Difficult child or difficult medicine ?

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Q1: Dear doctor, I would like to ask you for suggestions and tips on giving medication to children who refuse taking them. My nephew often starts crying and would spit out the medication every time . I resorted to giving suppository Paracetamol but other medications come in syrup preparation.  Thank you. (Zaid)

Q2: Doktor, anak saya berumur 2 tahun dan akan meronta-ronta bila diberi ubat sampaikan suami akan memegang tangan dan kakinya , dan saya akan memicit hidungnya dan memaksa dia makan ubat. Saya tahu cara ini mungkin tidak bagus tapi saya tidak ada cara lain kerana dia memang akan melawan dan meludah apabila diberikan ubat. Mohon doktor bagi sedikit panduan (Rabiatul)

A: Dear Zaid and Rabiatul

Most of the times a child does not want take medicine because it tastes bad, causing him or her to choke or vomit. A child also may refuse because of the medicines’ side effects or due to past horrible experience of taking medicine. It can also be due to attention seeking behavior especially when the child is sick.

However there are ways to overcome all these. First of all, parents need to be assured of the benefits of the medicine in order to provide confidence for the child. It takes a lot of patience and persistence to convince the child to take the medicine. Explain to the child what the medicine will do to them and it’s benefits.

Parents need to be honest and should never trick the child into believing that the medicine taste good. If the parents were to commit that mistake, they will lose the child’s trust. Never hide the medicine in food without your child’s knowledge. Trust is so important to children especially when they are unwell.

Children learn best when they succeed and they should be showered with praises and hugs even for a small success. Keep a positive attitude. Reward your child if he or she takes the medicine, for example giving them a sticker for each time they take the medicine or using the star chart. Make it fun!

All caregivers should use the same approach each time the child needs to take medicine. This is to provide consistency and prevent the child from manipulating certain caregivers.

You need to recognize when you are failing or getting frustrated. Step back, take a moment to yourself, and take a deep breath. Do not allow yourself to give in to force because it will create a bad experience for the child and make future attempts even more difficult for you. Ask another person for help if there is a need. Do not use threats or punishment or ridicule the child.

However, if you’re sure the child is able to comply with taking medicine without great distress, don’t let the child get away with not taking it. In such cases, the child should not be allowed any fun activities until the medicine is swallowed. Letting the child to skip a dose can create a pattern of future refusals.

Provide only a couple of choices in how the child can take his medicine, for instance, allow the child to choose the form of medicine (gel capsule, pill, liquid, syringe). Older children who can swallow a pill may choose that because syrup form may taste worse than pill. You can also crush and mix pills in a small amount of something flavored but please check with the pharmacist because not all pills can be crushed, chewed, cut or taken with food/liquid. You may mix the medicine in a food that your child likes e.g applesauce, juice, ice cream, chocolate syrup, maple syrup, jelly, mashed potatoes, yogurt. Let your child hold on to something that they like or familiar with, favorite soft toy or pillow.

To help numb the taste buds, have your child suck on a popsicle or ice chips before taking medicine.

Have your child try holding a peppermint candy under his nose while taking the medicine, as smell adds to the bad taste. Pinch the child’s nose to block the bad smell.

Have your child take a sip of a favorite drink or a bite of food quickly or suck on lollipop to change the flavor in his or her mouth immediately after taking the medicine. Strong flavored candies such as mints work quite well.

You might want to distract your child by having him or her to watch a favorite video before giving the medicine. You can use dolls or puppets to perform make-believe play to convince your child to ingest the medicine.

You may employ relaxation techniques on your child to lessen anxiety, e.g. muscle relaxation, deep breathing, imagery.

I hope these advices help.

( answered by Dr Ng Khuen Foong )

Reference:

1. http://www.seattlechildrens.org/pdf/PE398.pdf

2. http://www.uwhealth.org/healthfacts/B_EXTRANET_HEALTH_INFORMATION-FlexMember-Show_Public_HFFY_1126653857338.html

 

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