You want me to give a PILL to my NEWBORN?! I remember asking my son’s pediatric endocrinologist that question. As if it’s not enough to have to deal with giving birth, having your newborn diagnosed with Congenital Hypothyroidism, endure repeated blood draws in those first few days, and then you are told you must get your infant to swallow a medication that (at least in the US) only comes in pill form. Our endocrinologist said to crush the medicine and give it to our son through a syringe. It was as if this was no big deal. For me, it was a big deal.
The conversation had occurred over the phone. We hadn’t even seen our pediatric endocrinologist in person yet. Where would we get the syringe? Oh, the pharmacy has them? Are you sure? Our son only weighs about 7 pounds. They have syringes small enough for him at our local pharmacy? I remember asking. Well, they didn’t. We had to order pediatric sized syringes off the internet. My son, who was exclusively breastfed, had zero interest in the syringe and wouldn’t accept it, and would spit out the medication. So, imagine this, you are told that it is vital that your child take this pill every day. No matter what. Then, you try to figure out on your own how to administer the medication and then YOUR CHILD SPITS IT OUT! Yep. I still remember my husband and I sitting on the side of our bed crying. We were so worried that we weren’t getting enough medicine into our son, that he was spitting it up too soon, etc. There were no resources available on how to give infants medication that comes in pill form.
I would imagine that if your son was just diagnosed with Congenital Hypothyroidism, you are probably experiencing something similar. Recently, I polled a community of parents whose children were born with Congenital Hypothyroidism on how they administer the medication. Most of the parents said that they used a syringe (crushed the tablet, then mixed with a small amount of milk (breast or formula) or water). A few parents said that they preferred to crush the pill, wet a clean finger, and allow their infant to suck the meds off their finger. A few parents said they preferred to crush the pill between two spoons, and then give the medicine via spoon (mixed with either water or breastmilk). A handful of parents placed the tablet in their infant’s cheeks while nursing or bottle feeding. Using the syringe was by far the most popular method of administering the thyroid medication to infants. Usually by the time the infants moved to solid foods, they were chewing their medications. My boys began chewing their medication when they were able to chew foods and then learned to swallow their medication by age 3.
Here’s a sampling of what the parents had to say about giving their infants medication:
We crushed, dipped finger in water, and fed to her. She started gumming/chewing it around 5 months. She began swallowing it at 4 or 5 years old, yet my older child who doesn’t have congenital hypothyroidism still can’t swallow pills, haha!
I mashed it up when she was tiny, and she sucked it off my finger… then at about 6 months, I’d give it to her to chew up, and then on her own, she started swallowing it whole when she was ready.
Syringe until about 6 months when we introduced solid food.
I give my 9 week old her medicine first thing in the morning with a syringe in the cheek with a feed straight after. The pharmacy gave us very small syringes where the inner part fits into the very tip so nothing gets left in it.
My daughter is 18 months and we’ve always crushed the tablet and dissolved in a little water. When she was tiny we’d blow on her face to get her to swallow. Since 6 months she’s been sucking it out of the syringe. We see no reason to change as this works fine for us. If any is left in the syringe, at least it’s the same every day.
I smashed the pill between two spoons and mixed it with breast milk and spoon fed till about 2 yrs. Then I taught him to swallow it. He did this for a while then switched to chewing…he’s 4 now and is back to swallowing sometimes.
We did the spoon with it mixed in water up until he was about 8 months and we were more confident in his ability to chew and swallow without choking. Now I just put it in his mouth and he chews it up and has a sippy cup with water after.
From the beginning until now (3 weeks to 9 months), we have put it in folded parchment paper crushed it, put it on our finger and she sucks it right off!
We crushed the tablet on a teaspoon and mixed with water and then slipped it into her mouth. She started having the tablet whole maybe around 3 years of age!
We used a syringe until around 4 months old. Then at 4 months just popped the pill in her mouth to dissolve. She has chewed all her pills since.
When she was a newborn we crushed the pill in a pill crusher, turn put the crushed pill in a tiny “shot” glass with 1 ml of breast milk. We sucked it up into a syringe & slowly squirted it into her mouth. By 4 months, she was taking the syringe from us and sucking it out herself. At 6 months, we crushed the pill between two spoons & used a damp/clean finger (dipped finger in a tiny but of water) and she sucked it off our finger. At 10 months, we cut the pill with a pill cutter in 1/4 pieces & she picks them up herself & eats them. We also do this over a small bowl/plate to ensure any residue is caught & we use put finger to pick the dust up & she puts it in her mouth.
