Intended for healthcare professionals

Practice Practice Pointer

Giving oral medicines and supplements to children

BMJ 2020; 371 doi: (Published 05 October 2020) Cite this as: BMJ 2020;371:m3550
  1. Deonne Dersch-Mills, Pharmacy Clinical Practice Leader, Pediatrics and Neonatology1,
  2. Bonnie J Kaplan, Professor Emerita2
  1. 1Alberta Health Services, Calgary, Alberta, Canada
  2. 2Cumming School of Medicine, University of Calgary, Alberta, Canada
  1. Correspondence to B Kaplan kaplan{at}

What you need to know

  • Oral liquid formulations of common medicines are often tolerated by children who cannot swallow pills but they carry a risk of measurement error as well as other challenges

  • When medicines are not commercially available as oral liquids—or when the liquid formulation is unpalatable or unstable—short term goals of treatment are to make the dosage safe and precise, make liquid medications more palatable, and seek alternative formulations or medications when necessary

  • Children needing long term medication or nutrient supplements that are easiest to give in pill form may be best off learning how to swallow pills, and evidence supports the use of head position training to learn this skill

A 6 year old boy undergoing treatment for acute myelogenous leukaemia is discharged from hospital to continue treatment from home. He is unable to swallow tablets or capsules and so must use compounded liquid formulations, some of which have only seven day stability. His family live in a remote area, two hours’ drive to the nearest compounding pharmacy. They bring a cooler every week when they drive to obtain medication refills because the medications must be refrigerated at all times. The medications are unpalatable, and his parents are spending up to three hours three times a day, every day, trying to give him his medication.

Giving medications to children who cannot yet swallow tablets or capsules (hereafter referred to collectively as “pills”) is a common problem without a universal solution. Frequently, parents, clinicians, and pharmacists attempt to crush tablets, empty capsules into food, search for alternative dosage forms, or find a different medicine altogether. Unfortunately, finding alternative formulations that children will accept can be challenging. Oral liquid formulations are sometimes a viable solution, but many oral liquid preparations are not commercially available, can be difficult to measure and dose correctly, or may …

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