Teaching an autistic child to swallow a pill

Today’s answer comes from pediatric nurse practitioner Lynn Cole, associate director of clinical services at the University of Rochester’s Division of Neurodevelopmental and Behavioral Pediatrics, one of 17 Autism Speaks Autism Treatment Network (ATN) sites.

My son fights taking pills and liquid medications or supplements, though he likes “gummy” vitamins. Do you have any tips?

How to get an autistic child to swallow a pill

Many children with autism spectrum disorder (ASD) refuse certain foods because of sensitivities to tastes or textures. Some also have trouble swallowing medicines, vitamins and other supplements in pill form. Clearly this is of concern because it can make it harder to treat illnesses or address nutritional deficiencies.

We often discuss such issues with the families who visit our ATN center. They’ve shared their success with a number of tactics. The most common – and often successful – approach is to make the medicine or supplement more acceptable – keeping in mind your child’s likes and dislikes. For instance, some supplements and medicines can be crushed and mixed with a favorite food such as applesauce or yogurt or a favorite drink such as apple juice. You might even try disguising it in a squirt of chocolate syrup. But it’s very important to ask your doctor or pharmacist if it’s okay to crush or mix a given medicine as some can irritate the mouth or throat or are designed to release slowly over time. 

Other times crushing and mixing simply doesn’t work. If this is the case with an important medicine, consider working with your pharmacist and/or doctor to find an alternative medicine in a form or taste your child will accept.

Compounding pharmacists have expertise in mixing drugs to meet special needs. Your doctor or regular pharmacy may be able to refer you to compounding pharmacist in your area. You can also try a web search using your zip code and the phrase “compounding pharmacy.”

While these strategies can work well for the occasional distasteful medicine, they are not an ideal long-term plan. Over the long run, your child’s health will be better served if he learns to take medicines, including pills.

Many families give up prematurely on teaching pill swallowing. In fact, most children can learn this skill – given time and patience and some guidance. Speech pathologists, occupational therapists and some other behavioral specialists have expertise in this area. So I encourage you to enlist the help of your child’s health and educational team.

In addition to pill swallowing “lessons,” families can consider other behavioral strategies.

Many of our families report success with the following:

• Pair a difficult task, like taking medicine, with a favorite activity like swinging, a little computer time or simply playing a favorite song.
• Create a daily schedule that includes medicines.  Children with ASD often benefit from a predictable daily schedule. Including medicines in that schedule makes the task more predictable and your expectations clearer to your child.
• Use visual supports to help a child understand the daily medicine routine. For instance, visual supports can help a child learn each important step to swallowing a pill and can even be used to help make the connecting between taking the medicine and getting to enjoy that favorite activity (by showing a picture of a child taking medicine paired with a picture of the activity).

Know that taking medicines, vitamins and other supplements tends to get easier over time. The earlier you can start teaching these skills and employing helpful behavior strategies the sooner you can help ensure your child’s long-term health.