Syrups: Children are fussy about taking medicines. It is a common problem and causes problems to the parents and to the treating doctor. In a not so uncommon scenario, the parents have to catch hold of the child forcefully, the child thrashing, resisting to his fullest extent. Parents have to catch hold of his arms, then his legs; one of them have to hold his face so that there is no movement of the neck and open the mouth of the child somehow. Then the spoon of the medicine is forcibly put in the child’s mouth.
It is amazing that even with 2 adults holding the child, many times the child somehow jerks the spoon by a sudden, unexpected motion and the medicine is spilled on the bed or the floor. Since it is syrupy, it creates quite a lot of mess and has to be cleaned up. Almost always, some medicine lands itself on the child’s as well as the parent’s clothes also, which also has to be cleaned. So much struggle for a spoonful of medicine does not appear justified, but mostly there is no other solution. The only advice I can give is to give it to the child quickly before the child is fully aware of it, because once he is aware of it, he will throw up a struggle.
Give it in a casual, nonchalant way while engaging the child in an interesting game or conversation. Giving it quickly without much ado makes the child realize too late that he has been “cheated.” Otherwise you have to convince the child that he has to take the medicine. Usually he will listen to either threat of a greater pain (i.e. injection as a substitute) or will reluctantly agree if told that after having the medicine, his symptoms will abate (he will agree only if the symptoms are causing a great anguish to him, like severe pain).
Alternatively you can postpone the enjoyable activity that the child is engaged in till the less pleasurable task i.e. swallowing of the medicine is completed. The child with his mind on the enjoyable activity being denied to him temporarily may gulp down the “bitter” medicine. You can tell him that after the medicine, he can engage in the pleasurable task like playing etc (i.e. a thing which heloves very much). Finally his taking the medicines should be praised so as to act as a positive reinforcement.
It happens many times that the child, as the spoon with the medicine is forcibly put into his mouth, gags and vomits out all the medicine along with some of the stomach contents. This is due to struggle; with the child not at all wanting to swallow the medicine.
Some people recommend that you should block the nose of the child completely by pinching his nose tightly shut. The child having no alternative has to open his mouth to breathe and when he does so, the medicine can be rapidly given to the child. I don’t have much experience in trying out this method. But I am wary that while the child breathes through the mouth, some of the medicine may enter the windpipe, causing a bout of extreme coughing and vomiting. Anyhow this can also happen with an extremely struggling child without pinching the nose. So parents can give it a try and see whether it works for them or not.
Parents before giving any medicine to the child should make it a point to taste it itself, because in the majority of cases what turns the child off is the taste of the medicine. If the medicine is bitter and not palatable, it is wise to ask your doctor whether a suitable alternative exists. If it doesn’t, you should take steps to mask the bitterness of the medicine syrup by putting sugar, honey etc. in it. Parents also are in the habit of mixing the medicine (syrup or crushed tablet) with the milk bottle or the food of the child. I have nothing against it and do consider it as a suitable alternative with the caveat that the child should finish the whole milk; otherwise the required dose of medicine will not go!
Whenever you give syrups to your child, always shake it thoroughly. Otherwise the top part of the syrup remains diluted while the bottom part of the syrup is concentrated thus giving wrong dosing to your child. Syrups are available in 2 forms, ready made and those, which has to be constituted by adding water to them.
Once the ready made syrup bottle is opened, it is better to use it within 1 month. For reconstitution, you have to take clean, boiled and cooled water and add it to the powder in the bottle up to the mark specified on the bottle. After that you should close the cap and shake it thoroughly. Some mixtures take some time to dissolve and become homogenous. So be patient and go on shaking. After the powder is totally dissolved you will find that the level of the syrup has shrunken below the specified mark.
This is because as the powder dissolves into water, it occupies less space. In all cases, “top up” water should be added so that the “shrunken level” is again brought up to the mark. These types of reconstituted syrups should be used quickly, preferably within 1 week.
Children are usually given syrups with a spoon. Parents use different types of spoons according to the availability in their house. So some spoons are small and some are big, i.e. there is no uniformity regardinga spoonful measure. So when the doctor writes to give your child 1 spoon three times a day, different parents depending on the size of the spoon will give different doses. This is incorrect and imprecise. Many syrups don’t provide a measuring cap with the bottle and even if they do provide, it is calibrated only as 2.5 ml (=1/ 2 tsf), 5 ml and 10 ml.
