The Basic Approach: Shaping

Is It Candy or Medicine?

Here is a poster to share with your child. Click on the image to view it on your screen.

Shaping is the basic method generally used to teach patients how to swallow pills. It is a behavior modification term. Through "shaping", you teach a patient how to do a difficult task by breaking the task down into the simplest task and then increasing the difficulty as the patient has success. When teaching a patient how to swallow pills, one generally starts with very small candy ‘pills’ and then moves to progressively larger ones as the patient masters the technique.

With children, in particular, the best non-medication substances to use for practice are cake decorations and candies. Purchase a series of increasingly larger sized cake decorations (such as tiny round candy balls called “mixed decors” and sprinkles) and candies (such as mini-M&M's, Nerds, or Tic-Tacs). [Click here to view the Candy Chart for Shaping.] Although some suggest you only use the white decorations since they most look like medication, medication comes in many colors and it is equally reasonable to use colored candies and cake decorations.

The Basic Steps in Teaching a Patient to Swallow a Pill:

Sessions should last no more than 10-15 minutes, and possibly shorter -- depending on your patient's tolerance level.

Subsequent sessions should start with the last size with which your patient was successful before progressing to the next size. Your patient may be able to progress through all the sizes in one session; however, it may take anywhere up to 5 or 6 more sessions before the skill is mastered.

When your patient can reliably swallow the Tic-Tacs or mini-M&Ms, you can ask him to try swallowing an actual pill such as an appropriate vitamin for the patient's age group. By the way, for children, experts advise not to refer to these fake ‘pills’ as candy during practice, since swallowing real candy rarely triggers anxiety and the child may not transfer the skill to real medication if he believes he is practicing on candy. In addition, most people typically chew candy and medicine should usually NOT be chewed. In the sidebar on the right is a poster, "Is It Candy or Medicine?", that you can share with your patient that shows the similarities between medications and many well-known brands of candy. It is important to emphasize to the young patient that although the medicine may look like candy, they are very different.

Remember, your patient requires the opportunity to practice in order to maintain this new skill.

Some patients will enjoy tracking their progress through the different sized pills. Click here for a sample chart that your patient may find helpful. We have provided age appropriate charts.

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