How To Make Pill Swallowing Easier For Children and Adults

Episode Transcript

Dr. Nicole Beurkens:
Hi, everyone. Welcome to the show. I’m Dr. Nicole and on today’s episode, we’re talking with an expert on the connection between nutrients and brain function. Now, if you listen to the show regularly you know I cover a lot of topics related to physical health, nutrition, and mental health.

So today we’re going to touch on the foundational importance of nutrition, but then we’re actually going to dive into a specific issue that many parents face when trying to give their kid’s nutrients supplements; which is teaching them how to swallow the pills in my practice. This is an obstacle that comes up very often for kids. And even for some adults, there are various reasons why people can struggle to swallow pills, even once they get to the age where they’re capable of learning to do that. Right? I believe that it’s an important life skill and it’s one that I truly believe the vast majority of kids can learn. So to give us some key information and steps to work on this, I’ve asked Dr. Bonnie Kaplan to be my guest today. She has created some amazing resources for helping children and adults master pill swallowing. I’ve used her information regularly in my practice. Let me tell you a bit about her. She’s currently semi-retired and as a professor emerita in the faculty of medicine at the University of Calgary in Calgary, Alberta, Canada, she first joined the faculty in the department of pediatrics and then held a secondary appointment in the department of community health sciences. During her 40-year scientific career, she has published widely on the biological basis of developmental disorders and mental health, particularly focusing on the contribution of nutrition to brain development and brain function.

Originally from the U.S., she moved to Canada in 1979 to the Alberta Children’s Hospital and the University of Calgary and has now been a Canadian for more than half her life. Dr. Kaplan is one of the world’s pioneers in understanding the connections between nutrition and mental health for kids and adults. It is an honor to have her with us today. Welcome to the show, Bonnie.

Dr. Bonnie Kaplan:
Oh, thank you, Nicole. Boy, you make me sound interesting. Let’s hope that we can do that in the discussion, but thank you for inviting me.

Dr. Nicole Beurkens:
You are interesting. Your work is interesting. And as I was sharing with you before we started the show today, you have been such an inspiration to me with the research that you have done; on the connection between nutrition and child development and mental health really has been one of the catalysts for me to pursue that piece in the work that I do. So I’m so appreciative of everything that you’ve done over the course of, of your career.

I want to start by having you talk a bit about how you became interested in researching the physical nutritional issues involved in developmental and mental health conditions. Was that always something you were interested in? Was there a particular patient or something that you were doing at the time? What got you into that?

Dr. Bonnie Kaplan:
I actually was interested from the beginning. And it was kind of in the bio that you read, I’ve always been interested in the biological basis of human behavior.  I’m technically a psychologist, but not a certified clinical psychologist. My husband always says, I’m not a real psychologist because I just want to know what is happening in the brain that’s associated with the problems that we see amongst people. And if you’re interested in that you learn about brain function. And if you learn about brain function, you learn about how important every single micronutrient, and I’ll use that word, Nicole, to refer to both minerals and vitamins. What all those micronutrients do in the metabolic pathways in the brain. So to me, understanding nutrition in terms of brain function was just, you know, a natural thing to look at.

Dr. Nicole Beurkens:
And what I think is so interesting and simultaneously frustrating is how few people in the field of mental health or medicine in general, look at those connections are really understand that we’re so far. There’s such a gap between research that you and others have done showing these connections and what we’re actually doing in practice. Right?

Dr. Bonnie Kaplan:
Absolutely, people think it’s magic. Oh, taking vitamins and minerals? Improve your brain function? Because we’re not taught it in school. I mean, I was trained in the dark ages, but it hasn’t, well the dark ages, unfortunately, haven’t ended where people are taught that ‘we eat well in order to have strong muscles and bones’. Well, that’s not false, but it’s not nearly as important as eating well to make your brain function well. Because your brain is the most metabolically active organ. It’s sucking up disproportionately more nutrients than larger organs because you know, it’s only about two and a half pounds. And it is truly what we are feeding, most importantly, when we’re improving our diet, we are feeding our brains. And it’s been known forever that people who are starving, become depressed and apathetic and irritable and so forth. So it’s, there’s nothing mysterious about it except in the current generation, the last 50 years where people say, “Oh, You know, mental health problems. That means that they need a drug.”

