Medication - Refusal to Take

DEFINITION

• Your child refuses to take a medicine
• Techniques for giving liquid medicines, pills and capsules are also included

Wrong Technique For Giving Medicine Can Cause Vomiting

• Forcing a struggling child to take any medicine can lead to vomiting or choking.
• Using a better technique can sometimes eliminate the child's resistance.
• Your child's doctor can sometimes replace a bad-tasting antibiotic with a better-tasting one or an injectable antibiotic.
• Most non-prescription medicines are not essential and can be discontinued.

Good Technique for Giving Liquid Medicine

• Equipment: Plastic medication syringe or dropper (not a spoon)
• Child’s position: Sitting up (Never lying down)
• Place the syringe beyond the teeth or gumline. Some young children become cooperative if you let them hold the syringe and place it in the mouth.  Then all you have to do is push the plunger.
• Goal: Slowly drip or pour the medicine onto the back of the tongue or into the pouch inside the cheek.
• Avoid squirting medicine into back of throat (Reason: can enter windpipe and cause choking)

Uncooperative Child: Additional Techniques For Giving Liquid Medicine

• Caution: Never use this technique if the medicine is not essential.
• If your child is uncooperative, usually you will need 2 adults to give a medicine.
• One adult will hold the child sitting on their lap, using their hands to restrain the child’s hands and head from moving.
• The other adult will give the medicine using the following technique:
• You must have a medication syringe (available at all pharmacies without a prescription).
• Use one hand to hold the syringe and the other to open your child’s mouth.
• Open your child’s mouth by pushing down the chin or running your finger inside the cheek and pushing down on the lower jaw. 
• Insert the syringe between the teeth and drip the medicine onto the back of the tongue.
• Keep the mouth closed until your child swallows. Gravity can help if you have your child in an upright position (Caution: swallowing cannot occur if the head is bent backward)
• Afterward, say: "I’m sorry we had to hold you.  If you help next time, we won’t have to."
• Give your child a hug and other positive reinforcement (treat, special show, etc).

WHEN TO CALL YOUR DOCTOR

HOME CARE ADVICE FOR MEDICATION REFUSAL

Prescription Liquid Medicine and Your Child Refuses To Take It

1. Reassurance:
   • Young children don't understand the importance of taking a medicine.
   • Good technique can make a big difference.
2. Sweeteners For Medicines That Taste Bad:
   • Most liquid medicines have a good or at least acceptable flavor.
   • If your child complains about the taste, your job is to mask it.
   • Mix the dose of medicine with a strong-sweet flavor such as chocolate syrup, strawberry syrup, any pancake syrup, or Kool-Aid powder.
   • Medicines can safely be mixed with any flavor your child likes.
   • Also, have a glass of your child's favorite drink ready to rinse the mouth afterwards.
3. Good Technique for Giving Liquid Medicine:
   • Equipment: Plastic medication syringe or dropper (not a spoon)
   • Child's position: Sitting up (Never lying down)
   • Place the syringe beyond the teeth or gumline. Some young children become cooperative if you let them hold the syringe and place it in the mouth. Then all you have to do is push the plunger.
   • Goal: Slowly drip or pour the medicine onto the back of the tongue or into the
     pouch inside the cheek.
   • Avoid squirting medicine into back of throat (Reason: can enter windpipe and
     cause choking)
4. Uncooperative Child - Additional Techniques for Giving Liquid Medicine:
   • Caution: Never use this technique if the medicine is non-essential.
   • If your child is uncooperative, usually you will need 2 adults to give a medicine.
   • One adult will hold the child sitting on their lap, using their hands to restrain the child's hands and head from moving.
   • The other adult will give the medicine using the following technique:
   • You must have a medication syringe (available at all pharmacies without a prescription).
   • Use one hand to hold the syringe and the other to open your child's mouth.
   • Open your child's mouth by pushing down the chin or running your finger inside the cheek and pushing down on the lower jaw.
   • Insert the syringe between the teeth and drip the medicine onto the back of the tongue.
   • Keep the mouth closed until your child swallows. Gravity can help if you have your child in an upright position. (Caution: swallowing cannot occur if the head is bent backward)
   • Afterward, say: "I'm sorry we had to hold you. If you help next time, we won't have to."
   • Give your child a hug and other positive reinforcement (treat, special video or DVD, stickers, etc).
5. Call Your Doctor If:
   • Continues to refuse to take the medicine
   • Your child becomes worse

