Hi all,
my son has today been prescribed 2.5mg of methylphenidate twice a day for the next 30 days to see how he gets on with it. It has been a long road to this point. (we are in the UK)
Guilt and worry aside....how do I get this guy to take the meds. He has never taken any meds he has to swallow whole and there is no liquid alternative here I am told. Plus the second dose will be at school just before he goes to lunch. What has worked for other people....help please.
When my son first had to start taking pills I would have him fill his mouth with water, then put the pill in then swallow. He seem to do better that way if it’s not a capsule you can split it if it’s to big and do that too . Hope that helps.
Welcome to the group! Many of us have been in your shoes. Hope this one works for him. You should know within the first day if it makes a difference.
Do you know how long the medication will last in his system? 3-4 hours or 7-8 hours?
Here are some helpful hints:
Spoonful of pudding..ice cream..Whip cream... whatever it takes.
Please let us know how it goes, we are always here for you.
Thank you for the tips. It will last 3-4 hours and then another 2.5 at lunch time. If all goes well we hope to move to the 8 hours XR.
we take it in liquid form twice a day
We have been given Tranquilyn and it does not come in liquid form here sadly.
my little kiddo is sensitive to medication, so we skipped the fast acting and went straight to the Focalin XR formulation and it was the right fit. It delivers the total 5mg slowly through the 8 hour window, instead of spiking. May be worth a try if you dosing at school is a challenge. You can break open the XR caplet and sprinkle on applesauce or pudding, as long as kiddo doesn’t chew beads. Sending you good vibes! 🙏
If you are not able to get your kid to swallow pills - keep working at this life skill (more below for tips). But meanwhile, try opening the pills and mixing it with pudding or ice cream (check with the pharmacist or Dr first to make sure this medication can be taken this way - some kinds cannot). If that doesn't work, ask to try the patch - this has been a life saver for my kid!!
Pill tips:
- a while ago, someone posted a link to a video on how to teach a child to swallow pills.
Link: hardynutritionals.com/blog/...
What I remember is to try putting the test pill (like an m&m candy) in different places in your mouth before trying to swallow. For example, first try putting it in the front of your mouth and try 3 times in a row. Then try putting it on the right side of your mouth and try 3 times in a row. Etc. Ask your child which placement feels better. Keep trying for like 10 min a night with a small candy variety like an m&m or tic tac.
- Online, find the smallest empty capsules possible (size 5) and buy a pack. Fill them with something to give them a little weight (I used sugar) and have your kid practice with these after they are successful with the candy. Then move to the next capsule size up (size 4) and repeat.
Best wishes...
Thank you. We are practising with mini m&m this week. He has agreed to try really hard so he can fill up his sticker chart.
A patch would be AMAZING!!!!!
I'd cut a gum drop into small cubes, cut a slit and slide the Ritalin into the cubes. Because it didn't have a bad flavor anymore my five year old could abide having it in his mouth long enough to learn how to swallow it.
Hi MerryDay, because he has to take the second dose at school they don't want to be doing all that. They are willing to use a pot of yogurt or juice so I need to find a system that can be used in both home and school.
Hi - thanks for replying. We sometimes prepared ritalin the way I described for later in the day. It stored fine.
here is a handy video with a method that really helps with pill swallowing
When we were getting ready to start my son on meds, I had him practice swallowing mini M&Ms. Ordinarily I never give him candy, so I told him I would give him some candy but the catch was that he couldn't chew it, like a game, and explained how he could use water to help. I also told him that Mama couldn't do it (true), so he felt like it was a personal challenge. It took him literally 2 tries lol. He felt very proud of his newfound ability and was EAGER to try out his new pills a few weeks later just to show off to Mama what he could do.
Good luck!
We did essentially the same thing with mini m&ms with our 6 year old a couple of months ago, and he’s had no problem taking the pills!
competition works here too.
We are also in the UK. My son initially was prescribed Methylpenidate (following the diagnosis) as this is ‘first line of treatment according to NICE guidelines. We had it as Medikinet XL brand so it was ‘slow release’ which lasts until 3/4pm. I couldn’t quite understand how once it’s out of the capsule - how can it still stay ‘slow release’ but consultant said it can be opened ;the capsule) and mix it let’s say in small amount of juice drink (like on a spoon or medicine pot) or sprinkled in yogurt or apple sauce etc. My son was 8 then and he was fine to take it whole so we didn’t have to try those strategies.
It looks like your child is prescribed ‘immediate release’ formulation and that’s why he gets given second dose at school. Has his doctor explained why he preferred this medication given in 2 doses rather than once a day?
It’s great that his doctor is starting him so slowly and on such a small dose.