No, first what they need is adequate nutrition. They might need some medication somewhere down the line. I’m not anti-medication, but it’s the priorities are just reversed. And to this day, I’m sorry for giving you such a long answer, but to this day I have had psychiatrists in particular say to me, something to the effect of, “Hey, you know, those vitamins and minerals, you study, they don’t really do much in the brain. Do they?” And it’s because they aren’t, even in medical school, they are not educated about the role of nutrients in brain function.

Dr. Nicole Beurkens:
Yeah. No, I’m glad to have you speak to it because it’s so important. And it’s such an issue both in terms of why more parents and individuals don’t recognize that this is something to look at in terms of their child’s symptoms. Because they’re not being given the information, but then also when parents bring these things up, maybe they hear a podcast like this, or they read a book or, see a study. And they bring it up to their child’s psychiatrist or, primary healthcare practitioner. And it’s sort of like, they either don’t know about it or that doesn’t work. I mean, we approach, especially within the realm of children, where I spend most of my time kids through young adults as if,  Prozac deficiency is more a real thing than a vitamin D deficiency. Right? And that’s really how we approach it.

Dr. Bonnie Kaplan:
That’s just, it’s just crazy. One of the most-watched videos, I have a bunch of videos on my website, I know you know about but one of the most-watched ones, is a four-minute video that just shows using serotonin as an example. Cause everybody seems to know now what serotonin is, you know? Just showing what minerals and vitamins do in that metabolic pathway. And it’s to the point where I have promised myself for at least 10 years never to give a lecture without showing it. I always will show that. Because so many people say, I might not remember anything else you said, which is kind of discouraging, but that’s okay. But I’m going to remember that. I now understand that what nutrients are doing in my brain.

Dr. Nicole Beurkens:
Absolutely. And so backwards that we have to address it from a drug type of mindset in order to get it, the nutrition, when really the nutrition piece should be foundational. And as all my listeners know, that is such a foundational piece to be looking at for children, in general, particularly if parents have a child who has neurodevelopmental or mental health kinds of issues, special needs in any way, shape or form. Nutrients and food really that’s something we should be looking at from the get-go. Right?

Dr. Bonnie Kaplan:
Right, right. That’s why I try not to. I do use the word supplement occasionally, but I try not to use the word supplement to refer to vitamins and minerals because to me, medication is a supplement. The vitamins and minerals are the frontline primary treatment. And I know that you and I see this totally eye-to-eye.

Dr. Nicole Beurkens:
Yeah, yeah, absolutely. That’s a great way of thinking about that. I really appreciate that reframe. I’m gonna use that myself even because you’re right it’s not a supplement it’s foundational. And what we know is that most kids are not getting even the basics of what they need from a vitamin and mineral standpoint in their diet.

Dr. Bonnie Kaplan:
That’s true, actually, Nicole, the latest data show, no matter what the age people in North America, both your country and mine are consuming 50% of what we’re consuming at least is nutrient-free. I mean, it’s the ultra processed stuff that is mostly fats and it’s got macronutrients. It’s got fats, usually the wrong kind, it’s got sodium, it’s got salt, right? It’s got carbohydrates, but it doesn’t have the micronutrients that our brains need. So, when you cut half of the micronutrients out of your diet voluntarily by choosing ultra processed chemicals that some people call food, but I have trouble calling it food, you really do end up with people whose brains are not working optimally.

Dr. Nicole Beurkens:
Yeah, absolutely. And you know, we think about how even what we eat as moms, when we’re pregnant, how that sets up our developing child’s brain and then after birth in those first, you know, years and, and through childhood and adolescence. All of those years of impact of what we eat either for better or worse. Right? And that we had choices in that. And I think sometimes, I take for granted and I think maybe some of my listeners too, that everybody just understands this. Because to me now at this point in my life and career it seems so obvious. But even as I think back, my oldest is going to be 21 next week, as I think back on years ago of raising little kids. I would do things differently, knowing what I know now but we do the best that we can at the time. And that’s where I’m so passionate about sharing this information with, with parents. So it, no matter what the age, or even for yourself as an adult, it’s never too late to start looking at how we can use nutrition and use our food differently to support ourselves in our brain function.

Dr. Bonnie Kaplan:
Actually, I know that we’re we want to talk about pills following, but you’re reminding me one other thing that we talk about  in our upcoming book, Julia and I is the ‘thank you bite’ for fussy eaters. Do you want me to describe that to your audience? The fussy eater problem?

Dr. Nicole Beurkens:
Yeah. Let’s actually, I’d love for you to just give a little preview of the book and what the book is about and then yes, let’s talk about it.

