Medicine - Refusal to Take

Is this your child's symptom?

• Your child refuses to take a medicine
• Techniques for giving liquid medicines, pills and capsules

Wrong Technique for Giving Medicine Can Cause Vomiting

• Forcing a struggling child to take any medicine can lead to vomiting or choking.
• Using a better technique can sometimes get rid of the child's resistance.
• Doctors can sometimes replace a bad-tasting antibiotic with a better-tasting one. Another option might be to give an antibiotic in a shot.
• Most non-prescription medicines are not needed and can be stopped.

Good Technique for Giving Liquid Medicine

• Equipment: Plastic medication syringe or dropper (not a spoon)
• Child's position: Sitting up (Never lying down)
• Place the syringe beyond the teeth or gumline. Some young children become cooperative if you let them hold the syringe. Have them place it in their own mouth. Then all you have to do is push the plunger.
• Goal: Slowly drip or pour the medicine onto the back of the tongue. You can also aim for the pouch inside the cheek.
• Do not squirt the medicine into the back of the throat. (Reason: Can enter windpipe and cause choking.)

If Your Child Does Not Cooperate: More Techniques for Giving Liquid Medicine

• Caution: Never use this technique if the medicine is not needed.
• If your child will not cooperate, you will often need 2 adults.
• One adult will hold the child sitting on their lap. Their hands will hold the child's hands and head to keep from moving.
• The other adult will give the medicine using the technique below:
• You must have a medication syringe. You can get one at a pharmacy without a prescription.
• Use one hand to hold the syringe. Use the other to open your child's mouth.
• Open your child's mouth by pushing down on the chin. You can also run your finger inside the cheek and push down on the lower jaw.
• Insert the syringe between the teeth. Drip the medicine onto the back of the tongue.
• Keep the mouth closed until your child swallows. Gravity can help if you have your child in an upright position. Caution: Swallowing cannot occur if the head is bent backward.
• Afterward, say: "I'm sorry we had to hold you. If you help next time, we won't have to."
• Give your child a hug. Also, use other positive rewards (treat, special DVD or stickers).

Liquid Medicines: How to Measure the Dose

• Use the oral dosing syringe that comes with the medicine. This device gives the most accurate dosing.
• If you don't have a med syringe, buy one at a pharmacy.
• Dosing with syringe is more accurate than a measuring cup or teaspoon.
• Household spoons vary in the volume they hold.
• Risk: Using household spoons causes thousands of cases of poisoning each year.

When to Call for Medicine - Refusal to Take

Call Doctor or Seek Care Now

• Refuses to take a prescription medicine. Using a good technique from Care Advice has not helped.
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Refuses to take a non-prescription medicine advised by your child's doctor. Using a good technique from Care Advice has not helped.
• You have other questions or concerns

Self Care at Home

• Prescription liquid medicine and your child refuses to take it
• Non-prescription liquid medicine and your child refuses to take it
• Techniques for giving liquid medicine to cooperative child
• Techniques for giving pills or capsules

Care Advice

Prescription Liquid Medicine and Your Child Refuses to Take It

1. What You Should Know About Medicine Refusal:
   • Young children don't understand the importance of taking a medicine.
   • Good technique can make a big difference.
   • Here is some care advice that should help.
2. Sweeteners For Medicines That Taste Bad:
   • Most liquid medicines have a good or at least acceptable flavor.
   • If your child complains about the taste, your job is to mask it.
   • Mix the dose of medicine with a strong-sweet flavor. You can try chocolate syrup, strawberry syrup, or any pancake syrup. You can also use Kool-Aid powder.
   • Medicines can safely be mixed with any flavor your child likes.
   • Usually 1 teaspoon (5 mL) of the sweetener will do.
   • Also, have a glass of your child's favorite drink ready to rinse the mouth.
   • Tip: Coating the taste buds with the sweetener first may also hide the taste.
3. Good Technique for Giving Liquid Medicine:
   • Equipment: Plastic medication syringe or dropper (not a spoon)
   • Child's position: Sitting up (Never lying down)
   • Place the syringe beyond the teeth or gumline. Some young children become cooperative if you let them hold the syringe. Have them place it in their own mouth. Then all you have to do is push the plunger.
   • Goal: Slowly drip or pour the medicine onto the back of the tongue. You can also aim for the pouch inside the cheek.
   • Do not squirt medicine into the back of the throat. Reason: Can enter windpipe and cause choking.
   • Don't use household spoons for dosing. Reason: they vary in the amount they hold. They also often cause the med to spill.
4. If Child Does Not Cooperate - More Techniques for Giving Liquid Medicine:
   • Caution: Never use this technique if the medicine is not needed.
   • If your child will not cooperate, you will often need 2 adults.
   • One adult will hold the child sitting on their lap. Their hands will hold the child's hands and head to keep from moving.
   • The other adult will give the medicine using the technique below:
   • You must have a medication syringe. You can get one at a pharmacy without a prescription.
   • Use one hand to hold the syringe. Use the other to open your child's mouth.
   • Open your child's mouth by pushing down on the chin. You can also run your finger inside the cheek and push down on the lower jaw.
   • Insert the syringe between the teeth. Drip the medicine onto the back of the tongue.
   • Keep the mouth closed until your child swallows. Gravity can help if you have your child in an upright position. Caution: Swallowing cannot occur if the head is bent backward.
   • Afterward, say: "I'm sorry we had to hold you. If you help next time, we won't have to."
   • Give your child a hug. Also, use other positive rewards (treat, special DVD or stickers).
5. Call Your Doctor If:
   • You can't get your child to take the medicine
   • You think your child needs to be seen
   • Your child becomes worse

