Teaching your child how to swallow a pill

Many children’s medications come in chewable or liquid forms, but some are only available as pills that must be swallowed whole. For kids who struggle with swallowing pills, this can be a challenge – for both them and their caregivers. But with the right approach, kids can learn to take their medicine more easily and with less stress.

Lauryn Shackelford, Child Life Specialist at Children's Health℠, breaks down the process of helping your child learn to swallow a pill.

"Like learning any other skill, swallowing pills takes practice. So, when possible, I recommend that a child have opportunities to practice this skill before actually needing to swallow a pill for the first time," Shackelford says.

Why do kids have trouble swallowing pills?

There are a lot of reasons kids have trouble swallowing pills or tablets, including:

• A lack of practice. Swallowing pills isn't a skill we’re born with. It has to be learned and practiced. And younger kids need enough muscle coordination to swallow something – without chewing.

• A fear of choking. Many kids worry they'll choke or that a pill will get stuck in their throat.

• Size or texture. Some kids can gag because they are not used to the feeling of the size or texture of the pill in their mouth or throat.

• Taste. In some cases, kids struggle with the bitter taste of a pill on their tongue.

• Lack of control. Some kids may resist swallowing pills if they feel they're being forced to take them.

What age can a child swallow a pill?

Most kids are able to swallow pills around age 5.

"If you practice with pill-sized food that is not medicine, most children 5 or older can master this important skill in a few weeks," Shackelford says.

However, some kids are unable to swallow a pill regardless of their age due to a delay in there swallowing reflex, which can be caused by breathing. Check your child’s swallowing reflex before you demonstrate and practice pill swallowing. To check your child's swallowing reflex:

• Ask your child to take a mouthful of water and swallow it.

• If no water dribbles from their mouth, your child is ready to start learning to swallow pills.

How to teach kids to swallow a pill

Practice with pill-sized candy

It's easier to introduce pill swallowing when a child is not actually sick. "Kids are more willing to practice when they are relaxed, healthy and do not feel pressured," Shackelford says.

You can use small candies to practice swallowing without chewing and gradually increase the size.

For example, you might buy:

• Tiny round sprinkles

• Mini M&Ms

• Tic-tacs

• Edible sugar pearls

• Skittles

• Nerds

• Mike and Ikes

Demonstrate pill swallowing

To demonstrate the pill-swallowing process for your child:

• Start with the smallest candy

• Sit up straight and relaxed

• Swallow the water and the pill the way that is most comfortable

• Follow up with another sip of water to keep the “pill” moving

• Let your child know they can try different head positions when swallowing if easier for them (face forward, chin up, chin down)

Encourage your child to keep practicing

When your child is ready to start practicing themselves, begin with the smallest candy you have.

• Have your child put the smallest candy on their tongue, take a sip of water and try to swallow the small candy or sprinkle.

• If it doesn’t go down with the first swallow, encourage them to keep drinking.

• Let your child try as many times as they need – until they can swallow the tiny sprinkle every time.

• If they’re struggling, go back to simply swallowing water. Then, praise them for their effort and calmly tell them you can try again another time.

• If things are going well, move on to the next size of candy.

• If they’re unsuccessful twice with the next size of candy, end your practice session. (You always want to end on a successful note!)

• The next day, start with the smallest candy again. Ask your child to show you that they can swallow that size three times – before you move on to the next size up.

• Keep practicing every day for at least six more sessions, building up to the biggest size.

"Don't forget to praise your child's effort and willingness to practice – even if it takes a while for them to have success. Your time and patience will pay off," Shackelford says.

Other pill-swallowing tricks for kids

If you’ve tried the steps above without success, there are a few other techniques to try:

Place the pill on different parts of the tongue

You can experiment with two different tongue positions with your child:

1. Back of the tongue. Put the pill at the back of the tongue. Have your child take a few sips of water – before they try to swallow the pill. This can help the pill slip down more easily.

2. Middle of the tongue. Put the pill on the middle of the tongue. Fill the mouth with water until the cheeks are full. Then, swallow the water. The pill may slip down too.

Try different body positions

Sometimes, a small change in your child’s body position can make pill swallowing more successful.

• Standing up. If your child is struggling to swallow a pill while sitting down, have them try swallowing while standing up.

• Lean-forward technique – for capsules. Capsules are lighter than tablets and can sometimes float to the front of the mouth during swallowing. Have your child try leaning their head slightly forward while swallowing. This can force the capsule to move towards the back of the mouth – and be more easily swallowed.

Try other liquids or foods

If using water is not working, you may be able to try other liquids or foods. But Shackelford cautions that you need to make sure that’s OK with your doctor or pharmacist first.

• Do not swallow pills with milkshakes or yogurt drinks. Thicker drinks slow down swallowing and can make the pill less likely to separate from the liquid.

• Foods to tuck a pill in. Some children can swallow pills in spoonfuls of peanut butter, applesauce, pudding, ice cream, yogurt or Jello. Wrapping a small piece of fruit roll-up tightly around the pill can help mask its taste and texture. Just be sure to use a small enough piece so it doesn’t make the pill too large or difficult to swallow.

• Chewing a cookie or crackers first. Some kids have success popping their pill in their mouth after chewing a cookie or cracker – and just before swallowing them. This also reminds kids that they can safely swallow bites of food that are much larger than a pill.

The straw, pop-bottle and two-gulp methods

For some kids, these additional methods can do the trick.

• Straw method. Put the pill on your child’s tongue. Ask your child to take 3 gulps of water through a straw. When they swallow the water, they will often swallow the pill at the same time.

• Pop-bottle method – to reduce gagging. Have your child place the tablet or pill anywhere in their mouth. Then have them take a drink of water from a soda-pop bottle – keeping contact between the bottle and their lips (by pursing their lips and using a sucking motion). Keeping the bottle in that position, have them swallow the water with the pill.

• Two-gulp method. Place the pill on your child’s tongue. Have them take one gulp of water, focusing on swallowing the water only. Then have them immediately take a second gulp of water – to swallow the pill and the water together.

Get additional support

If your child needs to take a medication that can’t be cut, crushed or dissolved – and you have tried these pill-swallowing techniques without success – ask your doctor or pharmacist for alternative forms of the medication.

Need help finding a pediatrician? No matter where you live throughout North Texas, our pediatric primary care providers are here for you and your child. Find our primary care locations near you, from McKinney to DeSoto, in Dallas, Plano and many cities in between.