My personal advice is don’t up the dose if you as a mum think that results are good enough for you. You will see that consultant will then want to up the dose when you say that your child is doing well on what he’s on now. Be assertive and think for yourself- if you are happy in low dose stay there.
I compared dosing guidance (BNF) in the UK and in one other country in European Union and I was shocked as there is a massive difference in what is considered in that EU country a ‘maintenance dose’ for Methylpenidate for children- it says the daily dose for children and young people up to 18 years old is 5-10mg max.
In the UK I feel that children are overprescribed too high doses- my son when he was 8 years old and small frame -within 2 weeks climbed up to 30mg per day ‘maintenance dose’ Methylpenidate and consultant told us that ‘if we don’t see the positive effects yet, he can even prescribe 50mg per day’. My son was already ‘off his head’ and suffering severe side effects on 30mg Methylpenidate so when consultant said ‘I can even give you 50mg’ I was like thinking to myself ‘right, we need to change consultant ASAP’. And we did change.
I remember when my son was 8 years old 5mg Methylohenidate was ‘therapeutic’ and making him focus all right. We wanted to stay there at 5mg and consultant said ‘but such low dose can’t work’.
I’d say read NICE guidelines about management of ADHD in children- that’s very useful.
Also use your own judgment about your child, you are the expert. What we have learnt now after 2 years of medication trials with my son- ‘less is more’. Al those meds have side effects, all can have adverse effects.
I’d say also say do little easy to measure tests for your child, for example give him medication and then put a Disney film on and see if he’s able to watch it. But put a film which is kind of ‘neutral’ topic for him, not something he totally loves. That’s the test if he can focus and sit through the whole film whilst at home (at cinema most kids can sit through a film even with ADHD).
Also if he does any extracurricular like Saturday football club etc. You should see that he would be able to focus and follow instructions. My son when he was little - it was no point doing those clubs as he would chase pigeons and play with plastic cones and not pay any attention. Right medication has made a difference, he started being able to follow instructions, wait his turn in a queue for activity etc.
Good luck. It’s a journey but you made this first step and you are doing the right thing for your child.
OMG!!!!! Pattimum. Thank you. 30mg WOW!!!! I cannot imagine my son on the that much meds. I am already a nervous wreck on Tranquilyn 5mg. We are working towards XR. If we can curb the impulsivity for his own safety and increase his focus and attention that will be enough for us. A reduction in his temper outbursts would greatly help his sibling and he might be able to make friends and be invited to the odd party. He does Saturday football which at the moment is me giving money away but it gets him outdoors and he is able to run around and use up some of his endless energy but he does not play the game as he can't remember what goal he is scoring into or which team he is on. Exaclty as you described, the cones, the other balls, birds, bees you name it. The coach is very good and makes him his assistant and he gets to hold the red and yellow card because no one ever wants him on their team. I am hoping this will change on the meds and he will be able to do a summer camp this year. Thank you so very much for putting me on the alert.
Ah I do remember all that- being embarrassed when watching my son at the football camp- he used to rub the Astro turf with his hands as well 😂
Your son is very young and his attention will get better anyway as he grows (even without the medication) but mind you - kids with ADHD are always delayed a couple of years to their peers. For example my son is doing a football club which is for children from year 3-6 and now that he is in year 5 he interacts well there but that’s because most kids are year 3 and 4 so much younger than him. That’s the environment where he doesn’t stand out as the immature one… I’d say hang in there, do t give up on this football club. But also you may want to try to chat to coaches and see maybe some groups are more ‘committed footballers’ and some are less advanced - the less advanced is better for ADHD kid.
My son now at 10 even gets successes such as being a ‘player of the day’ and he does tackles and scores goals. But when he was 5- I had to be taking him to football club as my husband was ashamed of him. And watch him now- he now happily takes my son and stays to watch him and my son has even started doing cricket and my husband takes him there and tells me that he’s doing well- following instructions and keeping his queue.
I’d say, don’t give up on your kid, especially that sports are critical for ADHD kids- they need exercise and being around other kids. You will be thinking often- what’s the point, it will never get better, but it will.
I’d say- what to watch out with Methylphenidate is ‘rebound effect’ so for example my son was terrible in the mornings before medication kicked in and then also he was terrible at about 3-4pm when medication was coming out of the system. But I think this was because he was on such a large dose…I think had we stayed on a low dose, we probably would still be able to carry on this medication as he wouldn’t have developed such serious side effects …
Also monitor your child’s sleep - my son stopped sleeping well on Methylphenidate. And sleep is sooo important for young kids.