Doctors calculate the dose of a drug according to the body weight of the child and may write a prescription say, 2ml tds or 3.5 ml tds. Of course the doctor is theoretically correct and written the prescription precisely. But how will parents give 2 ml, 3.5 ml, 6ml etc.? As I have mentioned earlier giving by spoon is quite imprecise. Ideally, therefore, drug companies should come out with caps that are marked up to 10 ml and graded in ml; i.e. they should have marks at 1ml, 2 ml, 3ml…
The dose schedule is important. To give a drug 4 times a day means that it should be given 6,12, 18, 24 hours or 5, 11, 17, 23 hours etc. How can parents give a child medicine at 12 o’clock in the night or 5 o’clock in the morning without undergoing considerable trouble both for themselves and the child? Practically it is not feasible and as a result the child does not receive the required doses and thus the desired treatment. I tried myself to take drugs on a 6-hour basis and failed miserably in doing so.
Even taking medicines 8 hourly i.e. three times / day was a big task for me with only 70% compliance. So it is impractical for the doctors to believe that a 6 hourly drug regime for 7-10 days will be complied with. Drug companies have to come out and promote drugs that have a longer duration of action and can be given 12 hourly or even as a single dose/day.
Fortunately these types of medicines are nowadays freely available in the Indian market for practically all the common diseases and the onus now lies on the doctors to prescribe such medicines so that there is at least 80-90% compliance. Parents can also contend that since they cannot give drugs every 6 hours, the doctor choose an alternate but equally efficient drug (which is freely available) so that dosing can be 12 hourly or once a day. Even for the child it means less torture in taking medicines.
Companies are at fault in writing the doses on the bottle, for example Vi tsp till 1 year of age, 1 tsp for 2-6 years etc. This is a gross approximation and does not often tally with the dose that the doctors calculate and recommend. This is because the doctors calculate the dose according to the weight and obviously you don’t expect a 2-year and a 6-year-old child to weigh the same. So how can the dose for 2-6 years be the same e.g.l tsp? Why it is done? I think primarily to promote over the counter (called OTC) sale.
Many parents directly go to a drug store and ask for fever or cough syrup for the child without having a doctor’s prescription because they never visited the doctor. Drug stores are more than willing to give a brand in which they earn the maximum profit which usually is always 30% plus. I can only comment that parents are doing so at their own responsibility and with a risk to the child. Remember all medicines are chemicals and overdosing is potentially dangerous, while under-dosing will lead to sub-optimal cure, plus the drug brand being given to them may be of some sub-standard company.
Drops: Another form in which medicines are available is drops. I prefer them over syrups because the dose is less say 10-20 drops (0.5-1 ml), which is easy to administer (as compared to 5 ml of the syrup) and since the bulk is less; chances of the child vomiting it out are less. Plus the dose is accurate and precise. The only disadvantage is that they are a bit bitter because they are not syrupy and secondly few drugs are available in the market in form of drops that can be given on a 12 hourly basis.
Tablets: There are 2 types of tablets. One is known as the dispersible kid tablet, in which the tablet dissolves in a spoon of water, which can then be administered to the child. The dosing is precise irrespective of the size of the spoon as the tablet strength (say 125-mg) is being given to the child in the dissolved form irrespective of the spoon size. The most important advantage is uniformity of dosage i.e. it is not diluted at the top and concentrated at the bottom as happens in a bottle plus the shelf life is not limited as in the case of bottle. One tablet when opened is used immediately. Many drugs are nowadays coming in kid tablet forms and I prefer them to syrups for the reasons mentioned above.
The other form of tablet is the one that has to be swallowed. A child less than 7-8 years usually cannot swallow a tablet. So to give it to a younger child, one has to crush the tablet and make it powdered before administering. The powder doesn’t dissolve in water and so the child will not like the taste plus he will feel a gritty sensation in his mouth and so may reject the medicine. The best way to administer such powders is not to use water as a medium but instead a viscous gel like thing (e.g. honey, tomato ketch-up or jam).
The powder can be put at the centre i.e. it should be surrounded on all sides by the viscous liquid, which can then be administered to the child. Some children are fussy and once they know that a medicine is going to be administered, they reject it even though the viscous liquid “encapsulates” it and the child won’t feel the taste of the medicine. In such cases it is best to prepare the concoction of the powder and viscous liquid away from the sight of the child and then make the child take it.