Kara Wada, MD: Do you or your child dread swallowing pills? You are not alone. In fact, up to 40% of people, kids, and adults struggle with it. Today we're going to show you the simple tricks that can make pill swallowing way easier, especially when it comes to allergy medications.

Welcome back to Allergy Actually. This is another quick episode where we are working on talking through a skill that is really helpful for those who are living with allergies, asthma, eczema, all the things. So as allergist and as moms, we see this all the time. I was just commenting before we hit record that my little one has to take a daily medication. She's almost 10 and we're still doing the sprinkle on things. So I'm looking forward to sharing this with her and practicing what I preach in the coming weeks.


The "Applesauce Trick" for Kids Who Hate Pills
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Amber Patterson, MD: And you know, I think it's one of those things, especially as a parent, I remember with our first child, sometimes you don't know when a child is developmentally ready to do something like swallow a pill 'cause it's just not like on your radar. You're thinking, "Okay, they do liquids, we'll do liquids until I don't know when." So sometimes it takes just thinking, okay. Most school age kids that are able to follow instructions can swallow most allergy pills. A lot of 'em are really small. So it's something worth thinking about if you're to the point where your child is on, let's say cetirizine or Loratadine, and their dose is now 10 mls and it's a lot of liquid and they might do better with a pill.

Kara Wada, MD: The only one that I have available to me here is I had some Allegra and I was gonna compare it. So Allegra is the largest, so I think helpful to know that. And this is compared to my fish oil. So this is a pretty decent size tablet for the adult Allegra. The Zyrtec and Claritin are what, maybe a third of this size? 

Amber Patterson, MD: Oh yeah. They're tiny. Like half a tic-tac, maybe like a mini m&m.

Meagan Shepherd, MD: As far as swallowing pills, something that I just remembered too. You were talking about a child and I just recalled, you know, trying to teach my kids I have no pill swallowing technique that I teach patients. And I told Amber and Kara that I was gonna be pretty useless during this demonstration. I just thought that and

hope that, you know, it all goes down and I don't have a great way of teaching my children or my patients. So for my children though, one thing I recalled that I did is sometimes they actually do better transitioning into doing the swallowing first with something that has more substance to it than water.

Like we do it with a lot of applesauce packets and pudding. I had completely forgotten about that. They don't seem to like the feeling of the pill touching different parts of their mouth as they're swallowing and feeling it touched, you know, their sort of throat area. And so that helped my kids transition into swallowing a pill with just a straight up normal liquid like water or something like that.

Kara Wada, MD: That's great. And there's so many pouches now that I feel like, you know, are a part of our cuisine as moms and the snack options that we always have at least two boxes of applesauce pouches on hand at all times.

Amber Patterson, MD: So step one, if you've never swallowed a pill or you're afraid to swallow pills. Megan, do you wanna talk about a way to ease into this?


How to Practice: The "Orange Tic Tac" Method
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Meagan Shepherd, MD: Yeah. So like I said, I'm not a good teacher of this skill. We had a brilliant mentor that we all had at Nationwide Children's who would always advise patients to start small, like something the size of a Tic-tac. So if you start with Tic-Tacs, make sure that you choose the orange one, or now there's some other flavors, but if you do a minty one, you can kind of feel it going down and then that's a weird sensation. But if you can start practicing with orange Tic-Tacs, if you feel like you're ready to, you know, progress on just trying and seeing how you do. And then if that doesn't work, then you just spit it out and, you know, move on to a couple of these other techniques that actually have more information about what to do.

But that's the extent of what I'm able to tell my patients because again, you'll see my technique and it's not a technique. 

Amber Patterson, MD: Okay, so first try something that's not a medicine in practice. All right, Kara, what do we advise patients on for how to make it easier to swallow a pill?

Kara Wada, MD: so you can place the capsule on your tongue or tablet. Have your water ready, take a sip, but instead of tilting your head back, instead you're gonna lean forward slightly and you'll swallow while you're leaning forward. So I think we were all gonna try this together.

Amber Patterson, MD: Yeah.

Kara Wada, MD: I have my giant

Amber Patterson, MD: How'd it go?

Kara Wada, MD: Fine.

Amber Patterson, MD: Megan? You wanna go next?

Meagan Shepherd, MD: I do what?


The #1 Technique: Leaning FORWARD to Swallow
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Kara Wada, MD: Put it in your mouth, take a sip of water, and lean forward instead of back.

Meagan Shepherd, MD: Okay.

Amber Patterson, MD: Wait. Okay. Yeah, I was, I was gonna say I could go first and do in another instructional, but it looks like it's so natural for you. Look at that.