Consultant did say that he can prescribe Melatonin which is supposedly used safely in children for decades, it’s non addictive and has no side effects, it’s a sleep hormone I think… But since we had loads of other side effects plus the bad sleep, we just changed the medication to a non stimulant.
Have your consultant told you about the medication breaks with stimulants? Supposedly it is very important to do medication breaks for a child on Methylphenidate. Some parents do it over the weekend and some do longer breaks periodically like during holidays. This gives a chance for catch up growth and gaining weight (kids tend to suffer from dry mouth and appetite suppression whilst on stimulants such as Methylphenidate).
God bless him he really tries to focus on the game. I am hoping that his sleep is not affected too much as its the only thing we have that is predictable. He is asleep by 7:30 and up with the sparrows at 6am but he goes right through. I am meeting with the SENCO to discuss the meds and fill in the forms so I will mention the coming down from the meds. I have everything crossed for him and us.
We are planning on medication breaks during half terms and holidays rather than weekends. So he will be on during term times and breaks every 6 weeks.
I’d say double check with his consultant (not the specialist ADHD nurse as she may not know stuff) or with the pharmacist who checks all the prescriptions at your GP practice- double check that this form of Methylpenidate that your child is given can’t be taken out of the capsule.
As I said in my other long post - we are also in the UK and we were told that Methylphenidtae can be taken out of the capsule. So double check why your consultant says it has to be taken while capsule.
It’s Atomoxetine which has to be taken WHOLE, must not be taken out of the capsule and if gets into eye it has to be immediately rinsed with loads of water. So Atomoxetine can only be prescribed to kids who can confidently take a whole capsule.
Pharmacist told me he is too young have capsules and the Tranquilyn 5mg is very small. I collected them yesterday and they are very small and once I half it was tiny. I have been told not to crush the half. When he does go on to XR in a month or so if all goes well that capsule I think can be opened and mixed with something. Please feel free to share anything you think I should know about being in the UK. I would LOVE the option of a patch.
We do applesauce, which works pretty well. I put it in one spoonful & then have my son eat that. Good luck!
Reading your question … the solution could be simple! Isn’t there a higher dose? Like 5mg or 10mg pills? Because then you could split it in a smaller dose, like a quarter of a pill. I know dexamfetamine (tentin) has these options.
When I was started on methylphenidate, I was on 5mg pills, which you could split… since it’s instant release. As far as I know in Europe, we only have instant release and an extended release form (now generic, but before known as concerta) but since your child is young and has to take it twice a day, it’s most obviously IR…
If the pill has a "score line" down the middle it is ok to split. Like others have said open communication with the doctor is best so they understand.
We are on 5mg Tranquilyn which I am now cutting in half.
My son and daughter in law put the pill in a tiny Reese cup for my 5 year old granddaughter, until she learned to swallow her pill.
Putting the pill in apple sauce worked for us.
If he won't swallow the pill, I agree with putting into something (applesauce, pudding, chocolate, etc) and let him chew it. Some parents told me they crush it and put it into the above with success. Sooner or later, he should learn to swallow pills.
We would put them in chocolate pudding. Worked like a charm!
Our pediatrician suggested practicing with swallowing tic tacs and mini M&Ms. This worked for my son when he was 8.
I’m in the US. My daughter is 8 but has intellectual disability, autism, ADHD, with significant feeding/sensory issues. She functions at about a 3 year old level. Anyway, my daughter takes methylphenidate IR which comes in a capsule that I open & sprinkle in applesauce. The brand name here in US is Metadate CD. It lasts about 6 hours according to the manufacturer. Frosting (icing) or Nutella might be options if he likes those.
Here I don’t know if anyone is using Quillivant XR (long acting methylphenidate) liquid or Quillichews (long acting methylphenidate chewables) in 5 year olds. However, if that’s available in the UK it might be an option. There is a liquid short acting methylphenidate (Methylin) in the US but it’s almost impossible to find.
I feel your pain. Our son, now 12, started Ritalin at 4 y 9 m. It was a miracle once we could get it into him.
Update.....2wk and change on the medication which I crush and give with yogurt. The 2nd dose into school in the pill crusher and they just had to the 2nd yogurt of the day and administer. So taking the meds part is working out. In the beginning I was like I don't think its working. I don't see any change but school reports he is more settled and is still eating his lunch. I dont get to see the full effect of the meds as he is at school all day. Any way last saturday I had to give him the meds to attend a function. I was like wow and then on sunday he had none and I was like OMG!!! the two days were like night and day. back on meds today Monday and he was soooo excited to tell me all the people he played with during breaktime. I am so so happy for him. I guess the other children have noticed the change in him and are more comfortable to play him now. Fingers crossed things carry on this way.
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