Teaching children to take tablets: a success story!

For part of our trip through South East Asia, we have had to take anti-malarial medication. Malaria is not something to take chances with, so taking the recommended treatment is potentially life-saving. It is also very expensive. The medication we needed to take was not available in anything other than tablet form and this has been difficult for the kids because they have never had to take tablet medication before. To add to the pressure on them, we didn’t have any ‘extra’ or spare tablets, so it was essential that we all took our treatment exactly as prescribed. This blog is all about how our kids managed to learn the skill of taking tablets.

Malaria is a disease of the blood caused by the Plasmodium parasite. It is transmitted from person to person only by a particular type of mosquito, called the anopheles mosquito. This type of mosquito is a female mosquito that typically bites between the hours of 9pm-5am. Malaria is important because it is one of the top killers on the planet. 1 child dies every minute from malaria – just over 450,000 children a year – 90 per cent of these children are from Africa.

Compared with Africa, malaria is not as common in Cambodia where we have been travelling, but it is still a problem in some specific areas. We stayed in Battambang, a city which unfortunately has one of the highest levels of treatment resistant malaria in South East Asia. This means that most commonly available anti-malarial medications are not effective here, and if you are unlucky enough to catch it in this area, then it can be difficult to treat. So, malaria avoidance is extremely important.

Avoiding malaria can be done in a number of ways:

  1. Wearing long clothing to cover skin, particularly at peak ‘biting’ times – dawn and dusk.
  2. Using good quality anti-mosquito repellants on exposed skin.
  3. Taking the correct anti-malarials and completing the prescribed course.

When travelling with children, points 1 and 2 are easy to achieve (apart from the whining about having cream rubbed in “all the time“…), but point number 3 is more difficult. In Battambang, the only recommended antimalarial drugs currently are Doxycycline and Malarone (atovaquone and proguanil). Children under 12 cannot take Doxycycline, as it can affect growing teeth and bone formation, so Malarone is the only choice. Malarone is an effective, but very expensive treatment, currently costing approximately £1 per tablet. This drug also does not come in any form other than tablet: unfortunately there is no yummy-strawberry flavoured Malarone syrup available as yet!

Our children are aged 7 and 10 years old, and prior to this trip, have never before taken tablets for any reason. Back in the UK, we have always been able to source all common medications required in liquid suspension form – paracetamol, ibuprofen and even antibiotics. For this reason I was worried that the tablet-taking element of our treatment might be a bit of a problem for the kids. After doing some research, I found guidance that stated Malarone tablets can be split or crushed if necessary. However I was worried that doing this may mean that accurate dosage may be hard to measure, especially if the full treatment wasn’t taken (e.g. some is spilled or spat out!). So it meant we had to take a crash-course in taking tablets.

Luckily, our eldest watched us take our medication and copied, swallowing his tablets with a big gulp of water. No problems. Our 7 year old however, struggled. Initially, we did try to divide her daily half tablet dose into 2 smaller quarters using a tablet cutter (available from all pharmacies) as we thought this would make the process simpler. These 2 pieces were then put into a spoonful of yoghurt. Unfortunately, this wasn’t very successful, because as soon as she felt the ‘lump’ of tablet in the yoghurt, she would choke and have difficulty swallowing it. We tried the pieces in bits of soft banana too, but to no avail. In desperation, we did suggest the idea of crushing the tablet into the yoghurt, but apparently the tablets don’t taste nice and are bright yellow inside when split or crushed, so she felt this would probably be worse.

It’s at this point we need to say a big thank you to our amazing paediatric nurse friends back home, who gave us some brilliant tips on how to help children take important medication orally, and for giving us lots of encouragement to overcome this problem! We really appreciated your help!

She next tried swallowing the quarters with water or her favourite drink. This was a little better, but usually at least one of the quarters would get ‘stuck’ and could not be swallowed. This would then be followed by lots of tears as we tried to convince her that it needed to be taken and couldn’t just be spat out. These difficulties lasted about a week. Every day, we dreaded having to ‘take the tablets’, as we knew if would be difficult for her and stressful for us all to helplessly watch. But to her credit, she absolutely  persevered and took each and every single dose, however difficult and ‘yucky’ it was.

Eventually, we suggested she try taking the whole single piece of half-tablet in one gulp with the drink. Our theory was with less ‘corners’ of the tablet to get stuck in the throat, and with only one gulp needed, perhaps this would be easier?

And it was! Success!

It took 2 days to completely get the technique, but she can now take tablets like a pro! In fact, she even admits that she doesn’t mind taking them any more, and would now prefer to take ‘grown-up’ tablet analgesia in future or antibiotics, to avoid the usual sticky liquids with ‘weird’ flavours from the doctor! She is always the first to remind us all that its ‘tablet time’!

So in our case, practice really does make perfect! It took just over a week for Rosie to learn how to do it, but it goes to show that if you persevere, and try various different approaches, your child will hopefully find it gets easier as they get more confident.

Please see the video below of Rosie taking her treatment and explaining how she managed to overcome the difficulties. If your children are also struggling with taking tablets, they may find it reassuring.

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