Dr. Bonnie Kaplan:
Sure. So my former student, Julia Rucklidge, who is at the Univeristy of Canterbury  in Christchurch, New Zealand, and who has the most active research program in the world right now, I think on micronutrient treatment of mental disorders. I don’t know of anyone who comes close. She and I have written a book that will be coming out in a few months, published by Houghton Mifflin Harcourt, which is called The Better Brain. And we wrote this book because we felt like we weren’t making a lot of headway in the medical world getting people who haven’t been taught about nutrients to understand their importance for brain function. Let’s go to the general public. So this is a book full of stories and anecdotes. And I think written, you know, really the scientific work represents our own work of course, and other people’s. But simplified and explain in terms of relevance for individual people. And in there, one of the things we talk about is the fussy eater.

I don’t go into it at length, but I pass along a story that some people are finding useful. That is not evidence-based. No one has actually studied this, but I pediatrician once told me about the ‘thank you bite’. Now, is that something you’re familiar with Nicole? Yeah. Okay. So where did you hear about it?

Dr. Nicole Beurkens:
Oh gosh, just in years of working with kids and doing feeding work and that kind of stuff.

Dr. Bonnie Kaplan:
Yeah. Okay, so shall I describe it?

Dr. Nicole Beurkens:
Please do! Yeah, go for it!

Dr. Bonnie Kaplan:
So there, there are, especially if you deal with kids with neurodevelopmental problems in the autism world, et cetera, there are fussy eaters beyond fussy. Okay. And one of the things that happens is that mealtime with the family becomes so tense and so difficult. It’s just a battle ground. And it’s this isn’t a total solution. Yeah. It’s not even going to work for everyone, but a lot of people have found it useful. So what you do, if you have a child, who’s a very fussy eater. And usually, I mean, they’re going to be rejecting anything like  broccoli and asparagus and so forth. You select two or three or four foods that you really think they could start adapting to. Because there is a little bit of research showing that there is habituation of taste. Right? And so things that we reject initially after 10 times or so again, we begin to define them not so obnoxious. But how to get to that 10 or whatever if you have a child who just won’t even take a bite. So what you do is at every single meal, you put a little bowl next to your child’s dinner plate. And most nights I think it would depend on the child, how hard you push it.

You put just a small amount of, one of the things that they’ve rejected. And when she explained to them is that they’re forbidden to eat it. You will not let them swallow it, but all you expect of them is to take one bite. Put it in their mouth and chew it up and then politely spit it back into the bowl and say, thank you.

And then there’ll be no pressure to eat it. So what have you done? You’ve solved a lot of attention around the table and you’ve started, we hope for some kids, a little bit of that habituation to odd flavors.

Dr. Nicole Beurkens:
Yeah. Those strategies are so important because as we look at obstacles to addressing nutrition issues in kids, one of them that we’re going to delve into is how to get kids to swallow pills. But another one that parents talk about frequently is, but he doesn’t want to eat it, but it’s hard, but there’s those power struggles. And so parents are needing those practical strategies and those of you listening, there is an episode from last year where we talked with Dr. Kay Toomey, a pediatric feeding specialist about  lots of tips for that. So if you have a kid who’s a really picky eater or has diagnosed feeding problems, that would be a great resource, but that’s a great strategy, really practical.

And doesn’t up the fear piece of it, because I think. So often the issues around helping kids to broaden their palette and be what we would call healthier eaters or eat more nutrient dense food. It comes down to anxiety about something that’s different or something that’s non-preferred. And so the more tools we can have in our tool belt for dealing with that the better.

Dr. Bonnie Kaplan:
That’s right. That’s right.

Dr. Nicole Beurkens:
And I love that you and Julia have written this book. And by the way, for those of you listening, we will, when that book becomes available later this spring, we will be doing an interview with Dr. Julia Rucklidge, Bonnie’s coauthor about that book. So you can pre-order it now, we’ll tell you about that at the end of this episode, but then we’ll cover that in more detail later this spring. One of the things that I love about the way that you talk and write about this as that it’s based in research. And I think as you started talking about at the opening of this episode, one of the issues is that people look at this as sort of fairy dust, that can’t really help, right? Or, Oh, what a pie in the sky idea. And this is grounded in really for you a lifetime now of scientific research on these connections.