Caution during drooling periods such as teething times to make sure the dissolved pill doesn’t drool out!!
With my oldest I put it in a syringe until he was 3 and since then he chews it. With my youngest she hated the syringe, so we crushed it up on a spoon and mix it with water. For a while we feed it to her with baby food but we noticed that she started having problems so we went back to spoon feeding her.
When my baby was a newborn, I crushed it up and would dip my finger in the powder, then rub it in her cheek. It took a while, but it worked best and she couldn’t spit it out. Now she is 8 months old, and I have just started giving her the whole pill! She just gums it around until it dissolves. I have to watch to make sure she doesn’t spit it out, but she almost acts excited for it now!
As you can tell, there are many ways to administer thyroid medication to infants. You just find what works with your child.
Additional Medicine Administering Tips
1) Use your baby’s natural reflexes. Stroke your baby’s cheek to get them to open their mouth. Let your infant suck the medicine out of the syringe. If you squirt, be sure to squirt into their cheek pocket and not into the back of their throat.
2) If you give the medicine before or during a feeding, your child will probably be more receptive to taking the medication.
3) Be sure to keep your baby upright while giving the medication and for a while afterward to reduce the likelihood of choking or spitting up.
4) Once your child is old enough to chew the medication, don’t give the medicine with food. It’s important to take the medication on an empty stomach. So it’s better not to start the habit of expecting food (even applesauce or yogurt) with the medication. Just a cup of water is best. While we are on habits, don’t punish your child for not wanting to take their medication or make it seem like an awful thing to be pitied. Come up with a fun routine for administering medication. They will be taking this medicine for the rest of their lives, so it’s best to make it a positive thing.
5) A few safety notes: Never call the medication candy. Keep the medication in a safe place. Dogs and kids alike enjoy getting into bottles of thyroid medication. Heat can affect the medication’s strength. So be sure to store the medication in a cool, dry place. If you live in a very hot climate, ask your pharmacist if it is okay to store your thyroid medication in the refrigerator.
Another question that I have been asked a lot is when to re-dose the medication after spit up. In other words, you give your infant the medication and then they turn around and spit it out. Our pediatric endocrinologist told us that ten minutes is usually long enough to assume that the medication was absorbed. If your child spits up immediately after they take their medication and you can see any coloration or fragments of medication or it’s a full empty the stomach projectile vomit, then it’s probably best to go ahead and re-dose. If it’s just a little spit up or they throw up after ten minutes, they probably don’t need another dose. They take the medication every day so there should be a consistent level of medication in their bodies all the time. Even if you mis-judge and one dose is missed because of spitting it up, your child should be okay. That was our rule of thumb. You should ask your pediatric endocrinologist what they think. If you can’t get up with your pediatric endocrinologist, call your pediatrician. Never be afraid to ask. I called our pediatrician and pediatric endocrinologist so much that first year, I was worried they were going to start charging me per call. Eventually, I learned not to stress out about it because it didn’t happen regularly enough that I was worried about the boys not getting enough medication. If your child regularly spits up right after the medication, then you definitely need to discuss this with your pediatric endocrinologist because you could be dealing with an allergic reaction or a reflux issue.
I hope this helps you feel a little better about the whole infant swallowing a pill deal. Congenital Hypothyroidism can be overwhelming at first. Blood draws, administering medication, doctor appointments, etc. Whenever I feel overwhelmed, my husband always says “How do you eat an elephant? Bite by bite.”
I’m vegetarian so the idea of eating an elephant just seems absurd but the point is made. My goal is to help you eat this elephant…one bite at a time. I want to help you break down all of these things associated with having a child diagnosed with Congenital Hypothyroidism that make you feel overwhelmed into small, manageable parts. In addition to my website, another part of this is having a community of support. For that, I recommend both my Facebook page and the MAGIC Foundation’s private Facebook group for parents of children with congenital hypothyroidism.
As always, these are my thoughts. You should always check with your doctor about any questions and concerns that you have about your child’s medication, dosing, and symptoms.
By Blythe Clifford aka Thyroid Mom