Thursday, April 4, 2013

How to ACTUALLY Get Medicine into a Toddler, and Why You Shouldn't Feel Bad About It

We're really particular when it comes to medicating our three year old. We have been from the beginning. When he needed antibiotics for an ear infection at 5 months, it was like a battlefield around here before we finally decided antibiotics were absolutely necessary. Getting him to take them, however, was a whole different battle, although at 5 months it was at least, possible.

Fast forward to more recently.  We've all been coughing since November.  Viral, we figured.  We suspected it would go away eventually.  My cough continued to get very bad and I was diagnosed with pneumonia in late February/ early March. I knew it was bad news when I couldn't keep my temperature below 40C without Advil.  The antibiotics I took cleared me up pretty fast. 

Aias's cough was on and off, on and off, on and off.  In the middle of March we went to the doctor about it to see if it was maybe pneumonia like mine was.  We suspected it wasn't because he wasn't getting much of a fever and he still seemed to have plenty of energy, but at any rate, we figured we better get it checked out.  The walk-in clinic doctor said he wasn't certain what was going on but prescribed liquid antibiotics for Aias (the same one I took, Biaxin) just in case he started to get worse.  Aias seemed to get a tiny bit better for a week or two, so we didn't give him the antibiotics.  Then all of a sudden he was getting a low grade fever and the cough sounded "more wet," so we talked about it and decided we'd try to give him the antibiotics.

The antibiotics are a white and chalky liquid that come in a 120mL bottle.  We were supposed to administer 5mL to him twice a day for seven days, meaning we'd need 70mL total.  Of course, it quickly became abundantly clear why they would insist on giving us 50mL extra.

We approached Aias with the antibiotics pretty straightforwardly.  We explained to him that he's sick (which he understands) and that he has been for a while (which he also understands) and that the medicine would make him feel better (which he understands).   We showed him the (huge) dropper the medicine came in and we said he could have it out of the dropper, on a spoon, or in a little cup.  He seemed somewhat willing, until he had one single drop of it.  It was disgusting. So we both tried it to see what we were up against, and yes, while it was slightly flavoured "fruit punch" or something, it was absolutely disgusting.

We continued to explain that we knew it was gross but that he needed to have it because it would make him feel better.  Even though he understood that to a degree, he's THREE.  He wasn't thinking about cause and effect, or the benefits of taking something gross now so that he can feel less sick later.  No. All he was thinking about was how disgusting the medicine was NOW, and how he wasn't going to eat it.

We kept trying to talk to him about this.  We showed him the spoon and what a dose would look like on the spoon.  We showed him the cup and what it would look like in a cup.  We said we could mix it with orange juice.  We said he could have something yummy right after to mask the taste.

Nope. Nope. Nope. Nope.

After about 15 minutes of attempts, 7 doses wasted (a few spit out, a few knocked over onto the couch/floor/carpet), we put our heads together.  Were we going to "force" the antibiotics into him? Yep, we didn't want to, but we had to.  Among our many duties as his parents, one is to make sure he takes medicine when he's sick so that he doesn't get sicker or worse.  We said to him:

"Aias, we are going to have to hold you down and force you to take the medicine because if we don't, you are going to get sicker or worse, and you are going to have to go to the hospital."

Aias said he didn't want to take it.  We tried to be sneaky and mix it into some juice but the texture and taste were too obvious.  No dice.

We sat him on our lap, held his arms, and tried to put the medicine in his mouth. Guess what he did? He clamped his jaw. Duh, what else would he do?  We spilled it all over him, pissed him off, and that was that. Eight wasted doses and he probably got 1mL total into him.  And we were supposed to do this twice a day for 7 days? No freaking thanks.

I dropped him off at preschool and went straight to the pharmacy and explained the situation.  Maybe they could give me some pro-tips, or offer me the antibiotics in a different form. Chewable, maybe? In chip form (kidding, but that would have been awesome)?

"We're not sure what to say, you need to administer the whole dose to the child for the  medicine to work. "

Alright, I said.  And guess what I did? I walked to another pharmacy.  We live in the city and we have a dozen pharmacies in walking distance, and I had nothing but time.  I had gone to four pharmacies and was given basically the same information.  "Just do it" was what they suggested.  Easier said than done, people.  A few suggested mixing it with thick chocolate syrup, but they also admitted the texture and strong taste may make it tricky to do with a particular child.

That night we decided we would just make an appointment for Aias with our family doctor, because surely he would have some sort of plan.

The next day we went to the doctor.

"I'm having trouble giving him the antibiotics," I said. "He won't take them."

Blank stare from the doctor.

"What do you mean he won't take them? Are you saying you are having trouble administering the medicine to the child?"