Dr. Bonnie Kaplan:
Yes, the public wouldn’t know this. And this brings in the issue of the media coverage. The media has taken a position and you can figure out why. I mean, it’s a matter of following the money that the only kind of nutrition and mental health research worth mentioning in the media is something that is negative. And I could point to so many examples of it. It’s, it’s unbelievable. But then you get a positive result and replicated in multiple laboratories, which is the scientific gold standard, and with randomized placebo controlled trials and every other kind of study you can think of and the media has no interest in it.

Just the work that Julia and I have done with the ‘broad spectrum formulas’, and I can explain that later, there are over 50 peer reviewed scientific publications now in the medical and scientific literature. And it’s a whole range of children, data, adult data. It’s in sometimes we’ve shown off control of symptoms. You give them a formula and they get better. You take it away, they get worse and you go back and forth that way. Database analyses, with hundreds of people, randomized controlled trials with comparitors where you’re comparing a broad spectrum. I mean, there’s just every design you can think of. And yet the media is not interested. It’s very frustrating. So that’s another reason we wrote the book.

Dr. Nicole Beurkens:
For sure. And I think the thing that has always been so astounding to me even years ago, as I was starting to look into these connections, because of course, in my clinical psychology training program, in my education and child development training program, these are not topics that were covered.

So as I started delving into the research, I was astounded at how much was there and what has always struck me. And you just described it beautifully. If medications, if pharmaceuticals had the kind of  research trials and the rigorous types of research behind them that a lot of these micro nutrient and broad-spectrum micronutrient formula studies have, they would be out there all over the place because it’s really, really good data. And I wanted to, as we get into the pill-swallowing piece, I just felt like it’s really important to touch on that because you’re right. The general public doesn’t necessarily have access to those scientific journals. Doesn’t know that all of this really good rigorous research literature exists.

Dr. Bonnie Kaplan:
That’s right. And we hope to change that oddly enough. And I don’t know if you’re going to want to tell your audiences, but just since we’ve been talking, Nicole, I just got the notification that an article on this, that Julia and I wrote with another colleague has been accepted by the APA journal for evidence-based practice in child and adolescent mental health. So finally, we’re going to be teaching clinical psychologists a lot more about it if they’re willing to look at it.

Dr. Nicole Beurkens:
Fantastic. And you know that I’m out there trying to get my colleagues on board with that all the time, because you know, one of the challenges is, in this podcast, I’ve got thousands of amazing parents and some practitioners who are learning about this. But then the challenge is when they need professional support, who do they turn to? There’s not enough of us that are doing this kind of clinical work. So we need to be getting the word out there to our colleagues. So that’s really exciting that that’s going to be published. That that’s wonderful.

I want to delve into this particular obstacle of pill swallowing because as I mentioned at the outside of the show, one of the barriers that can come up when we start to talk about this type of an intervention with families is, “Oh, my kid doesn’t swallow pills or, Oh, that’s going to be too big or that’s going to be too much. Does that come in a liquid? Does that come in a gummy?” And while there are some non-pill formulas and things that we can use really when it comes down to it, having kids be able to swallow the pills is more economical, it’s more efficient and time-saving. There’s a host of reasons, I feel, for why it’s really beneficial and important to teach kids to swallow pills. I’m assuming that that’s sort of how you came to do a segment of work focused on pill swallowing is because of this obstacle in your research?

Dr. Bonnie Kaplan:
Absolutely. I’ll tell you the story of what happened because it’s a memory that’s well, about 20 years old and yet it’s so vivid because it just stunned me. I was interviewing a mother and her son, he was about eight years old, to join one of our first trials of a broad spectrum formula that came in large capsules and they impressed me because the mother was so gentle and supportive and the son had meltdowns apparently, but you know, when he wasn’t melting down, he was also a really sweet kid. And they were in my office at children’s hospital and we were going through the intake and the criteria, et cetera. And one of the things we had to make sure was he could swallow large capsules. And the mother said, “I don’t know if he can.” So we had some dummy capsules, you know, just without any nutrients in them for kids to try.

And so I put some water on the table and gave him a few capsules and said,  “Try this out and make sure that they’ll go down, make sure you have some water in your mouth. Cause they’re gelatin capsules in the gelatin gets a little slippery and that helps them go down.” And I watched him put capsule after capsule in his mouth and a little bit of water and it came right back out and he was quietly sitting there with tears starting to run down his cheeks. And his mother was not being helicoptering or anything just gently saying, “Well, let’s try it again.” She was being so appropriate and he could not be in our study and it was breaking their hearts. And I just sat there. I thought, “Well, why doesn’t he just swallow it?” I was so naive. I really thought, I really thought that anybody who couldn’t swallow a pill. Just was being you know, oppositional and they wouldn’t swallow it. I didn’t know it was a thing, I didn’t know there were people who couldn’t do it.

