November 29, 2011

A Spoon-full of Sugar Helps the Medicine Go Down

Lots of parents have trouble getting their children to take medicine, so here are some tips to help:

Some techniques to help medicine go down easier:

Marry Poppins was right- a spoon-full of sugar helps the medicine go down! More accurately, a spoon-full of chocolate syrup will cover up the taste of most yucky medications. Apple sauce and yogurt are other common foods used to mask bad tastes. Many medications can be made to taste like your child's favorite flavor by the pharmacist before you even pick it up, so ask about this when you submit your prescription. Some medications come in "orally dissolving tablets" which kids (age 3 and older) can put in their mouth and they will dissolve without having to chew or swallow.

Liquid meds are often easiest to give to babies with a syringe (a tube that looks like shot, but does NOT have a needle on it), which you can get at any pharmacy, baby store, or from your physician. Squirt small amounts of medication into your baby's cheek and they'll usually swallow it. Don't squirt it directly onto their tongue or into the back of their throat, as this can lead to gagging. Follow-up with breast milk or formula (whatever they normally drink), before giving the next part of the dose. Alternatively, you can put the liquid medication in a bottle nipple along with a little breast milk/formula, and have them suck directly from the nipple, without the bottle attached. I do not recommend mixing the medication in a whole bottle, unless you know the baby will take the whole thing regardless of taste.

Most baby stores also sell special devices to help kids swallow medications,such as something that looks like a bottle, but keeps the medication separate, so you know exactly how much the child takes. I do not recommend giving children medications with droppers, because it's difficult to measure the amount you're giving, difficult to get all of the medication out of the dropper, and difficult to clean and dry the dropper fully between each use.

Learning how to swallow pills:

Once your child is ready to swallow pills (often by age 5!), it's a great help to teach them how, since many medications are easier to take in pill form, the older they get, the bigger the dose, and some medications are not available in liquid/ chewable form. Starting young can also be beneficial in preventing anxiety associated with swallowing pills. Adolescents and adults often have trouble swallowing pills because they fear that the pill will get stuck in their throats. Relaxation techniques and deep breathing can help. Looking in a mirror, sticking your tongue out, and saying "aaah" out loud (this lifts the palate so you can see your throat), can help people see that their throat is much bigger then the pill, and ease some of the anxiety.

The first step in learning how to swallow a pill is to practice with something that is NOT medication. I recommend starting with small, smooth, round candies (such as mini m&m's), and progressing to slightly larger candies (such as regular m&m's). People with anxiety may want to start with tiny candies, such as sprinkles. Other people prefer to start with tiny bread balls (made from mooshing a tiny piece of bread between your fingers), and go progressively bigger, since the bread dissolves easily in the throat. You will also need a big glass of water, juice, or carbonated beverage (such as sparkling juice, which the pill can float on).

Younger kids can be told to just try swallowing the candy without chewing, because they are often successful without thinking about it. Older children, or those without a natural tendency to swallowing whole pieces, can start by visualizing the item floating down their throat on water, like a little boat. They should start by making sure the mouth is moist, by salivating or taking a sip of their drink. Nest place the candy as far back on the tongue as possible, using the teeth to scrape the candy to the back of the tongue (a mirror helps some people see how far back it is). Then take a big gulp of the liquid, which should float the candy and allow it to be swallowed, just as you would usually swallow any regular drink. Some children will swallow the candy (and later pills) more easily by drinking the liquid through a straw.

When it comes to taking real medicine, some people hide their pills in mini-marshmallows, which are slippery when wet, and therefore easier to swallow. I recommend trying this without medication first, since these are bigger then most pills. You can also try covering the pills in chocolate syrup, applesauce, yogurt, or jam (but see the warnings below before trying that).

I suggest experimenting with these techniques in a relaxed environment until you find something that works for you.


These techniques are for generally healthy children, with normal anatomy and mentation! They should not be used for children with any anatomical abnormalities, dysphagia (trouble swallowing regular foods or drinks), or any medical conditions that effect swallowing, the head/face, the GI system, or the neurological system.

All children should be supervised when practicing swallowing candies, and when taking ANY medication. NEVER tell your child that the medication is candy, as this can cause them to sneak some more when you're not looking (many medications these days actually do taste like candy). Always keep medications (over the counter and prescription) and vitamins/ supplements out of reach AND in a LOCKED container. Kids are good at climbing and getting into high cabinets, purses, closets, and other hiding places.

