I have always had a problem swallowing tablets, and one of the phobias I have had is that they will get stuck in my throat and I wont be able to breathe. In fact, it seems to be a self fulfilling prophecy because that’s what happens each time I do take a tablet.
I thought that Sahil would have the same problem. When he was seven, given the fact that he may have to take medication at some stage in the future,I decided that I would take the plunge and make the effort.
He learned swallowing pills within a few days and I realized this was something he was ready for and I could have possibly tried earlier. While I am not a huge advocate of stuffing our kids with antibiotics, antipyretics and other sundry medicines it is now a proven fact that a lot of autistic children need certain supplements and medications to help them with issues in their body chemistry
The issues to consider when deciding to try giving tablets orally are as follows:
1) Medicines are absorbed better when they reach the gut or small intestine rather than powder form in the stomach where they may interact with digestive acids
2) Medicines which are not specifically compounded for children may irritate the stomach lining if powdered and mixed with a substance such as honey so that the child can ingest it. This can lead to nausea.
3) Medicines in tablet/capsule are cheaper than liquids (yes this can be a consideration at times!) or dispersible tablets. They keep much longer too.
4) A wider choice in types of medicines is available if the child can swallow tablets.
5) Many additives like artificial coloring, flavourings, sweeteners such as sugar/aspartame are put in syrups to make them attractive and palatable. It is generally better to put less of these “extras” into our already over sensitive babies
6) It is so much more convenient and faster! Try traveling with bottles of syrup.
Given all the above is the child ready to swallow pills? Well certain prerequisites have to be in place:
1)The child should be eating solids
2)The child should allow you put your hand in their mouth without biting it off!
3)The child should understand and be able to readily follow simple relevant commands like: open your mouth, tongue out,drink, swallow it, no biting/chewing
If these are not in place then I would work on these skills first.
The first thing I did with Sahil was
Demonstration– I took a piece of boiled rice and put it on the back of my tongue and then drank water to swallow it. I also told him what I was doing.
Preparation-The next step I told him what he was going to do.
Action-I asked him to open his mouth, stick out his tongue, put the the rice at the back of his tongue and then told him to drink the water and swallow it. Praise/reward the success or even the effort.
Generalise-If and only If step 3 can be done without trauma, the size and the texture of the pill can be changed.
The best real pills to start with would be gel caps. Do not try dispersible tablets – they are tough to swallow because of their texture and stick to the tongue
Since the piece of rice is small and is unlikely to cause choking-hopefully Step3 should go smoothly. If there is a gag reflex for the back of the tongue(I have one) I would put the rice in the middle of the tongue. The process should not be traumatic for the child. If it is even slightly traumatic I would stop and try again after a few weeks break, and during this period do plenty of demonstration.
This has worked with Sahil and now as part of the DAN procol he swallows gelcaps that are an inch long!!!