So I thought about it for a year or so, and it really troubled me. And then I had a student who actually went on to become a family doctor. But at the time,  she was very interested in physiology and I said, go find a literature, go read up on this for me and tell me what’s known about it. And she came back and she found, and since then, we still think it’s the only study that has ever shown this, where they tested people, swallowing, different sized capsules. And they discovered that if people saw and they were not, I don’t know what kinds of people, they were normals in the sense that they weren’t looking for treatment. Right. But they found that if you swallow even water, with your head turned to the side, just about a 45 degree angle. Either side, there is a sphincter it’s called the upper esophageal sphincter, UES, and the upper esophageal sphincter did two things.

When your head was turned to the side, one is it stayed open a few milliseconds longer. And secondly, it opened a few millimeters more. So it was larger and a little delayed. And we actually came to around to testing people using just water. I have holding a cup of tea for your viewers who can see. And we discovered for many people, we could hear the sound.

We called it the”unk” noise that when you swallow to your side, you do that. So we did a study and I won’t tell you about all four of them, but we did four studies. And the first one we did actually, we did five. Cause the first one we did and never went anywhere. What happened is I had some students and they got some dummy capsules and they sat in the reception, the big lobby of children’s hospital and just flagged people down and said, would you be interested in just trying swallowing pills, you know, in different head positions, we just want to get your impression. And they signed a consent form and lots of people tried it and then everybody hated it. And, and they came back to me and said, “Oh, it’s impossible. We just can’t do it.” And I thought about that.

Now you might not know this Nicole, or maybe you studied it when you were in grad school. If you, if you got a course in the history of psychology and you read a book by E.G. Boring, that in the early part of the 19th century, when when research was really beginning in human physiology, experimental psychology, they never, ever used data from the first exposure. It’s called using practiced subjects. And it relates to what we’re talking about, habituation to food, habituation to capsules. And so we decided to try to get people used to the different positions. And as soon as we did that It was a whole different ball game. And so many people I’m one of them, I never had trouble swallowing a pill, but I would never swallow them with my head center. Again, it is so much easier with my head to the side, but we also found some people preferred other positions, some prefer ups, some prefer less, some prefer, right? Very few people prefer slightly down. Some people went back to center.

But it opened up a whole new world. And so long story short, we did four studies on that. And then we made the training video, which is available on the web and is the link is on my website. So that’s how I really got into it. It’s been quite interesting.

Dr. Nicole Beurkens:
Well, and it’s such a practical and important thing. I mean, obviously for you being able to do research on these nutrient formulas people need to be able to take them. But those of us in clinical practice for parents who are trying to, you know, do this with their kids, I know that it was very helpful to me with my younger two children. I approached it differently with them having this information compared to the older two, but has been so valuable for so many kids in my practice. And one of the things that I’m seeing, I don’t know if you see this as well. We, my colleagues and I have more kids coming in at older ages who have never learned to swallow that it’s just sort of been like, “Oh, they’ll take gummies or, Oh, the pharmacy will give us liquid” or whatever. And it’s like, I’m the first one to say, you know, this is something that you can learn to do. You know, I think it’s an important life skill. I think it’s something that builds confidence and competence in young people to know, “Oh, I can do this.” It’s one less thing that they have to be fearful or avoidant about in their lives.

And so to me, unless there is an underlying physiological. You know, or, or really severe developmental reason why it would not be appropriate for them to do it. I really encourage parents to, let’s let’s roll our sleeves up. Let’s work on this to have kids or, or even young adults practice with it. And the amount of pride that they feel when they master that it’s huge.

Dr. Bonnie Kaplan:
And I’m so glad you’ve seen that. We had one little girl who was, she was from oncology. She had leukemia and she, she just, you know, it was a terrifying prospect for her, but when she learned, and she did, we always give recommend two weeks of practice and she learned no problem. She went and she taught her older sister taught her mother, taught her grandmother. Yeah. We had another child who went in, taught his entire kindergarten class. It is a life skill and everybody, and we had another child who used it in the science fair. So a lot of kids got very excited about it. You know, now I get emails from all over the world, sometimes in people who are 50, 65, who say, “I happen to find your video and the training video and I’ve spent my entire life afraid that someone would give me a prescription I’ve avoid getting treatment for things, because I knew I wouldn’t be able to swallow or chew up the pills.” So there you go. Could we put a link on your website? Not just for the training video, but the British medical journal just featured this in an article a couple months ago, we could put a link there too?