Meagan Shepherd, MD: And I have coffee too. I don't ever even bother to try water. Like do it with a coke. It's, I'm not the one to listen to about this, but that successfully went down, is what I'll say about that technique.

Amber Patterson, MD: Okay. I am someone that with bigger pills, sometimes they get stuck. I have had supplements before that tend to be like the size of your fish oil ones, Kara, that literally got stuck and it is terrifying. I had to kind of like choke it up to get it out. So I'm a little hesitant when it comes to pills if they're bigger than I feel comfortable.

If you can break it in half, I will break it in half and swallow two halves before I'll attempt a really big one. But, I've got one here that's kind of like medium size. I use the same technique that Kara described. Instead of lean forward, just simple modification, chin down works too. Doing that movement opens your throat. When you look up, it actually causes your esophagus to collapse, so it makes it a little harder. So here it goes.

It went mostly down. I need a little more water.

Meagan Shepherd, MD: Sometimes I do a food chaser, a little food chaser if I feel like one of the big ones gets. Something with substance. This is one of my supplements that I take every day. And it's, I'm not like, I don't have a banana for comparison, but it's pretty large. But again, I don't have a great technique. I have learned that I can only do one at a time. I'm very bad to swallow a handful of pills, like with my morning meds. 

Amber Patterson, MD: Do some people just toss them all back?

Meagan Shepherd, MD: That's how, that's my technique. When I told you I have a terrible technique.

Amber Patterson, MD: Yo do have a technique.

Meagan Shepherd, MD: Well, yeah, my technique is not something that I think other people should probably do, but I do have a technique, I guess. Yeah. Yeah. So for instance, this is my little container. These are the pills that I typically take, like altogether at one time. I don't know if you can see, I've got.

Amber Patterson, MD: Okay, there we go.

Meagan Shepherd, MD: Several there and then I have at least learned that that is, that's acceptable for me. They're tiny. And then this I can take together, although these are kind of large, this is a migraine prevention. And then I have the supplements and I have made the mistake of forgetting that these are just simply too large to take together. But I have attempted it on accident and I'm one of those people. I put liquid in my mouth first, then pill in, then swallow. So it's all the things you're not supposed to do.

Amber Patterson, MD: Well, I think that first part's preference, right? Like if you do pill than water or water than pill, that part's preference. But once it's in your mouth, it is easier to swallow if you lean forward or put your chin down. So that part we're sticking to it.

Meagan Shepherd, MD: I'll just be awkward and maybe choke sometimes.

Kara Wada, MD: Well, I think, you know, it's important to normalize the fact that if you or your child feels nervous, that that's totally normal. And it can take getting some reps in like anything. Like, I'm just thinking, my kiddo at softball last night, it was our first game like. She struck out like, that's gonna happen. It's part of learning, right? But we can celebrate those small wins of, you know, even just trying with the Tic-tac, and getting those practice reps in and with time, most people will find that it does become second nature.


Pill Swallowing Alternatives: Cutting & Crushing Pills Safely
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Amber Patterson, MD: Yeah. And if not, then work with what you got. So, like I mentioned, sometimes I'll cut pills in half and check with your pharmacist first again 'cause some of the extended release pills, they're not intended to be cut, but most of the allergy pills are just the pressed powder, we'll say type pills. So for those get a pill cutter, it's, you know, 20 bucks from the grocery store, or order on Amazon, cut the pill in half.

Some of them can be crushed. Mix it with applesauce. So figure out what works. But in my opinion, pills are way better than liquid most of the time.


When It's More Than Fear: Eosinophilic Esophagitis (EoE)
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Meagan Shepherd, MD: And keep in mind if you struggle, not necessarily with the portion of swallowing it and getting it into your esophagus, but if you have the issue where it continues to get stuck in your esophagus, that's actually something that you need to see your doctor for and something that you may end up actually seeing an allergist for.

Because there are some disorders that can cause you to have a stricture in your esophagus. There's something called eosinophilic esophagitis, which causes a lot of inflammation inside your esophagus that causes pills and food to get stuck a lot. So if that starts happening or you don't feel like you ever get better at "swallowing pills" in quotations, it's something to talk to your doctor about because you may actually need a medical attention for an esophageal issue that once that's solved, you might be a champion pill swallower.

Amber Patterson, MD: Just like Dr. Shepherd.

Meagan Shepherd, MD: Just, just like me.

Kara Wada, MD: So if you found these tips helpful, make sure to hit the like button, share the video with someone you know who is struggling to swallow pills and subscribe to Allergy Actually for more practical tips from three allergist moms who get it. Have a pill swallowing success story or another trick that works for you, maybe our speech therapist colleagues that are listening can draw some additional wisdom that we totally missed. We'd love to hear it. Add those to the comments. And until next time.



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