Non-Prescription Liquid Medicine and Your Child Refuses to Take It

1. What You Should Know About OTC Medicine Refusal:
   • Most non-prescription medicines (OTC) are not needed.
   • Examples of these non-essential medicines are most cough and cold medicines. Fever medicines are also not essential for most fevers.
   • Never try to force your child to take a medicine that is not needed.
   • Most often, symptoms can be helped with other types of treatment. See the specific topic that covers your child's main symptom for other treatment options.
2. Fever Medicine:
   • Fevers only need to be treated with medicine if they cause discomfort. Most often, that means fevers above 102° F (39° C). Fevers less than 102° F (39° C) are important for fighting infections.
   • They can be treated with acetaminophen suppositories (such as FeverAll). The rectal dose is the same as the dose given by mouth.
   • Other options. If your child spits out or refuses ibuprofen, try oral acetaminophen (such as Tylenol). You can also try a different flavor or brand of the medicine. Other flavors or brands may taste better. If your child is old enough, you might also try chewable tablets. They may taste better than the liquid.
   • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
3. Good Technique for Giving Liquid Medicine:
   • Equipment: Plastic medication syringe or dropper (not a spoon)
   • Child's position: Sitting up (Never lying down)
   • Place the syringe beyond the teeth or gumline. Some young children become cooperative if you let them hold the syringe. Have them place it in their own mouth. Then all you have to do is push the plunger.
   • Goal: Slowly drip or pour the medicine onto the back of the tongue. You can also aim for the pouch inside the cheek.
   • Do not squirt medicine into the back of the throat. Reason: can enter windpipe and cause choking.
   • Don't use household spoons for dosing. Reason: they vary in the amount they hold. They also often cause the med to spill.
4. Call Your Doctor If:
   • You think your child needs to be seen
   • Your child becomes worse

Techniques for Giving Liquid Medicine to Cooperative Child

1. Sweeteners For Medicines That Taste Bad:
   • Most liquid medicines have a good or at least acceptable flavor.
   • If your child complains about the taste, your job is to mask it.
   • Mix the dose of medicine with a strong-sweet flavor. You can try chocolate syrup, strawberry syrup, or any pancake syrup. You can also use Kool-Aid powder.
   • Medicines can safely be mixed with any flavor your child likes.
   • Usually 1 teaspoon (5 mL) of the sweetener will do.
   • Also, have a glass of your child's favorite drink ready to rinse the mouth.
   • Tip: Coating the taste buds with the sweetener first may also hide the taste.
2. Good Technique for Giving Liquid Medicine:
   • Equipment: plastic medication syringe or dropper (not a spoon)
   • Child's position: Sitting up (Never lying down)
   • Place the syringe beyond the teeth or gumline. Some young children become cooperative if you let them hold the syringe. Have them place it in their own mouth. Then all you have to do is push the plunger.
   • Goal: slowly drip or pour the medicine onto the back of the tongue. You can also aim for the pouch inside the cheek.
   • Do not squirt medicine into the back of the throat. Reason: can enter windpipe and cause choking.
   • Don't use household spoons for dosing. Reason: they vary in the amount they hold. They also often cause the med to spill.
3. Call Your Doctor If:
   • You have other questions or concerns

Techniques for Giving Pills or Capsules

1. What You Should Know About Giving Pills or Capsules:
   • Many children have trouble swallowing pills or capsules.
   • Fortunately, most medicines also come in a liquid form.
   • Call your child's doctor if you aren't successful with these tips for swallowing pills. Ask about the possibility of a liquid or chewable form of the medicine.
2. Tips for Swallowing Pills or Capsules:
   • Use a thicker fluid than water. Juices or smoothies are good. It's always harder to swallow pills with water. Place the pill or capsule far back on the tongue. Then, have your child fill the mouth with fluid. Have your child try to swallow large gulps at a time. The pill should disappear from the mouth.
   • Keep the head in a neutral or slightly bent forward position. It's difficult to swallow if the head is bent backward.
   • Drinking quickly through a straw can also help.
3. Split or Crush Pills:
   • For easier swallowing, one approach is to split the pill into halves or quarters.
   • Another approach is to convert the pill to a powder. Crush the pill between two spoons. Crushing is made easier by wetting the pill with a few drops of water. Let it soften for 5 minutes.
   • Mix the crushed pill with a pancake syrup, chocolate syrup, or yogurt. You can also use any sweet food that doesn't require any chewing.
   • Note: You can do this with most pills. However, don't do this with slow-release or enteric-coated pills. Check with your doctor if you are unsure what you can do.
4. Capsules:
   • Slow-release capsules can be emptied. Just make sure the contents are swallowed without chewing.
   • These capsules often contain medicines with a bitter taste. So, the contents need to be mixed with a sweet food. Applesauce or yogurt may work.
5. Prevention Through Practice:
   • If your child is over age 8 and unable to swallow pills, he should practice. Practice this skill when he's not sick or cranky. Some children can't swallow pills until age 10.
   • Start with small pieces of candy or ice and progress to M&M's. Try to use substances that will melt quickly if they get stuck. If necessary, coat them with butter first.
   • Once candy pellets are mastered, pills can often be managed as well.
6. Call Your Doctor If:
   • Your child can't take the medicine after trying these good techniques
   • You think your child needs to be seen
   • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.