Dr. Nicole Beurkens:
Absolutely. In the show notes on the website, we will put all the links to all the resources so that everybody has them. You know, at what I’ve observed in practice and even with my own kids, is that for kids who don’t just master it quickly. And some do, you know, sometimes we say, okay, let’s just try this and they just do it. You know, I mean, we’ve had three year olds come in who whether because of medical issues or whatever over the course of their life have learned to do that young. But what I find the barrier tends to be is is the anxiety about that? What you find is the biggest barrier to sort of that thought of like, “Oh no, it’s going to get stuck. It’s not going to go down. What am I going to do?”

Dr. Bonnie Kaplan:
Yeah. Yeah. So one of the things that you’ll see in the training video, you might remember this is that we explain, you know, you can’t really deal with anxiety with rational arguments. But it helps to get a little rational information in there and we point out about soft tissue, how expandable it is and how they swallow pieces of carrots or hotdogs that are bigger than any capsule they’ll ever see in their life. So we try to allay that fear, but there are people who also do deep breathing and normal kinds of relaxation, antianxiety kinds of maneuvers also and that helps them. It helps them with the practice, pardon me, it doesn’t solve the problem or they wouldn’t have been there in the first place.

Dr. Nicole Beurkens:
Right? I think it’s the combination of reducing the anxiety with appropriate information and then maybe some relaxation kind of techniques, but then also the very specific teaching process of here’s how you do this. And so, you know, we’ll make the links available for all of you listening to this video that she’s referring to takes you through the entire thing. But Bonnie I’d love for you to just kind of give a, a summary of, you know, you mentioned the different positions, what sort of are the steps to work on? And maybe also, if there are things that we tend to do as adults and teaching this to kids that really are not helpful or tend to backfire, let’s weave those into.

Dr. Bonnie Kaplan:
Okay. Well, I give a few tips, but they’re a kind of quick in the video, so I I’d love to mention a few of them here. Yeah. It’s really important to do this with your shoulders back. I often require the children stand up and not sit over, you know, where they slouch as if they’re playing video games with their shoulders back to learn the five positions to swallow straight ahead, up, left, right, and down. A second thing is when we were doing the studies, we used to forbid them to try their medication, and we were dealing, you know in our studies, we were mostly not dealing with nutrient stuff. We were dealing with kids who were inpatients or outpatients of rheumatology oncology, et cetera.

So, we used to say, you’re not allowed to do this with your medication for the first two weeks. And we, the most successful substitute we had was tic-tacs. Tic-tacs are small. They’re sweet. There’s no, we tried, M and M’s, or Smarties, people wanted to chew them out. That didn’t work too well, but tic Tacs are a really a good way to start. They’re small, they’re hard. And you know, they can do a number of trials. We required them to try each position every single evening, which would only take five to 10 minutes. So their homework was swallowing candy. And then we also asked them for some introspection and I think this is something we over look. Well, maybe not you, your a psychologist, but it’s important for kids, especially the older kids to think about what that felt like.

Like what did the right feel like compared to the left? And so we use a little and it’s downloadable from my website. We use a little smiley facescale. You know, so the people could think about, you know, did I really like that one today or not? And which ones worked and which didn’t? So those are probably the main things with really little kids will use the duck shake, which I explained, you know, getting it into the back of their throats, which I explained in the video.

Dr. Nicole Beurkens:
So, so helpful because you, you talk about in the video and, and we teach kids that often one of the issues is, people automatically sort of tilt their head back. Right. It’s like, okay, put the pill back there, tilt your head back in. Now, fill it with water. And then the pills float to the top and then they can’t get them down.

Dr. Bonnie Kaplan:
Right. And I think that’s what parents, if parents make any mistake in my experience, what they say is, “Well, you don’t have enough water in your mouth take more”, but especially the really young kids. They don’t have the motor control of their tongue in their mouth as much. And so the less, you have to have some obviously, but if you get too much water in there, it floats around even a tic-tac and they’ll have trouble getting it down. So yeah.

