Clinical Tip: For older children, premeditation is the key to swallowing pills

Swallowing pills is a skill usually acquired in childhood. For children who do not learn how at an early age, the stigma grows as they get older. Not only are they embarrassed to seek help, but they often develop a mental block about pill swallowing. Practicing with small round candies before moving onto larger real pills does not always work, and many patients find splitting pills or crushing them into applesauce to be inconvenient and distasteful.

One of our teenage patients, who had always been advised to "just swallow the pill with a glass of water; the pill will go down by itself," observed that every time he took a pill with water, his throat instinctively filtered out the pill. One day, he had a revelation: He realized that his mind saw the pill as a foreign object that he had to flush down his throat by unnatural means. Subconsciously, he did not want to swallow the pill; he just wanted it to go down by itself. The patient began actively trying to swallow pills-and was rewarded with immediate success. He described the experience this way: "Swallow some saliva and feel it going down your throat-in other words, feel the process of swallowing. Now, just as you focused and tried to swallow the saliva, try to swallow the pill. Remember, the water is just there to help it slide down. Your throat will stop anything from going down by itself unless you actually want and actively try to swallow it."

Your reluctant swallowers may benefit from this kind of coaching, and can be encouraged to start their own "internal dialogue" to help themselves overcome their problem.