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Where it is desirable for the child to take their medicine as a tablet or capsule, the following technique (sometimes known as ‘pill school’) can be used.

Pill School’ will test how effective a training program would be in switching children from liquid medicines to the tablet or capsule version.

By this service a pharmacist can offer a safer, convenient and cheaper option to liquid medicines.

Preparation

Discuss the child’s ability to swallow food, especially hard or chewy food, with the parents. Ask the parents, and the child if possible, whether they think the child would be able to swallow tablets or capsules.

Ask whether the child has had any previous experience of taking tablets and capsules and whether this was successful.

Check any dietary issues with respect to the placebo capsules to be used, e.g. allergies to food colouring or consumption of gelatin products.

Ask parents to ensure that the child has not eaten or drunk anything immediately before the session so that they are not too full to swallow the capsules or water.

Arrange the appointment for a time when the child will be alert and cooperative—e.g. not straight after school or nursery when they may be tired.

Advise parents and other healthcare workers not to tell the child in advance what the session is about because this might create anxiety and resistance.

To avoid possible disruption, ensure that the child has been to the toilet before starting the session.

Equipment

Prepare a series of capsule shells of different sizes containing sugar strands and place in bottles labelled with the sizes. Place some loose sugar strands in a bottle. Keep bottles and labels hidden from the child’s view.

Two cups (one for the child and one for you) and a bottle of water.

Two small trays or containers (e.g. Weighing boats), one on which to place capsules and one to use if the child spits out a capsule.

Tissues for mopping-up purposes.

Process

Explain the purpose of the session to the child in simple terms. Talk enthusiastically and mention good things about taking tablets or capsules—e.g. avoiding bad-tasting medicine.

Show the bottle of sugar strands and place a few on the tray. Ask the child to show you that they can swallow these.

Place two of the smallest capsules on the tray. Explain to the child that now you want them to try swallowing the sugar strands inside a capsule. Explain how to swallow a capsule without chewing and demonstrate this:

• Sit or stand upright
• Take a breath
• Put the pill in the middle of your tongue
• Take a mouthful of water and swallow
• Keep your head straight.

Show the child that you have swallowed the capsule by opening your mouth and sticking out your tongue. Make the process fun, but be firm if necessary.

Ask the child to show you that they can do the same with the other capsule.

Get them to show you that their mouth is empty by opening their mouth and sticking out their tongue. Praise the child for their success.

If the child has been successful, repeat the process with the next size of capsule, again demonstrating how to swallow it if necessary. State that it is the next capsule, not that it is larger. Give praise and encouragement at each stage.

If the child has difficulties swallowing a capsule at any stage, get them to spit it out. Encourage them to try again with the same size of capsule.

If the child is unsuccessful in the second attempt or if they refuse to try again, stop the session. Do not pressure the child because this could create an association between capsule taking and distress. Praise the child for trying hard.

At the end of the session, if the parents were not present, bring them into the room so that the child can demonstrate successful capsule swallowing.

Give the parents a supply of the largest size swallowed and written instructions on how to take capsules for further practice at home.

Explain to the child that the medicines they will take could look different to the sample capsules, but they should be able to swallow them in the same way.
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