Dr. Nicole Beurkens:
And that shake helpes with it too. And, you know, one of the things that I think has been that, that I’ve noticed using that the protocol in my practice. Is it gives kids something really predictable and tangible to work on. There’s not an expectation that, right away the first or second time, in fact, we frame it as. We’re going to practice this for this period of time, you’re going to try all these different positions and your going to choose. And so it really engages them in sort of I think of it sort of like a detective way, like, Oh, practicing. Oh. Which is going to be better. It takes their mind off of sometimes just that pressure of like, I have to get this pill down right now. And I’ve had some super, super anxious kids, teens, and young adults who have done really, really well with this process. So if you’re listening and you’re thinking, well, my kid has a really bad experience with this, or it gets really panicked. This really does work. You may have to break it down. You may have to go slowly. I’ve had kids who we’ve had to start with a sprinkle. Like literally a sprinkle because they had such panic and emotion worked out around it. And just that idea of you can have this in your mouth and it’ll be okay, so you can break it down as much as you need to, but just know that this process really does, does work.

Dr. Bonnie Kaplan:
Yeah, that’s very interesting. We’ve had some funny experience. I remember a young girl. I think she was probably a 12 year old  and I think she was in rheumatology clinic. And she learned it so well in about two days, she spent the rest of the two weeks begging her mother to let her take her medication and using, using the, you know, her favorite position. And eventually her mother of course gave in and everything was fine, but the sprinkles, I never had any luck with because they can float. So, I guess it’s more of a psychological thing that you were doing there. Yeah. Interesting.

Dr. Nicole Beurkens:
More of the idea of, I can have something in there and know that it’s there without going into panic. And because some of the kids, especially in my experience, kids who maybe a parent or a medical practitioner or someone has tried to address this with them unsuccessfully, and they’ve had a lot of fear or failure experiences around it, can really almost develop a phobia of anything involving having something like that in their mouth. And so I have found that even just starting with allowing them to realize that I can intentionally put this tiny thing in there and keep breathing and keep myself calm and it’ll be okay. And look it’s gone. And I didn’t even notice, you know, that, that if a kid is really, really anxious, can, can sometimes be a helpful entry point.

Dr. Bonnie Kaplan:
That’s interesting. And this is probably a good time to remind your audience that neither of us has magic right out there. And so there will always be people who you just can’t, you know, who don’t learn this. And sometimes I think they just probably a year later, try it again and do succeed, but I only have some anecdotes about that. So it’s important they not feel guilty about that, but it’s so much better if they aren’t taking gummy things, et cetera, with all those additives and so forth, it’s much better just to learn to swallow pills.

Dr. Nicole Beurkens:
Yeah. And what parents say is they’re motivated to do it. For a couple of reasons. I mean, one wanting the child to be able to have the skill, but also financially, like formulas tend to be more expensive. It’s more expensive to get medications. If you have to have them specially compounded, or if you can’t even get something that your child needs because of that, or often in the nutrient world, powder formulas, liquid formulas, there’s an increased cost. So parents are motivated that way, but also the ease of it, right? It’s so much more complicated to have to deal with opening capsules and mixing stuff in applesauce or, you know, juices or whatever. So this just gives everybody more ease and, and ultimately, as kids get older, it gives them more independence, which is also to me, a really important thing for many of us the patients that I see they need to stay on their nutrients and, or their medications long-term. And for them as they grow into adolescence and adulthood, to be able to independently manage that as a really important thing.

Dr. Bonnie Kaplan:
Absolutely. Absolutely.

Dr. Nicole Beurkens:
Yeah. So we’ll put the links to these things. I want parents to know that this is something absolutely worth tackling, if it’s been a struggle for your child. And what I find too, is when parents do this along with their kids, sometimes parents will admit like, you know, I get some anxiety about it, or I maybe haven’t been a very good model. That modeling and the emotion that we bring to it is important too. Isn’t it?

Dr. Bonnie Kaplan:
It is, and it’s very common for parents or grandparents to learn too, but I wish it were taught in kindergarten. I mean, I really think it’s a basic life skill. It would just solve so many problems.

Dr. Nicole Beurkens:
Yeah. And when we look at some of the nutrient pieces of things and you know, maybe at some point we can have you back on to talk specifically about the research on that broad-spectrum, multi-nutrient formula that I use all the time in practice. But one of the things that, that we look at with that is kids do need to be able to consistently take larger pills and larger amounts of pills in order to get the best results. And so working on the pill swallowing really opens up a realm of treatment options that otherwise is not as available to them. As you beautifully illustrated with the story of the young man that you told who wasn’t able to be in the trial.

