by Sabine Hack, M.D.
Many children have difficulty in swallowing pills. They may be unable to perform the necessary reflex, they may be feeling too sick, or they may have unpleasant associations with pills and illness. 
Many desperate parents have coaxed, wheedled, cajoled and bribed their children to take their pills. They’ve mashed pills in apple sauce or bananas, diluted them in soda, and tried other creative ways to disguise them. But sometimes pill-taking becomes a battleground and compromises the child’s health. Parents, however, can help children learn to swallow pills automatically. The secret lies in patience and in a system that teaches the skill by using gradual steps with candy “pills” of different sizes.
[These are the s]upplies [you need to help your child practice]: Multi-colored round candy balls called mixed decors found in the cake-decorating section of a supermarket; tic-tacs
- Be sure your child is capable of an automatic swallowing reflex. To assess this, make sure that the child is able to swallow small amounts of water without difficulty. Have the child take a mouthful of water (not so much that his cheeks are full) and attempt to swallow it without having any dribble out.
- If there are no problems with swallowing water, have the child swallow one of the multi-colored round candy ball “pills.” Some children may not need to start with the smallest size. The child should begin with the appropriate size candy “pill” that he can comfortably swallow. Starting with a bigger size enables the child to move up more quickly without wasting water swallowing nothing. Tell the child to place one ball as far back on her tongue as possible, take a drink of water from a cup (not a fountain) and swallow the “pill.” The child can have as many practice trials as she needs. Most children find swallowing these balls surprisingly easy, so the first attempt is almost always a positive one. Praise the child for both effort and success.
- After five consecutive successful attempts, the child may move on to the next size candy “pill.” The candy pill levels are:
- the multi-colored mixed decors
- color shots
- small silver decors
- snowflakes
- larger silver decors
- 1/2 of a cinnamon or fruit decor
- whole cinnamon or fruit decor, and
- tic-tacs
- Practice trials should be given at each level.
- If the child is unable to swallow a candy “pill” five times in a row, continue the procedure using the same size candy pill (even if the child has swallowed the candy four times in a row and then failed on the fifth try). Sessions generally last 10 to 15 minutes. However, it’s not advisable to prolong the sessions so that the procedure becomes aversive to the child. Consider the following factors:
- the amount of candy the child has ingested
- the amount of water the child has had to drink
- the extent to which the procedure appears to be anxiety-provoking for the child.
- If the child moves to another size candy pill and is not successful, return to the previous size pill before ending the session, so that the session ends with success.
- In subsequent sessions always begin with the first size candy pill used at the first session. If the child swallows it easily on the first attempt, progress directly to the next size, and so on. If the child is unable to swallow the pill, move to the size below that. Give practice trials, using a criteria of 5 successes before trying the size that the child was unable to swallow again. Some children move through all the sizes easily in one session. Others may have more trouble and move up slowly over 2 to 6 sessions.
- Progress from the candy pills to actual medication. It is rare that a child progresses through the shaping program through the tic-tac level and then has difficulty in swallowing the medication.
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