good thing is that no one is discussing the economy; it is all chatter about flu. It is important to reiterate that H1N1 is another flu, really no different than seasonal flu which we experience every year in the U.S. The difference is that this is a new or novel flu virus and it has managed to spread, quite effectively, throughout the spring and summer months, and into the early fall, with a clear predilection for school aged children. With that being said, now that schools are back in session and our children are all together in close quarters, we are seeing an increase in H1N1 activity throughout the country. Because of the previous concerns about swine flu last spring and the uncertainty of how the population as a whole would handle this virus, there has been a great deal of anxiety associated with this particular virus. Fortunately, over the last five months, the data is showing that H1N1 has not caused more pediatric deaths than we see each year with seasonal influenza (which is still yet to come this winter). The MAJORITY of children with this virus are doing well, and are recovering within two to seven days, even without the routine use of antivirals like Tamiflu and Relenza. The CDC has reiterated that routine testing for influenza and use of antivirals is not necessary for the school aged child, without underlying chronic illness, who is not seriously ill. That is most of our children. Younger children, under the age of five, and especially under the age of two, needs to be evaluated and may or may not need antiviral treatment. That is a decision for their pediatrician to make. Despite these ongoing recommendations parents are frantically calling the office requesting that antivirals, like Tamiflu, be prescribed for their family, “in case” they are exposed to flu, get sick, feel like they might get sick, or as one mother actually said, “I’ll feel better if my son is just on Tamiflu all winter.” This is not going to help anyone. The exposures are going to continue throughout the winter. Not just at schools, but also at the grocery store, cleaners, church, after school events and the list is endless. We need to try and keep a level head and not horde a medication that others may truly need, or spend unnecessary valuable health care dollars on medicine that will be thrown out in a year, or have people start and stop Tamiflu and Relenza as they feel better. Just like antibiotics, overuse and indiscriminate use of antiviral medication will lead to resistant influenza strains. When we really need these drugs, we all want them to work, for our children, for ourselves and for all of those that may get seriously ill throughout this flu season. This “swine flu frenzy” is reminiscent of the hording of Cipro during the anthrax scare. I wonder how much Cipro was hidden away, “just in case you opened your mail and found a white powder.” As I recall, there were shortages of Cipro for months, and the same might happen with antiviral medications. It is easy to write prescriptions, but it is much harder to do the right thing and try and teach patients and families why doctors are not routinely prescribing antiviral medications. If things change and recommendations change doctors will let you know, but in the meantime, keep sick children home until they are fever free, read the information about those who might need to take an antiviral medication and keep washing hands. That’s your daily dose, we’ll chat again soon.

Play
1752 views in 2 years
ADHD Drugs

ADHD Drugs: Brand Name vs. Generic

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

DR SUE'S DAILY DOSE

Nutrition and your baby.

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.

 

Please fill in your e-mail address to be included in our newsletter.
You may opt out at any time.