Taking Medicines

Many children, especially those under 5 years, find it hard to swallow pills. This is usually because they have never had to do it. Most children with cancer need pills at some time, and it is best to teach them how to swallow a tablet or capsule before they really need it.

The following steps can be used to teach children how to swallow medicines, including pills:

  1. Keep a calm and positive attitude.
  2. Be honest about any unpleasant taste, and always tell your child if medicine is mixed with food or drink.
  3. Show the child how to swallow pills calmly and quickly. Demonstrate by placing a tablet or capsule well back in the centre of the tongue. Take a sip of a drink, then tip the head back and swallow. This can be followed with another drink.
  4. Learning to swallow pills should be done in small steps, with success at every stage. For example, have your child practice with a very small cake decoration. When the smallest size can be swallowed with no problem, a slightly larger size may be tried. Then work up to the size of pill your child has to take. It is best to work in short sessions (5-10 minutes) several times a day over a few days. If this does not work with your child, talk with the hospital staff.
  5. Reduce distractions and interruptions during medicine-taking times. For example, close the door, pull the curtains around your child's bed, and turn off the television.
  6. Some children like to play "beat the clock". Use a one or two minute time limit, then have a small treat.
  7. If the child gags or vomits, be calm and clean up any mess in a matter-of-fact way. Let the child settle for 10 or 15 minutes, and try again.
  8. Give plenty of praise. Use specific praise such as "Oh good! You swallowed it right down."
  9. Some pills may be easier to swallow if they are broken in halves or quarters. Ask the nurse whether this can be done with the pills your child is taking.
  10. Arrange for something pleasant, such as getting a sticker or playing with a favourite toy, right after the medicine is taken.

When taking pills is too hard, a liquid form may be available. Liquid medicines can be given on a spoon, from a tiny cup, or with a mouth syringe. They may be taken "straight", or may be able to be mixed with a small amount of favourite drink or "chased" with a drink or food. As well, some pills can be crushed and given on a spoon with ice cream, yoghurt, or applesauce. Others can be dissolved in liquid. If your child has trouble swallowing pills, be sure to ask the nurse if any of these ideas can be tried. But remember, don't trick the child. Let the child know what is happening.

Some children may not be able to swallow medicine because of sores or other disease in their mouth or throat. In these cases, pain medicine can be given by continuous intravenous infusion. This method can also quickly control severe pain. It is very reliable, but may be a little inconvenient since an intravenous pump is needed.

Sometimes a special computer-controlled device, called a Patient Controlled Analgesia (PCA) Pump, is used to give a small dose of intravenous medicine when it is needed. Older children can usually control this device themselves. With younger children, the pump is controlled by a nurse or parent. The computer is set ahead of time so that too much drug cannot be given. PCA is ideal because the right amount of drug can be given exactly when it is needed. It also helps the child feel in control and know that their pain will be looked after right away.

Another approach is to give morphine or similar drugs subcutaneously (just under the skin) on a regular basis. This can be more convenient than continuous intravenous infusion, especially when the child is at home. A tiny needle is placed anywhere on the body and is easily changed by the child, parent, or visiting nurse. The needle is usually changed twice a week.

A patch (like a bandaid) is being developed to give a strong analgesic called fentanyl through the skin. When available, it will give a steady dose of the medicine without any needle and may be helpful for some children.

With some unusual pain problems, an anaesthetist will inject local anaesthetics to block specific nerves or use an epidural catheter to place a strong analgesic close to the spinal cord. Both these methods can control very severe pain