Sunday, February 5, 2017

Tips for giving medicine/ The old spoonful of sugar/2017

Parents have to pick their battles. Sometimes things really aren’t so important and we don’t have to necessarily get “our way”. I am a big fan of discussion and compromise when appropriate. Generally though, the medication battle has to be one where we come out on top.
The obvious assumption is that you have decided for a valid reason that your child has a condition that needs to be treated. If this is the case, have a firm but loving attitude.  (Think Mary Poppins and her spoonful of sugar.)
Make it clear that you mean business and whether or not they like it, they will be getting the medicine, one way or another.
If they cooperate give them lots of positive feedback.
If they are resisting use the following technique.
For your young child, hold them at a 45 degree angle,  If they are flat they can choke a bit, and if they are sitting up too high they can spit. Getting the right angle makes a big difference.
If they are using their hands to knock the medication away, wrap them in a blanket (think straight jacket!)
A syringe is much more effective than a spoon and is better for measuring.
Squirt a small amount in the side of a cheek.
Keep the chin elevated.
Give a tiny bit at a time and wait for a swallow in between.
Some of our tough customers are most likely crying and screaming throughout the process. It gets easier.
If you are giving a teaspoonful, that would be 5 ml in a syringe. Giving .5 ml per squirt would mean 10 squirts. This may take several minutes, but the dose will go in.
The only kids that can beat this system if you are doing it slowly enough are the ones that learn how to vomit.
Okay, what are your options if you have a vomiter on your hands?
If your child needs antibiotics, sometimes we can give an injection.
If you are simply trying to get in a dose of fever reducers, suppository form might be your best option. (Not so easily 'spit' out.)
For kids who are old enough to reason, let's give them some choices. What would they like to drink after the medicine? Should we have the pharmacy add a flavor?
Sometimes holding a lollipop and taking a lick after each squirt helps with a bitter taste.
A compounding pharmacy can do almost anything in flavored suspensions and can even do some medications in topical gels. This year my compounder of choice is Eddie Lau over at Feel Good Compounders. They can be reached at 650-898-8221 or
Eddie was telling me that they can do creative things like ibuprofen in a topical gel form or suppository for our most difficult medicine takers. I never realized that those were an option. Some of the generic antibiotics are truly vile. Your poor child is not putting on a show. Eddie told me that he has tried to mask the bitterness, but there is no real hiding it.

Franklin pharmacy (the old 450 Sutter pharmacy) is back in business at their new location at 1508 Franklin Street in San Francisco. Elaine, the compounder there has done some wonders turning antibiotics into either savory cheese crackers or sweet sandwich cookies.
Their phone is 415-775-3917. This creative option has worked well for some kids.
Don’t wait until your child is sick to teach them about cooperation with medicine. It might be a good idea to do some role playing ahead of time.
Have one cooperative stuffed animal and one stuffed animal (or doll) who throws a fit.
For the cooperative doll say things like, “ I know this tastes a little yucky, but it is really important and it will help make you feel better. I am really proud of you for being so cooperative."
 For the challenging doll, wrap the arms in a blanket the way you may have to with your child. say, "I am sorry that this is so hard, but it is very important for you to take this medicine."
You might also let them pretend to be a parent who has to give the medicine to the uncooperative doll. Don't make it easy. Role reversal can give both sides some insight.
When the time comes that you have to give a dose of medication,choices and rewards are fine, but make it clear that the discussion will last 5 minutes and no more (set a timer.) When the timer is up they will be given the medicine the same way a baby gets it, The window of opportunity for having any choices will be gone. When the kids realize you mean business they cave fairly quickly.
One reward method is to make it possible to earn 10 pennies per dose. Put the money on the table.
A penny is taken away for every 30 seconds that passes without cooperation. Kids hate seeing something concrete being taken away.
If your child is old enough, this is a great math opportunity. A 10 day course of antibiotics can be worth 2 dollars (adjust the reward however you choose.)
Never try to sneak medicine into a larger volume of food or drink. Your kids will know it is there. If they do end up taking only part of it, you will have no real idea how much of it they got.
I have actually had some pretty young kids who hate taking liquid medicine learn to swallow capsules or pills.
Start with tic tacs or other small pieces of candy. See if they can swallow one. If they fail, oh well. They have a piece of candy in their mouth. If they can’t swallow it with water, try putting it on a spoon tucked  into some yogurt or jelly and see if it goes down.
Remember you are doing this with your child’s involvement. No sneaking things. Don’t lose their trust over something like this. You are on the same team, trying to help them feel better.
If your child ends up taking syrupy medications at some point or another make sure you brush their teeth after each dose.
If they are taking antibiotics I strongly suggest that they also take probiotics to protect the body chemistry and prevent yeast. Ideally, don’t give a probiotic at the same time as the other medications, but stagger it throughout the day if possible.
Some children take a daily medication or vitamin pill and quite like them. This year we had a 9 year old boy who presented in the office with an ongoing stomach ache. After some questioning, it turns out that he was helping himself to a handful of gummy vitamins daily.
Telling your child that medicine and vitamins are not candy and can only be given by the grown up is a start, but it is also essential that all medications and supplements (including vitamins) be kept in a childproof area. If your child does take an overdose of any medication call the Poison Control Center to find out how concerned you need to be.
Poison Control number for California is 1-800-222-1222
If you are ever giving a medication and are not sure about proper dosing, never hesitate to call your doctor’s office/ advice nurse for clarification.

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