Dr. Bonnie Kaplan:
Yes.

Dr. Nicole Beurkens:
So. I think that for parents to just know, there’s so many valuable reasons to work on it. And if you yourself have been having an issue with it, this is a great technique. I’ve had more than a handful of adults, you know, parents, grandparents, whatever, who have said this really solved a longstanding problem in my life.

Dr. Bonnie Kaplan:
But I’m going to add a little anecdote that is a kind of a disappointment I had a student who then said, “Well, why don’t we go to a senior’s home and teach people and see whether they’re able to learn it”. And it, the study was a total bust. He could not get a single volunteer. And the reason was for the time you’re 80 living in supported living or something, you’re so fixed in your habits. “It’s like, it’s okay. I know how to get it down with. Yogurt or whatever. And, and I’ve always mashed it in beneath symmetric and I’ve managed, I can tolerate the flavors.” So there’s a certain point where you’re not going to change a person’s habits. Yeah.

Dr. Nicole Beurkens:
Which I think speaks to the importance of starting now with your child, if they are at an age and developmental level where it’s appropriate to start working on that. The sooner we start to do that, the sooner we stop that process of them becoming so embedded in those habits of, “Oh, it’s not a big deal. I can, I can just do it”. But, you know, yeah. I I’ve had many adults who have said this has made my life easier and so I really want to encourage people. Access the video go through the process. And as always, you know, there can be roadblocks with specific kids depending on particular behavioral challenges or other kinds of issues going on. Share these resources with the practitioners that you’re working with, you know, I wish every pediatrician knew and this information was out there to talk to parents about it early on, in a child’s life to say, “Hey, here’s a great resource for this.”

But, I think to access professionals that you’re working with say, “Hey, here’s something that is important. This is a goal that our family has. Can you help us troubleshoot this?” Here’s the basic protocol that helped me implement this for my child. And any therapist that you’re working with should be able to help you with that but this, this video and this set of resources at least provides a good baseline and a good protocol for starting.

Dr. Bonnie Kaplan:
It can help a lot of people that’s for sure. We know that. Yeah.

Dr. Nicole Beurkens:
So Bonnie, as we wrap up, I want to make sure that people know where they can find out more about your work. So your website and then also, if you can tell us the title of the book again, that’s coming out later this spring.

Dr. Bonnie Kaplan:
Sure. Well, I’d be happy for people to go to my own website. It turns out there are a lot of Bonnie Kaplan’s in the world. And so my website has my middle initial, which is J. So it’s, BonnieJkaplan.com.

Kaplan is K A P L I N. So BonnieJkaplan.com. And from there, you can take a look at, can preview our book and take a look at how to pre-order it. And that’s this, The Better Brain, by Bonnie Kaplan and Julia Rucklidge. You can take a look at there’s a video tab and the pill swallowing video is there probably just about everything else that we talked about.

Maybe not the link to the British medical journal article, which talks about, the first author is a pharmacist here at children’s hospital, Deonne, and she really went over all the ways pharmacists, try to help kids who have trouble swallowing pills, but then of course the best thing is to learn to swallow pills. And so that’s, my link is in that article too. And that’s just from two months ago, so maybe we can put that up. Yeah.

Dr. Nicole Beurkens:
Yep. I’ll make sure to find that we’ll put that with the show notes, but go to Bonnie’s website, check out the book, the better brain it is available for pre-order now on Amazon and at all the major bookstores. And then, like I said, stay tuned because later this spring in April, the book releases April, April 21st. So we will have an episode right around that time with Dr. Julia Rucklidge talking more specifically about the book. So stay tuned for that. Bonnie, it has been such a pleasure to have you with us today. I can’t thank you enough for all the work that you’ve done in these areas over the course of your career, and still being so dedicated to sharing the information. Thank you so much for being here.

Dr. Bonnie Kaplan:
You’re welcome. Thank you, Nicole.

Dr. Nicole Beurkens:
And thanks to all of you for listening. We’ll see you right back here next week for our next episode of the better behavior show.

Thank you for listening to the better behavior show with Dr. Nicole. Beurkens leave a review on iTunes and share this episode with your friends. Visit Dr berkins.com to ask any questions for an upcoming episode, post comments for today’s show and sign up to receive weekly updates. That’s D R B E U R K E N s.com.