A Spoonful of Sugar Helps the Medicine Go Down

The words from the song, “A Spoonful of Sugar”, in the Disney movie, “Mary Poppins”, take on new meaning in the world of pediatrics. A spoonful of sugar helps the medicine go down…literally! We literally do use sugar-containing substances to help kids take medicine. In some pediatric residency programs, doctors-in-training occasionally take a little taste of some of the common medications that we give children, in order to get an understanding of what kids are experiencing when they are prescribed an antibiotic liquid, fever or pain-relieving syrup, vitamin drops, or bitter pills to swallow. However, this attempt at empathizing with kids and their taste buds is rarely a helpful strategy to enable children to take medications better or at all. Medication refusal may not be about taste, but may be related to the personality or developmental age of the child. However, managing the taste of the medication is an important place to start.

I have seen many children with an illness, mostly around toddler age, who refuse an oral pain medication, fever reducer, antibiotic, or steroid to be taken for pain, fever, infection, or breathing problems. All of these issues would significantly improve, if they would just take their oral medication and their suffering would be relieved. Nonetheless, they refuse to take the medicine. Medication refusal or vomiting medicine immediately after taking it is commonplace in pediatrics. So, what are we to do? In the extremes, we resort to administering the medication rectally or giving it by injection, if there is a preparation available. Both of these methods are far less desirable than just having children take the medications by mouth.

While there are various techniques used to make a child take necessary medications, there are easier methods. The most common easier alternative is to try and disguise the medication in something sweet or flavorful to cover the taste of the medicine. We give them a “spoonful of sugar” to help the medicine go down! Some common foods or drinks used to mix the medication in or use as a “chaser” to remove the taste of the medicine after it is ingested include:

· Chocolate milk or chocolate syrup

· Ice cream

· Apple sauce

· Yogurt

· Strong flavored grape juice

· Orange juice

· Cake frosting

· Pudding

· Or any other food or liquid that the child likes

Nevertheless, despite these techniques, children may still not want to take their medication by mouth and other alternatives methods need to be considered. We can always try to sweeten the deal by adding sugar. But, in the end, a spoonful or even bagful of sugar may not be enough for the most stubborn of kids to take a medication, if they decide they don’t want to take it. As I write this, the beginning of the lyrics to the song rings in my ears, “Just a spoonful of sugar helps the medicine go down…” and ends with “…in a most delightful way.” I take pause and think that many parents and pediatricians would find nothing delightful about struggling to give a child medicine, especially if you have to trick them by adding sugar to encourage them to take it at all!

What tricks have you used to give your children or patients medications that they are refusing to take by mouth? Please post your answer in the comment section for everyone’s benefit!