Please speak to your pharmacist (who is usually in the back of the store, who has spent at least 5 years in post-graduate university studies, getting a doctorate degree in pharmacy), about what you can take your medication with, and whether you can cut, crush, chew, or open the medication. Many medications should NOT be taken with grapefruit juice. Some medications should NOT be taken with anything dairy. Some pills can be crushed and mixed with foods, where as others can not. Your pharmacist and/ or physician are the best people to speak to before taking your medication with anything but water.

Good luck & feel free to leave your own tips & experiences below :)
My son loves taking medicines! (c) 2009

September 15, 2011

Tips for Stopping Bad Habits (giving up the bottle, paci, and thumb)

When should you quit?

The bottle should be the first thing to give up, between 12 and 18 months. Continuing to give a bottle at bedtime increases the child’s risk for ear infections and dental problems. Your toddler should be drinking 16oz-24oz (2-3 cups) of milk per day. Less than 16oz does not give them enough calcium and vitamin D, but too much milk can cause iron deficiency anemia and fill up your child, preventing them from eating other nutritious things.

The pacifier is usually the next thing to give up, between 1 and 3 years old. It is important to stop in order to prevent ear infections and poor teeth/ jaw alignment. The pacifier has also been blamed in some for lisps, and delayed language development (the child may use it as an excuse to not speak properly).

Thumb sucking is the hardest to stop, and most pediatricians recommend no intervention until age 4, since most kids will stop sucking their thumb on their own before then.

Sleeping solely in the child’s own bed is a very personal decision, as there is nothing medically wrong with sharing the bed with a toddler (unlike in infancy, when you must be careful of how you co-sleep to prevent SIDS). However, teaching them to sleep on their own is a way to help children learn to self-comfort, as well as providing the whole family with better sleep.

How Do We Stop?

Some tip for breaking any habit:

  (1) Decide if you want to stop the behavior completely all at once (“cold turkey”), or wean it off gradually (usually by limiting the activity to bed time).
 (2) Do not turn it into a confrontation with the child. Let them know you are here to help them stop the habit, and why you want them to stop.
(3)     Have them come up with alternative methods of self-soothing with you. Ask them, “What can you do instead?” Guide them to choosing something that is reasonable.
(4)  Point out that their older siblings, friends, even characters that they like, do not use a pacifier/ suck their thumb/etc… and let them know “big kids” don’t do it. Example while watching Dora The Explorer, “Wow, look what a big girl Dora is! She and Boots have all these adventures and she doesn’t suck her thumb, even when Swiper comes.” Point out how much your child has changed/ grown in other ways, and let them know how proud you are of them.
(5)  Do not prohibit them from self-soothing in high anxiety situations, or when there is a big change (such as a new sibling being born or a parent going on a business trip).
(6)  Make sure they are aware they are doing it (by pointing it out in a helpful, positive way), and distract them with something else to do.
(7) Give them an acceptable substitute, such as a blanky/lovey, small stuffed animal, special new cup, or small cloth square to keep in their pocket (this last item can be rubbed by the child with fingers in pocket, especially when substituting for thumb-sucking or nail biting). Make sure the child is involved in choosing the new item, and knows why. If you decide on a lovey that your child gets attached to, make sure you have 3 identical ones in rotation, so one can always be in the wash, one in use, and one back-up.
(8) Reward charts can be helpful for children who are age 3 and above (the older, the better). This is a sheet with calendar spaces for 2 to 4 weeks, with the last space with a pre-determined prize, such as a trip to a special place (e.g. Disneyland), or special new toy. The child puts a sticker or X in the space every day that they don’t do the habit, in some cases only consecutive days of not doing the habit are allowed to be charted.

The bottle is the most important thing to give up, for your child’s health. At 12-18 months transition to a sippy cup, then around 21 months transition to a regular cup for meals and snacks (sippy and straw cups are fine to use when going out). Start by holding the cup for the child, and teaching them to hold it themselves with very small amounts of water in it (to reduce spills/ clean up). You can also give gradually less milk in the bottle until there is none (e.g. decrease the amount of milk in it by 2oz each day).