Non-prescription Liquid Medicine and Your Child Refuses To Take It

1. Reassurance:

   • Most non-prescription medicines are not essential.
   • Examples of these non-essential medicines are most cough and cold medicines and fever medicines.
   • Never try to force your child to take an unnecessary medicine.
   • Symptoms usually can be relieved with other types of treatment. See the specific topic that covers your child's main symptom for other treatment options.
2. Fever:
   • Fevers over 102 F (39 C) that cause discomfort can be treated with acetaminophen suppositories. (same as the oral dosage)
   • Alternative approaches: If child spits out or refuses ibuprofen, try oral acetaminophen (Tylenol). You can also try a different flavor or brand of the medicine (may taste better). If your child is old enough, you might also try chewable tablets instead of the liquid.
   • FOR ALL FEVERS: Give cold fluids in unlimited amounts. Avoid excessive clothing or blankets (bundling).
3. Good Technique for Giving Liquid Medicine:
   • Equipment: Plastic medication syringe or dropper (not a spoon)
   • Child's position: Sitting up (Never lying down)
   • Place the syringe beyond the teeth or gumline. Some young children become cooperative if you let them hold the syringe and place it in the mouth. Then all you have to do is push the plunger.
   • Goal: Slowly drip or pour the medicine onto the back of the tongue or into the
     pouch inside the cheek.
   • Avoid squirting medicine into back of throat (Reason: can enter windpipe and
     cause choking)
4. Call Your Doctor If:
   • Your child becomes worse

Techniques for Giving Liquid Medicine to Cooperative Child

1. Sweeteners For Medicines That Taste Bad:
   • Most liquid medicines have a good or at least acceptable flavor.
   • If your child complains about the taste, your job is to mask it.
   • Mix the dose of medicine with a strong-sweet flavor such as chocolate syrup, strawberry syrup, any pancake syrup, or Kool-Aid powder.
   • Medicines can safely be mixed with any flavor your child likes.
   • Also, have a glass of your child's favorite drink ready to rinse the mouth afterwards.
2. Good Technique for Giving Liquid Medicine:
   • Equipment: Plastic medication syringe or dropper (not a spoon)
   • Child's position: Sitting up (Never lying down)
   • Place the syringe beyond the teeth or gumline. Some young children become cooperative if you let them hold the syringe and place it in the mouth. Then all you have to do is push the plunger.
   • Goal: Slowly drip or pour the medicine onto the back of the tongue or into the
     pouch inside the cheek.
   • Avoid squirting medicine into back of throat (Reason: can enter windpipe and
     cause choking)
3. Call Your Doctor If:
   • You have other questions or concerns

Techniques for Giving Pills or Capsules

1. Reassurance:
   • Many children have trouble swallowing pills or capsules.
   • Fortunately, most medicines also come in a liquid form.
   • Therefore, if you aren't successful using the following tips for swallowing pills or capsules, call your child's doctor about the possibility of a liquid or chewable form of the medicine.
2. Techniques for Swallowing Pills or Capsules:
   • Place the pill or capsule far back on the tongue and have your child quickly drink water or favorite fluid. If your child concentrates on the liquid and gulps large amounts, the pill will disappear from the mouth.
   • Keep the head in a neutral or slightly bent forward position. (It's difficult to swallow if the head is bent backward).
   • Drinking rapidly through a straw can also help.
3. Split or Crush Pills:
   • For easier swallowing, one approach is to split the pill into halves or quarters.
   • Another approach is to convert the pill to a powder. Crush the pill between two spoons. Crushing is made easier by first moistening the pill with a few drops of water and letting it soften for 5 minutes.
   • Mix the crushed pill with a pancake syrup, chocolate syrup, yogurt or any sweet food that doesn't require any chewing.
   • Note: You can do this with any pills EXCEPT slow-release or enteric coated pills. Check with your doctor if you are uncertain what you can do.
4. Capsules:
   • Slow-release capsules can be emptied as long as the contents are swallowed without chewing.
   • Since capsules usually contain medicines with a bitter taste, the contents need to be mixed with a sweet food. Apple sauce or yogurt may work.
5. Prevention Through Practice:
   • If your child is over age 8 and unable to swallow pills, he should practice this skill when he's not sick or cranky. (Some children can't swallow pills until age 10, however. )
   • Start with small pieces of candy or ice and progress to M&M's. Try to use substances that will melt quickly if they get stuck. If necessary, coat them with butter first.
   • Once candy pellets are mastered, pills will usually be manageable.

6. Call Your Doctor If:

   • Your child can't take the medicine after trying these techniques
   • Your child becomes worse.

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 10/26/2011
Last Revised: 10/26/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D