Advice on administering medicines

[scarlet]

Advice on administrating medicines

Reflux medicines come in all sorts, add on top of that children who don’t generally like things in their mouths, and gag at the drop of a hat it can be quite hard to get the medicine down and stay down.

We have put this together to help you out

Medications that they spit out

In general, when the medication is a liquid and the worst problem is that they either shut their mouths, spit it out, gag or throw it up.

With medicines that you are having a hard time getting down, there are a few things you can try. Please note that once your child is used to having the medicine they actually learn to like it, so it may seem very hard in the beginning but eventually you will not have to fight them. So these are the best tips we have:

• Use a really skinny syringe (like the 1ml kind) and put it way in the back of the mouth and squirt it really fast.
• Put it in a small syringe and administer it right on the side of the tongue , in the back, slowly, that way they cant spit it out or gag.
• Try giving it slowly, bit by bit, especially when they are unsuspecting
• Prop up the head of the child, lay them down and if necessary restrain arms and legs by putting your legs gently or firmly (depending on age of child) over them. Take syringe or eyedropper and squeeze medication slowly into back cheek pouch of mouth and give time to swallow. Try to avoid the tongue as that is where the most taste receptors are and most medication tastes awful. By syringing into back of cheek it avoids these receptors.
• If they are crying you could squirt it a little each time they breathe
• Put in a teat or a special pacifier medicine dropper
• Add a drop of quick or syrup, JUST as you administer it
• Use a second person to restrain the heads and arm’s
• When the level of the meds gets too low in the bottle to be able to just stick the syringe in and draw up what you need, pour some into a shot glass and use that to draw up meds. Whatever you don’t use, pour back into the bottle. This way you don’t drop your syringe into the bottle of meds if you hand slips.

For H2’s (Zantac, Axid, Pepcid)

Can be given with or without food
Space one hour between PPI’s
Space two hours between Antacids
Should notice a difference within a week, though give two weeks to be sure, for a med increase a week should do

• Zantac is notorious for being the one kids won’t take, it has a very strong taste, flavored minty. Believe it or not, perservere and you child will eventually like it.
• Add with a little formula, try not to add to a whole bottle, because if they do not drink it all then they do not get the correct dose.
• Also if adding it to too much milk, this may change the taste so it is less appealing, and turns the child off and eventually will not take the bottle even without the medicine in it.
• If still having problems could try the Zantac Efferdose.
• Never keep the other half of a Zantac Efferdose.

PPI’s (Prevacid, Prilosec…)

Must be given 30minutes before food
The beads is the medicine do not chew or crush
Space at least one hour with other medication (i.e. Zantac, antacids). Longer if possible
Flavoring added to compound will decrease the stability and longevity of the med
Give the medicine 2 weeks to see an improvement in symptoms and a week to notice an improvement with a med increase.

Solutab

• Cut in half with your fingers, store the other half in a sealed air tight container away from the sun
• When giving solutab’s, if child is old enough, put in the cheek or under the tongue, by the time they can work it out, it is dissolved.
• If not old enough, then put on a baby spoon with a bit of water and then slide it into the baby's mouth.
• To administer with a syringe you have to shake the syringe a lot to make sure your getting all the beads out. Example: Pull stopper out of syringe, drop in solutab, place stopper back in syringe making sure not to crush the tab, draw up 4-5mL's of water, shake, shake, shake, place in mouth squirt into back of cheek pocket, allow to swallow, shake shake shake, to get all beads in the tip of syringe, squirt into back of cheek, repeat till all meds are out, draw up a little more water, like 1-2mL's shake give again. Its a little bit of work, but works well for kids that are too young for the tab in the mouth

PPI Packets for Suspension/Capsule (open pour out the beads)

• With PPI’s the medicine is the bead so you must get all of the beads in, the suspension can take a little while to get a handle on.
• Can add with a little water and syringe in with a large hole (20ml) syringe.
• You can add the pack directly to the syringe (20ml) and draw up the water, shake and give
• You can sprinkle onto of apple sauce/puree
• If splitting in half pour it into equal amounts in two containers and compare them, then give one half, and seal the other away from sunlight.
• Use a motrin dropper to suck up the medicine (after mixing it in a dixie cup). The motrin dropper is big enough to get the beads through it and they wouldn't clog up
• If old enough sprinkle the beads into the mouth while lying down and then follow with some water.
• Make it like a paste and spoon it like they are eating, make sure not to crush the beads too much
• Once you mix it you have to use it, don’t keep it for later
• Put it in a nipple hole just the right size to get the beads out. Or cut the nipple so the hole is large enough.
• Apple juice can be used instead of water
• Do not use hot apple sauce of apple juice

MUPS

Multiple unit pellet system, which is basically the PPI in a tablet form

• Put tablet in a large hole (20ml) syringe and draw up approx 5-7ml of water, draw up some air and shake till dissolved, then administer through the syringe
• Once a liquid you could use the advice for suspension
• Use two spoons and crush slightly with the back of one spoon, be careful not to crush too much then administer with a little water or sprinkle on applesauce.
• Give older children the MUPS to swallow whole

Compound

Get the medication made up every two weeks to avoid instability problems
Shake really, really well, sometimes have it upside down and hit the bottom of the bottle with your hand to loosen any residue at the bottom. This way the medicine will be more consistent.
Keep refrigerated
Generally tastes awful and very bitter (they do get used to it). A compounding pharmacy can flavor it with only certain flavors. Flavoring will decrease stability so again fill it more often.

• Use advice given above for liquids

Giving Flovent/Ventolin by Aero Chamber:

• Prop up head, lay down and restrain child's arms and legs by putting your legs gently or firmly (depending on age of child) over them. Shake med container, place in aerochamber, place chamber over nose and mouth gently, but firmly and squeeze trigger. The more your child screams, the better the intake is of meds, so do not pull back as it is vital your child receives the meds. Leave on for 8 to 10 breaths. If necessary, repeat.
• You can play a game and pretend that you are doing it also, and count to 10 and then they have ‘their turn’ this time with the medication given
• If you give Flovent, Pulmicort, or another inhaled steroid, be sure to give the child a drink and wash their face. The steroid can cause a yeast infection called thrush to grow on the face and in the mouth and throat. It's very painful, and can be avoided by just rinsing.
• To see if you are getting low on a pump, pour some water into a deep bowl and toss in the pump. If it floats, you are likely in need of another pump OR count the number of "Puffs" or squirts you've used. Most inhalers contain 200 puffs (the exact number will be printed on the canister). When you get to that number, toss it out and get a new one.
• If you squirt it again at say 201 or 202, you will see something come out of the canister, but it's mostly propellant (the stuff to push the med out of the canister) and very little medication.

Other Tips


When you child has a high fever you can stagger Tylenol and Advil giving one dose of each every 3 hours.

If child is old enough, you can give a small piece of ginger slice to help get rid of the yucky taste of meds. Ginger slices (think of what is provided with sushi) is a great way to neutralize tastes.

TUBE FEEDING STILL TO COME!

[Pictorian]

You can purchase compounding syrup off the internet and add a few drops on a per-dose basis.