Your child has just been diagnosed with epilepsy and the doctor has prescribed seizure medicine. But just giving Tylenol or Motrin for a fever now and then has always been a difficult task. How are you going to give two or three doses of seizure medicine every day? Will your child be able to swallow the whole dose? Will he (or she) cooperate and swallow the medicine, will he refuse to open his mouth, or will he spit the medicine out?

As a parent, you want your child to get all the benefits of the seizure medicine your doctor has prescribed. By applying some "pearls of wisdom" from experienced nurses and parents, you can succeed in giving medicine to your child!

Seizure medicines come in different forms: tablets, chewable tablets, extended-release tablets, capsules, sprinkle capsules, extended-release capsules, suspensions, and syrups. Each form has its advantages, but not all forms can be used for infants or toddlers. For example, Depakote ER, the extended-release form of Depakote, cannot be given to infants because the tablet must be swallowed whole. Depakene syrup (a liquid form of a related medicine) is available for use with infants, but you will have to give it more often. Your doctor should prescribe your child's seizure medicine in a form that is appropriate for the child's age and abilities, and will be well absorbed by a child of that age. If you have difficulty with the form prescribed, ask whether there is something else that can be substituted. Rest assured that the manufacturers try to supply the medicines for children in flavors that most kids will love!

Infants (under 1 year of age) obviously do best with syrups and suspensions, the liquid forms of medication. Unfortunately, not all seizure medicines are available in these forms. Some other medicines (Lamictal, for instance) are available in tablets or chewable tablets, which can be used if they are crushed and dissolved in a small amount of water. "Sprinkle capsule" forms of medication (capsules that are opened to release tiny pellets of medicine, which are then sprinkled onto food) are OK for infants once they are old enough to eat baby foods.

In general, it is easy to give medicine to infants unless they have feeding or swallowing problems. If you are using a suspension, shake the bottle thoroughly. Then take up the correct amount of liquid medicine or the dissolved tablet into an oral syringe, a device that operates like a needle used to give a shot but has a hollow tip instead of a sharp point. Direct the syringe to the side and back of the child's mouth and push the plunger slowly until all the medicine is given. Your child's comfort in swallowing the liquid is your guide to how fast you push the plunger.

Toddlers have a wider range of options. Some toddlers can chew the chewable tablets. Others will need the same liquid forms of medication as an infant, though you may be able to use either a syringe or a spoon. Sprinkle capsules are also useful for toddlers. Open the capsule and sprinkle the contents over a small amount of soft food, such as applesauce, yogurt, or ice cream (food that the child enjoys!). Then give the food and medication to the child with a spoon. Be sure to give the mixture right away — if it sits around after you mix the medicine with the food, the medication dosing strength becomes unstable.

You will need to experiment with your toddler to find the best approach. Toddlers are unpredictable when it comes to taking their medicine. The unpredictable behavior is part of their developmental age. Look for creative ways to give the medication. One mother reported making a game out of taking the medicine. She sang "A Spoonful of Sugar Helps the Medicine Go Down," from the movie Mary Poppins, at each dosing time. Another mother used a reward system, in which her toddler was given a star each time the medicine was taken successfully. Accumulating twenty stars earned a reward — a choice of cookies after dinner.

Seizure medicines do not interact with foods or beverages, so you don't have to choose the time to give the medicine on the basis of meal or snack times. Actually it's a good idea to give your infant or toddler a drink from a bottle or a sippy cup right after giving the medicine, to make sure that the full dose is swallowed and none is left in the mouth.

Just as with other aspects of child care, you will gain confidence and skill with practice in giving medicine. In a very short time, it will become part of your normal daily activities. Then you might need reminders like pillboxes or watch alarms to ensure that you give all the doses prescribed.

Topic Editor: James W. Wheless, M.D.
Last Reviewed: 10/5/06

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