The pacifier is usually a difficult transition because of age, and the new toddler’s desire for independence. In addition to the general tips above, you can also try the following: (1) Give it away to a baby (not the child’s new sibling, since that can lead to jealousy), or a favorite character (such as on a trip to Disneyland). Make sure the child participates in the giving away ceremony. (2) Have the pacifier sewn into a stuffed animal (like at one of the Build a Bear workshops), then the child can sleep with the stuffed animal. (3) Cut a hole in the pacifier, so the sucking action stops working. (4)  Make a necklace out of the pacifiers, and hang it on their crib. Let the child know if they don’t use the pacifiers for a certain amount of time they get a pre-determined reward. This works well with older children, with a reward chart.
[Photo of my son while still happily sucking his pacifier at 9 months old (c) ]

Thumb sucking is the hardest habit to break, since you can’t take away their fingers. For this reason, and since most toddlers stop thumb sucking on their own, it is recommended to wait until the child is 4 years old before intervening. Peer pressure at that age also helps them try to stop (at least in public), and they respond better to reasoning. First try all of the above tips in the general section, especially pointing out when they do it, distracting them, giving them a substitute, and reward charts. In addition, you can provide a barrier by tying socks or mittens on their hands (there is no need to spend money on the fancy devices that do the same thing). Some girls respond to having a manicure. Other children are better reminded to stop by placing bandaids on the thumbs. I think bitter nail polish should only be used as a last resort, since this seems like a punishment to me, and I try to keep the experience positive, letting the child know that their parent is there to help them. The key at this age is that they need to want to stop, which means a lot of discussion in the house about why it is important to stop.

Bedtime is usually a big struggle with toddlers, so each family needs to decide for themselves how they want to handle it (pick and choose your battles). If the parents want the bed to themselves, or simply want the toddler to sleep on his own, the younger you start with sleep training, the easier it is. If your toddler is getting up in the middle of the night and coming to your bed, you can firmly, but simply, bring them back to bed each time. A music box or sleep sheep (white-noise maker) that they associate with going to sleep can really help (be sure to use this at regular bedtime and naptime as well). Another option is allowing them to sleep in your room, but not in your bed, so they feel close to the parent, but not comfortable. You can put a simple mattress down on the floor, or even just a blanket. This minimizes the parents waking up, which can be a big help to everyone. Another option which some people recommend, but which I never use, because it just seems cruel and unsafe, is to put a baby gate or lock on the child’s bedroom door, so that they cannot open it and leave their room at night. Whatever method you choose, or even if you choose to let the child sleep in your bed, just try to provide minimal attention when they wake up, since you do not want to reward them for getting up in the middle of the night, and everyone needs a good night sleep.

About myself & the blogosphere

Hello everyone, I am excited to be joining the blogosphere. I have decided to start a blog in order to provide general pediatrics advice in a longer format than I usually have in clinic, as well as share my experiences as a mother. This information does not substitute speaking to your physician, and all opinions are my own and do not necessarily express the opinions of my employers. The following is my bio:

I  grew up in Los Angeles, California, graduating from the Hamilton High School Academy of Music. My mother is a pediatric rheumatologist, giving me some extra insight into how medicine has changed over the past 30 years.

The University of California at Berkeley is where I spent my under-grad, receiving my B.A. with honors, majoring in Inter-Disciplinary Studies, Environmental Science. I went on to get a Master’s degree in Regulatory Science from the University of Southern California School of Pharmacy, which led to a position in clinical research at Childrens Hospital Los Angeles. While working there  I realized research was not enough for me, and I wanted to be a doctor too. I love medicine because it allows me to be a scientist, teacher, and detective every day, as well as help the next generation of children grow up healthy.

I obtained my M.D. from the Ben-Gurion University Medical School for International Health in Collaboration with Columbia University Medical Center. I received the Dean’s Award for Outstanding Contribution to the Medical School for International Health.  The school not only has an outstanding emphasis on clinical skills, but also allowed me to work with diverse populations, including a very short time in Ethiopia, and a senior project with the Bedouin community.

My internship and residency in pediatrics was completed at Maria Fareri Children’s Hospital, Westchester Medical Center,  New York Medical College, where I was their American Academy of Pediatrics Delegate.  I am honored to have received the Pediatric Residency Leadership Award. I am a member of the American Academy of Pediatrics and the Los Angeles Pediatric Society. I am certified by the American Board of Pediatrics.

I am happy to have recently moved back to Los Angeles with my family. I am lucky to have a wonderful, supportive husband, and a beautiful toddler son, who teaches us something new each day.

I am now seeing patients at Roxbury Pediatrics in Beverly Hills, CA. You can check us out at

Thank you for taking the time to read my thoughts!