Suggestions for Psychological Struggles with Pills

About a year ago, at age 6, Jack suddenly developed an aversion to taking pills. He would either gag when he tried to swallow or he would be frozen with anxiety and unable to swallow at all. I was in a horrible state of panic, and it didn’t help that when I called the oncology clinic for help, I was told by our nurse case manager that he absolutely HAD to take his pills because every missed dose increased his risk of relapse.

Yeah, way to help.

The social worker was about as helpful – she recommended stronger discipline.

Um, lady! WTF! My kid is dealing with some massive fear and anxiety here and you are suggesting I discipine him for that??

Up until that point, Jack had taken his pills in applesauce or yogurt. He kept developing aversions to the foods he was taking the pills with, though. We tried peanut butter, as well, and that worked for a bit before it didn’t anymore. I tried crushing the pills and dissolving the pills in liquid – no dice.

We met with the clinic’s child life specialist who had a talk with Jack about why taking medications isn’t very much fun. Jack wasn’t very talkative, though. It stressed him out even more to discuss it. She was very empathetic but had no more success than anyone else. She quickly realized he couldn’t even practice taking pills because it was the THOUGHT that was getting to him, not the actual pills themselves.

Even though she wasn’t successful in helping, at least I felt like she understood our situation better than the other professionals we were working with. I felt a bit better because I knew I’d sought out help, even if it wasn’t ultimately all that helpful.

It got to the point where Jack was going to need an NG tube. We’d tried for hours to get his pills into him one night with no success. We were ALL in tears. We resigned ourselves to going in for the NG tube placement the next day and headed to bed. Thankfully, though, I tried one last bribe and it worked.

What we learned was that a combination of things would ensure the success of pill taking:

  • He had to take his pills in nutella – but with just enough to cover the pills up. No big globs!
  • We had to say that it was time for nutella, and ONLY nutella. “There’s nothing in this spoonful but nutella!” He considered it to be a fun joke.
  • Jack chose where in the house he wanted to be when this occurred – it couldn’t be in the place where he ate dinner or watched shows. He tried sitting in a chair and standing up and decided what worked best.
  • Bribery – I told him he could have any toy he wanted but he had to keep trying his very best to take the pills every day.

Also, Jack really had to be the one to make the decision to do this. Kids going through treatment for cancer (and other treatments for chronic illnesses) lack so much control about what is happening to them. So I had to hold the spoon but not push it into his mouth – he had to tell me he was ready and put his mouth around the spoon while I stood still. This was a way he could take back some of the control and feel less pressure.

Now that we’ve had more time under our belts with this, I’ve come up with some other ideas that might be useful if you’re dealing with this kind of (psychological) struggle.

  • Offer a distraction – it might be easier to take pills if there’s something else to focus on (the school nurse gave Jack a spiral bound notebook to draw in when it was time for him to take his afternoon dose), such as a favorite TV show to watch or book to read.
  • Have another parent or professional administer the pills – and stay out of the room while this happens. Your child may sense your stress and worry, so remove yourself from the equation.
  • Offer a comfort item during the process.
  • Remove other sources of stress and avoid trying to give pills at times of high fatigue. If your kid hates taking a bath, try not to line up a bath right before or after medication time and maybe take fewer baths. If homework is creating more stress and exhaustion, reduce the workload. Jack always had a more difficult time at the end of the day because he was more worn out.
  • Disguise the pills. It didn’t work for us, but it might for you. I know one mom who crushed the pills and put them into melted chocolate, which then became candy. You could also try a smoothie or milkshake – just make sure the ingredients won’t impact the medicine’s potency AND you have to ensure the whole serving is finished.
  • Again, bribery and/or rewards! This doesn’t have to be a toy – it can be an activity, money, or a piece of candy that is granted after the pill is taken. Instead of doing something because I’ve told him he has to, Jack feels like he is choosing to do it in order to get a reward. For instance, we have a list of chores that Jack can choose to do to earn tokens – those tokens can then be collected and traded in for things like movie rentals or gift cards for shopping on amazon (which are things he is particularly interested in).
  • Seek psychological help. Sometimes a psychologist can figure out something that will work based on your child’s emotional state and needs. Perhaps play therapy?

It took us a lot of tears and stress and phone calls and begging to get Jack to take pills regularly, but once we figured out what worked for him and stuck to it, things got a lot better. Chances are even if you can’t find a solution right now, your kid will outgrow some part of the problem and you can try again at a later date.

Hang in there. You can only do your best and no more!

I guess this is the part where my mom gets payback

It’s happened.  I’ve been dreading this development…Jack has figured out that he can climb right out of bed and come knock on my door at night.  He has apparently decided that no more will he lay there idly in bed calling for me – he’ll just go ahead and get his mama when he needs her.  Or, more accurately, he will plop himself down outside of our bedroom door and play with his toys noisily until we open the door.  When asked why he isn’t in bed, he will reply, “I had a bad dream.”  He pays no mind to me when I point out that I know he hasn’t actually been sleeping…

Added to this new interest in leaving the island that is his bed, he has also decided he’s not very tired at night.  Sunday night he didn’t fall asleep until around 1am and he was up at 8am.  Last night it was closer to 11 even though he had a shorter nap than usual and we started the bedtime routine (brush teeth, don PJs, read books) at 8.  David and I take turns going into Jack’s room to reassure him that he’s safe, we love him and will protect him, etc.  He gets lots of hugs and kisses and we snuggle, too.  And after all that and not falling asleep until late, Jack was up this morning bright and early at 7:30 but clearly still tired!  I don’t get it!

I know this is a phase and it will pass and in the grand scheme of things, it’s not a horrible one.  I am aware that staying in bed when you can’t fall asleep isn’t a healthy sleep habit, so it’s not as if I’m going to lock him in his room.  I just worry about leaving him to his own devices while I go to bed because I clearly remember being of a similar age and disposition…my mom still has the dresser that is caked in the evidence of one of my late night “baking” experiments.  She is also fond of reminding me about the time I climbed out of my bedroom window (at 2 years old) and ended up in the neighbor’s yard down the street crying because I was lost.  These are not things I stopped to consider before having a child of my own.  Doh!

Drop-off Drama

Jack has suddenly become super clingy during daycare drop-off.  This morning it took me roughly 20 minutes to extract my legs from the tangle of his limbs and get out the door.  I tried every trick I could think of:

Jack, will you do me a favor and close the door for mom?
Jack, I have a job for you.  I need your help!
Jack, your friends need you!  They want to play with you.
Jack, there’s a party today!  Don’t you want to have a party?  (this is true)
Jack, mama’s work is no fun.  There are no kids there.
Jack, G needs a hug.  Can you give her a hug so she isn’t sad?

The kid didn’t budge.  Finally I picked him bodily and stuck him inside the door and quickly closed it behind me.  I just about collapsed on the stairs, though.  Days like this break my heart because I feel like I am abandoning my kid.

I am not sure if this is a phase or what.  The reading I’ve done suggests that is the case.  I’m fine with that…but I’d like to find a way to make Jack feel more secure and get myself to work on time.  If it’s just a matter of waiting it out, then I hope this passes quickly.