Helping the medicine go down

This year is the 50th anniversary of the release of the Walt Disney film Mary Poppins. While the movie was in production, the sibling songwriters Robert and Richard Sherman were asked for a new song to replace one that the studio didn’t like.

Robert, the main lyricist, spent a day searching fruitlessly for ideas. At home, his wife greeted him with the news that their children had been vaccinated against polio that day. Had it hurt? No, because they had taken the new oral vaccine, given as a drop of liquid on a sugar cube.

Early the next morning, Robert arrived at work with a song title, “A spoonful of sugar helps the medicine go down”. His brother came up with a catchy melody, and a memorable song was born.

But does sugar really help the medicine go down? Many people find it difficult to swallow tablets and capsules, but a spoonful of sugar is not the ideal aid.

So what do you do if you can’t swallow your pills? Official advice is sparse, and some of it is contradictory. For example, the NHS Choices website tells you to put the pill on your tongue, take a sip of water and “wash the pill directly into your throat, throwing your head back”. But a few lines later it suggests: “Try putting your chin to your chest when swallowing — this opens up your windpipe and may be better for you than throwing your head back.” (And surely you need to open up your oesophagus, not your trachea?)

Personally I find it better not to tilt my head when swallowing pills, and research suggests that the best technique depends on the individual. Patients should experiment with five different head positions — straight, tilted up, tilted down, turned left and turned right.

Moistening the mouth certainly helps, as does swallowing the pill with a sip of water, but in my experience pills can most easily be ingested with food rather than with liquid. Chew a bit of bread until it is ready to swallow, then pop in the pill and gulp it all down together.

So, is a spoonful of sugar ever useful? Yes, but not for oral medication. It seems that, for babies at least, a little sucrose can help with injected medicines.

Evidence suggests that infants experience pain more sharply than adults when subjected to needle-stick procedures such as injections, heel pricks and blood tests. Their heart rate and blood pressure rise. Tiny babies may even stop breathing. But research by Paul Heaton at Yeovil District Hospital suggests that a few drops of a sweet-tasting substance on the tongue can reduce the pain response. He found that infants who taste a sucrose solution will cry less and recover faster. They may even respond less to pain later in life.

Every baby born in the UK receives several jabs in the first few months of life. If a little syrup — costing almost nothing — can ease the pain, and even offer long-term health benefits, then sugar, if not by the spoonful, should perhaps be a standard accompaniment to any needle-stick procedure in infancy.

Last updated
The Pharmaceutical Journal, PJ, 20 September 2014, Vol 293, No 7828;293(7828):DOI:10.1211/PJ.2014.20066350

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