"Yes... yes I am having trouble. He says it's gross, and he clamps his teeth down, and it gets everywhere.  What does get in his mouth is spit out."

"Just sit him down, reason with him, and be firm" was his advice.

Yeah. I'm serious.

We stopped at all the pharmacies on the way home; these were in a different neighbourhood and we hadn't tried these ones yet. 

On pharmacy number 5 I explained the situation and the woman whispered to me:

"Well, we aren't really supposed to officially suggest this, but I can tell you what I'd do.  I'd sit them on your lap, tilt them back a bit, hold their arms, and get another person to shoot the medicine down the side of their mouth.  There is a gap in the back between the their jaw and their teeth and the medicine will go through that gap.  Give them a light blow on the face and they will have a reflex to swallow."


She looked at me to see if I would react negatively.  I must have made a face.

"I know it sounds mean," she continued.  "But if your kid needs to have the medicine, this is a lot nicer than letting them get a worse infection.  If the child won't take oral antibiotics, I can't imagine they'll be much more cooperative to get them through a needle."

I thought about it.  When Aias got sick before and needed an IV at the hospital because he was dehydrated, it was the worst experience of our lives.  We had to hold him down to get it in, and then hold him down for 45 minutes (literally) while he begged and pleaded for us to help him and remove the IV.  If we had let him even move at all, he would have plucked it right out (he actually did at first, gross and awful to witness).

I spoke to many parents about it after this later that afternoon at the local play centre.  Some parents said their kids would take the medicine with a bribe. Two even said their kids liked medication.  Of course, most parents described the same resistance Aias had, and after much hesitation, guess what method they told me they used?  The same exact method the pharmacist told me about, almost word for word. Even one of my own AUNTS told me the same method!

I couldn't believe how many parents were telling me this method, of course, with a guilty face and a disclaimer along with it.  "I'm not a bad person" or "I hope this doesn't sound awful" or "Please don't think I'm a terrible parent" or "I'd never do this unless it was absolutely necessary."

Word for freaking word.  The holding the arms, the clamping of the teeth, the putting it in the side of the  mouth, and the light blow on the face so the kid would swallow.

Why the hell couldn't someone have just told me this before? Was it because they didn't know? Or was it because they thought it sounded "mean?"   

I find it nearly impossible to believe that pharmacists hadn't been asked this question before, or told this strategy. I think I wasn't told this solution because it sounds like a "mean" thing to do.  I think I wasn't told this solution because people worried how I'd react.

I think this is a serious problem. I think it's a serious problem because sometimes kids are really ill and need to have medication.  It's actually really stressful, difficult, and frightening for both the parents and the child if the administering of the medication seems nearly impossible and if there is little to no real support in helping ease the process, or simply just make it happen at all.

I understand that it this point, some people reading are probably thinking how AWFUL and HORRIBLE it would be to force  medicine into your child in this way.  Totally against their wishes and in a way that may seem scary.  To a degree, I agree as well.  If someone had asked me 4 years ago about this  method, I'd have said it was an awful thing to do to a kid.  If Aias had taken medicine even remotely willingly or with a bribe, I'd also have said this method was an awful thing to do to a kid.  As someone who will probably have to do this someday, I still think it's pretty awful, but I also think it's probably necessary.

If your child is sick and really needs medication, they really need medication.  I know it's better to treat kids in the same way as you'd treat an adult at times, and of course you should always treat them with respect, with dignity, with compassion.  In this case, there's a marked difference between an adult and a child.  We are raising our kids because they can't raise themselves.  An adult can do two things a child can't in this situation.  An adult, if they don't want to take a "yucky" medicine, can decide not to and they can be fully aware of the consequences of not taking them. If they choose not to take it, it's fair enough, as they are in charge of themselves and can be considered responsible for sealing their own fate.  A child cannot.  An adult can also understand fully that the medicine may be "yucky" but that it's still very important they take it. An adult can choke it down and know that in the long run, the outcome will be better for them.  Preschoolers and young children can't, necessarily, have a real grasp on this. 

Our job as parents means that sometimes we will have to make decisions about these things that aren't easy, aren't fun, and maybe don't even align with what we consider our parenting values.  I hope that no parent actually ever has to do this to get antibiotics into their child; I hope the reasoning, the "being firm," the bribes, or the logic and negotiating techniques will work for you.  However, if they don't, and this is the only way you can get your kid to take medicine that they truly need and that isn't negotiable, I hope you can find success in this method and not beat yourself up about it.

Finally, in case you are curious, we didn't have to give him the antibiotics in the end.  The family doctor said we could wait a bit longer, and that the cough sounded more wet not because it was getting worse, but because that's how coughs sound when kids are at the end of them.  He said to come back in a week if Aias was lethargic or had a high fever, but we didn't have to in the end. 

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